Health system barriers to HPV and MMR vaccination in recent migrants/refugees in Greece

Abstract Background Migrants have lower vaccination rates compared to the general population and report multiple barriers in accessing related services. We explored practices and perceptions regarding MMR & HPV vaccinations in migrant children & adolescents from third countries to inform the development of tailored interventions to increase vaccination coverage. Third country nationals for the RIVER-EU project are migrants arriving to the EU from countries beyond Europe (the Middle East, Asia & Africa) escaping civil conflict, war, and poverty. Methods A qualitative study was conducted in the wider Athens area as part of the RIVER-EU project. Four Focus Groups and 23 semi-structured interviews were conducted with health care professionals, children and parents with a migrant background. Data were analysed using thematic content analysis. Findings: Identified barriers relate to the lack of standard operational procedures at system level that would define a schedule of vaccinations for migrants. Migrant vaccinations are subject to availability of vaccines (MMR as opposed to HPV) and potential threat of outbreaks (MMR vs HPV). There is no consistent, unified recording system of vaccinations while at system level there is a lack of trained cultural mediators. Targeted health promotion campaigns are rare while the few related activities that do exist are not systematically evaluated. Conclusions MMR vaccination is more frequent compared to HPV which is not prioritised by the target group or health professionals. Nevertheless, the target group is open to learning more about HPV while the important role of mothers concerning vaccinations emerged as crucial. Health professionals focus more on MMR due to the availability of the vaccine and the threat of outbreaks. The vaccination system has flaws and inconsistencies with a lack of vaccination related data. There is urgent need for culturally appropriate vaccination and appropriately evaluated vaccination campaigns.


Background:
People from marginalized Roma communities often experience poverty, limited access to education, employment, housing, and health care (HC).The aim of the study was to explore the perceptions of people from marginalized Roma communities and health professionals regarding health system (HS) barriers to HPV vaccination.Methods: A qualitative study was conducted in the Kosice region as a part of the RIVER-EU project.Semi-structured interviews with marginalized Roma parents (N = 18), children (N = 15), and health professionals (N = 18) were audio-recorded and thematic analysis of the transcripts was performed in MAXQDA.

Findings:
Four main themes were identified regarding HS barriers: 1. Lack of information (lack of culturally and linguistically appropriate information, lack of information provision from HC providers, unreliable and conflicting information on the internet), 2. Restricted access to HC providers (lack of capacities, work overload, long wait in the waiting room, distance, traffic connection), 3. Financial and organizational barriers (limited coverage of vaccination expenses from health insurance, picking up prescribed vaccines in a pharmacy by parents, parental consent), 4. Attitudes and behaviours of HC providers (neglect of care, double standard, inappropriate behaviour and communication, prejudices, racism).

Conclusions:
The reasoning and perception of several barriers to HPV vaccination differ among groups of respondents.Nevertheless, HPV is not viewed as a priority by both -marginalized Roma and health professionals.HS fails to reach marginalized Roma with appropriate information about HPV and HPV vaccination.Moreover, the lack of capacities and motivation of HC providers to address these topics lead to a lack of awareness.Organization and health insurance coverage of vaccination pose additional barriers to HPV vaccination.

