Table 1.
Pile Sorting the Barriers into Respective Groups
| System Issue | User Issue | Service Provider Issue | Socio-Culture Factor |
|---|---|---|---|
| No mass vaccination1 | Vaccine confidence gap2 | Health Worker Poor Knowledge about dose administration3 | Children in the lowest wealth quintiles are still the least likely to receive immunizations4 |
| No active out-reach activities including notification services and supplementary immunization activities for migrants5 | vaccinations are delayed beyond recommended ages, alternative schedules are used, or vaccines are totally declined6 | Insufficient screening of high risk group including migrants7 |
Cultural beliefs and norms among groups from different socioeconomic positions and racial/ethnic minorities, and the impact these differences can have on vaccine confidence.8 |
| allocation of insufficient public resources to increase awareness and implement guideline9 |
lack of awareness on HBV in General population and high risk group10 | Fear of vaccine wastage11 |
Female subjects had better vaccine compliance as compared to males12 |
| Coverage National Immunization Program (NIP) vaccines is low13 |
Negative Screening Result So didn’t feel the need of vaccination14 |
Incomplete recording and reporting15 | Cultural factors may reduce access to health care by women in the postpartum period16 |
| Lack of PPP in immunization17 | low birth weight baby18 | Poor stock management19 |
significantly associated with more siblings in household, shorter duration of living in the surveyed areas, lower family income, mother with a job, mother with poor awareness of vaccination, and mother with lower education level.20 |
| The mono valent vaccine is not funded so becomes costly21 | Name of child changes in the first year of life22 |
Poor communication23 | Low vaccine coverage was associated with poor family wealth status, less than 8 years of maternal schooling and smaller time of residence in the urban area of the city, being related to socioeconomic inequities24 |
| Parents wanted vaccination information to be available at a wider variety of locations, including outside health services (low confidence) and in good time before each vaccination appointment25 | Mobility of families26 | Insufficient training of HW27 | Migrants from non-urban areas and children from low income families low coverage28 |
| Private health facilities have been shown to lack knowledge on immunization schedule29 |
Lack of opportunity30 | Incomplete knowledge and awareness among doctors, dentist and nurse/HW31 | Failure to understand the importance of vaccination Requirement for translation issue of Indian, Bengali, Turkish, or Vietnamese origin32 |
| Quality of outreach services33 | Fear of needles34 | No home visits to identify unimmunized children35. |
Coverage with a timely birth dose of HBV vaccine is still low among high risk and rural area36 |
| Patent protection remains the major barrier to the production of affordable small-molecule generics37 |
Parent concern on adverse effect38 | Vaccine storage39 | Prematurity birth of newborn40 |
| No sufficient generic vaccine in market41 | Mother awareness42 | Conflicting guideline at hospital43 | Birth at home44 |
| Monetary incentives45 | Vaccine compliance was lower in health professionals46 |
long delays to vaccine access47 | Ethnic minority48 |
| Logistics are not yet adequate49 |
Caregiver education/Awareness50 | Vaccine spacing errors51 | Media report on adverse effect52 |
| Poor Hepato Cellular Cancer surveillance53 | Fear of Side effect54 | Identification of all high risk pregnancies55 |
Decrease the proportion of women giving birth at health care facilities56 |
| Inefficient strategies for tribal and high-risk groups57 |
