Vaccine confidence and timeliness of childhood immunisation by health information source, maternal, socioeconomic, and geographic characteristics in Albania

Abstract Background: Albania is facing decreasing childhood immunisation coverage and timeliness despite a growing economy and universal health insurance. Our aim is to estimate vaccine confidence and timeliness of childhood immunisation by health information source, maternal, socioeconomic, and geographic characteristics in Albania. Methods: We used the 2017-2018 Albania Demographic and Health Survey to analyse vaccine confidence, measured via the proxy of vaccine timeliness, among 2,156 mothers of under-5-year-old children using simple and multivariable logistic regression. Results: 77.9% [74.2, 81.2] of mothers had confidence in vaccines. Immunisation delay was reported by 21.5% [18.3, 25.3] of mothers, but a majority (65.7%) were caused by the sickness of the infant at the time of vaccination, while a minority (8.7%) due to maternal concerns about vaccine safety and side effects. Among 1.7% of mothers who ever refused vaccination of their children, the main concerns were about vaccine safety (35.9%) and adverse events (42.7%). Factors associated with lower vaccine confidence were using the Internet/social media as the main health information source compared to other sources (AOR=0.66 [0.47, 0.94], p=0.020), maternal work outside the home (AOR=0.65 [0.47, 0.91], p=0.013), lack of maternal education (AOR=0.14 [0.03, 0.67], p=0.014), and living in AL02-Qender (AOR=0.38 [0.23, 0.63]) and AL03-Jug regions (AOR=0.36 [0.24, 0.53]) in comparison to AL01-Veri region (p<0.0001). Conclusions: Reinforcement of scientific evidence-based online communication about childhood immunisation and monitoring anti-vaccination movements on the Internet/social media would be beneficial in improving vaccine confidence and timeliness in Albania, together with traditional ways of promoting vaccination by healthcare professionals who enjoy confidence as trusted sources of information.