Background:
Migrants have lower vaccination rates compared to the general population and report multiple barriers in accessing related services.We explored practices and perceptions regarding MMR & HPV vaccinations in migrant children & adolescents from third countries to inform the development of tailored interventions to increase vaccination coverage.Third country nationals for the RIVER-EU project are migrants arriving to the EU from countries beyond Europe (the Middle East, Asia & Africa) escaping civil conflict, war, and poverty.Methods: A qualitative study was conducted in the wider Athens area as part of the RIVER-EU project.Four Focus Groups and 23 semi-structured interviews were conducted with health care professionals, children and parents with a migrant background.Data were analysed using thematic content analysis.Findings: Identified barriers relate to the lack of standard operational procedures at system level that would define a schedule of vaccinations for migrants.Migrant vaccinations are subject to availability of vaccines (MMR as opposed to HPV) and potential threat of outbreaks (MMR vs HPV).There is no consistent, unified recording system of vaccinations while at system level there is a lack of trained cultural mediators.Targeted health promotion campaigns are rare while the few related activities that do exist are not systematically evaluated.Conclusions: MMR vaccination is more frequent compared to HPV which is not prioritised by the target group or health professionals.Nevertheless, the target group is open to learning more about HPV while the important role of mothers concerning vaccinations emerged as crucial.Health professionals focus more on MMR due to the availability of the vaccine and the threat of outbreaks.The vaccination system has flaws and inconsistencies with a lack of vaccination related data.There is urgent need for culturally appropriate vaccination and appropriately evaluated vaccination campaigns.Organised by: IMAgiNE EURO Study Group Chair persons: Ce ´line Miani (Germany), Marzia Lazzerini (Italy) Contact: celine.miani@uni-bielefeld.de From 2020 the COVID-19 pandemic has deeply affected maternal and neonatal care.The implementation of governmental policy responses to limit the spread of the disease and the development of new hospital protocols have forced healthcare workers and women alike to adapt.The perception of the quality of hospital care by both groups has been at the core of the IMAgiNE EURO project, led by the WHO Collaborating Center for Maternal and Child Health (Trieste, IT).With a network of 18 countries and more than 40 institutions, this collaborative project has gathered so far data from more than 50 000 births and 5000 health workers, through two validated online surveys.It allows monitoring the quality of maternal and newborn care in four domains: the three domains of the WHO Standards for improving quality of maternal and newborn care in health facilities (namely provision of care, experience of care, and availability of human and essential physical resources) and the additional domain of key organisational changes related to the COVID-19 pandemic.Following multi-country analyses, and analyses at the regional and national level, the project findings show major gaps in the perceived quality of maternal and neonatal care in hospitals during the pandemic, as well as large variations in practices across different countries of the WHO European Region.In this workshop, Dr. Emanuelle Valente (WHO Collaborating Center for Maternal and Child Health, Trieste, IT) first introduces the methodological development of the project and the two validated data collection instruments.Dr. Marzia Lazzerini (WHO Collaborating Center for Maternal and Child Health, Trieste, IT) then presents the main results of the women's questionnaire for all countries.The focus will be on the Quality of Maternal and Newborn Care Index (QMNC Index) and how the different countries perform with regard to the four above-mentioned dimensions.Then, we carry on with two presentations focusing on specific topics relevant to maternity and newborn care.Dr. Ilana Chertock (College of Health Sciences and Professions, Ohio University, Athens, Ohio, USA) and Dr. Rada Artzi-Medvedik (Ben-Gurion University, Beersheva, Israel) will present findings on the factors influencing exclusive breastfeeding in healthcare facilities during the pandemic.Dr. Ce ´line Miani (Institute of Public Health, Bielefeld University, Bielefeld, Germany) will discuss the topic of medicalisation, looking at the potential associations between individual and country-level factors and medicalisation of birth.We will conclude the workshop with a panel discussion on the implications of our research for policies and practice, and examples of the first steps already taken to bridge the gap between monitoring and implementation.

Key messages:
This workshop will present two new, validated tools to monitor the quality of maternal and newborn care in WHO European Region, from the perspective of the women and of the healthcare providers.
It will also provide an overview of key findings so far, highlighting inequalities and gaps in the quality of maternal and neonatal care at hospital level in the WHO European Region.Results: 21,027 mothers were included in the analysis.Among those who experienced labour (N = 18,063), 41.8% (26.1%-63.5%)experienced difficulties in accessing antenatal care, 62% (12.6%-99.0%)were not allowed a companion of choice, 31.1% (16.5%-56.9%)received inadequate breastfeeding support, 34.4% (5.2%-64.8%)reported that health workers were not always using protective personal equipment, and 31.8%(17.8%-53.1%)rated the health workers' number as ''insufficient''.Episiotomy was performed in 20.1% (6.1%-66.0%) of 15th European Public Health Conference 2022

Abstract
3.N.Workshop: IMAgiNE EURO: Quality of maternity care in the WHO European Region during the COVID-19 pandemic Abstract citation ID: ckac129.188 citation ID: ckac129.189Quality of facility-based maternal and newborn care around the time of childbirth during the COVIDin Action, Zagreb, Croatia Contact: marzia.lazzerini@burlo.trieste.itBackground: Multi-country studies assessing the quality of maternal and newborn care (QMNC) during the COVID19 pandemic, as defined by WHO Standards, are lacking.Methods: Women who gave birth in 12 countries of the WHO European Region from March 1, 2020 -March 15, 2021 answered an online questionnaire, including 40 WHO Standard-based Quality Measures.