Parent unwilling58 | No routinely test for HBsAg during prenatal visit of women who engage in behaviors that put them at high risk for infection59 | |
| Low effectiveness of the primary health care system60 |
False Contraindication61 | Cold chain62 | |
| High costs of HBIG63 | Health education plus 'reminder-type' immunization cards to remind caregivers64 | ||
| Outreach Inconvenience65 | Poor communication and negative relationships with health workers66 |
||
| lack of co-ordination of various level67 | Maternal HBV DNA levels and detectable HBV DNA in the cord blood68 | ||
| Lack of official communication69 | High levels of viremia in mothers70 | ||
| System Issue | User Issue | Service Provider Issue | Socio-Culture Factor |
| No mechanism for recording birth dose71 |
Subject with HBV infection not aware of their infection72 | ||
| cost of vaccine73 | Private maternity services74 | ||
| 22 | 16 | 22 | 14 |
| 29.70% | 21.60% | 29.70% | 18.91% |
1, (Butsashvili et al., 2012; Giles-Vernick et al., 2016b; Larcher et al., 2001b); 2, (Cox et al., 2012b; Fourn et al., 2009b; Ritvo et al., 2003); 3, (Butsashvili et al., 2012; Ko et al., 2017b); 4, (Branco et al., 2014; Wu et al., 2017); 5, (Han et al., 2014); 6, (Bowman et al., 2014; MacDougall et al., 2015b); 7, (Han et al., 2014; Philbin et al., 2012b); 8, (Philbin et al., 2012b); 9, (Akibu et al., 2018; Butsashvili et al., 2012; Harris et al., 2007); 10, (Juon et al., 2009b; Khan & Ross, 2013; Yau et al., 2016b; Zacharias et al., 2015); 11, (Butsashvili et al., 2012; MacDougall et al., 2015b); 12, (Navarro et al., 2014); 13, (Akibu et al., 2018; MacDougall et al., 2015b; Mollema et al., 2012); 14, (Chingle et al., 2017); 15, (Akibu et al., 2018; Branco et al., 2014); 16, (Butsashvili et al., 2012; MacDougall et al., 2015b; Philbin et al., 2012b); 17, (Kabir et al., 2010); 18, (Harris et al., 2007); 19, (Han et al., 2014); 20, (Ganczak et al., 2015; Larcher et al., 2001b; Philbin et al., 2012b; Wu et al., 2017); 21, (Akibu et al., 2018; Ayalew & Horsa, 2017; MacDougall et al., 2015b; Zacharias et al., 2015); 22, (Branco et al., 2014); 23, (Mollema et al., 2012); 24, (Zacharias et al., 2015); 25, (Mollema et al., 2012); 26, (Branco et al., 2014); 27, (Ko et al., 2017b); 28, (Branco et al., 2014; Ganczak et al., 2015); 29, (Giles-Vernick et al., 2016b; Jaquet et al., 2017); 30, (MacDougall et al., 2015b; Said & Jou, 2014c); 31, (Ganczak et al., 2015; Jaquet et al., 2017; Kelling et al., 2016); 32, (Mollema et al., 2012); 33, (Han et al., 2014); 34, (Chingle et al., 2017); 35, (Branco et al., 2014; Wu et al., 2017); 36, (Branco et al., 2014; Harris et al., 2007); 37, (Akibu et al., 2018; Ritvo et al., 2003); 38, (Butsashvili et al., 2012; Ritvo et al., 2003); 39(Harris et al., 2007); 40, (Butsashvili et al., 2012); 41, (Akibu et al., 2018); 42, (Navarro et al., 2014); 43, (Harris et al., 2007); 44, (Wu et al., 2017); 45, (Bowman et al., 2014); 46, (Jaquet et al., 2017); 47, (Butsashvili et al., 2012; Chingle et al., 2017); 48, (Fourn et al., 2009b); 49, (MacDougall et al., 2015b); 50, (Ritvo et al., 2003; Wu et al., 2017); 51, (Kelling et al., 2016); 52, (Mollema et al., 2012); 53, (Yue et al., 2018b); 54, (Butsashvili et al., 2012); 55, (Jaquet et al., 2017); 56, (Wu et al., 2017); 57, (Harris et al., 2007); 58, (Fourn et al., 2009b; Mollema et al., 2012); 59, (Bowman et al., 2014); 60, (Ganczak et al., 2015); 61, (Fourn et al., 2009b); 62, (MacDougall et al., 2015b); 63, (Akibu et al., 2018); 64, (Oyo-Ita et al., 2016); 65, (Chingle et al., 2017; Ganczak et al., 2015); 66, (Butsashvili et al., 2012); 67, (Akibu et al., 2018); 68, (Navabakhsh et al., 2011); 69, (Mollema et al., 2012); 70, (Navabakhsh et al., 2011); 71, (MacDougall et al., 2015b); 72, (Larcher et al., 2001b); 73, (Butsashvili et al., 2012); 74, (Ganczak et al., 2015; Wu et al., 2017).