{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,10]],"date-time":"2026-08-10T15:19:03Z","timestamp":1786375143538,"version":"build-2736575974"},"reference-count":23,"publisher":"BMJ","issue":"7","license":[{"start":{"date-parts":[[2023,7,31]],"date-time":"2023-07-31T00:00:00Z","timestamp":1690761600000},"content-version":"unspecified","delay-in-days":30,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2023,7,13]]},"published-print":{"date-parts":[[2023,7]]},"abstract":"<jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>This study investigated the association between vaccine stockout and immunisation coverage, and infant\/under 5 mortality rates.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design<\/jats:title>\n                    <jats:p>A retrospective cohort study.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Setting<\/jats:title>\n                    <jats:p>Low-income and middle-income countries.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Participants<\/jats:title>\n                    <jats:p>A cohort of 131 low-income and middle-income countries from 2004 to 2019.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Primary outcome measures<\/jats:title>\n                    <jats:p>Main outcomes included immunisation coverages of (1) diphtheria-tetanus-pertussis containing vaccine (DTP), (2) measles containing vaccine (MCV), (3) BCG and (4) oral polio vaccine (OPV). We also included infant and under 5 mortality rates as secondary outcomes.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>The countries that experienced national-level stockouts of DTP and MCV had 3.7 and 4\u2009percentage points lower coverage rates of DTP3 and MCV1, respectively, compared with the countries without the stockout events (p&lt;0.01). Moreover, the statistically significant differences in the immunisation coverage rates across the countries with and without the stockout events are 2.4\u2009percentage points and 2.6\u2009percentage points for BCG and OPV, respectively (p&lt;0.01).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Our findings show that the incidence of vaccine stockout events is associated with the decreased immunisation coverages for children in low-income and middle-income countries. However, we did not observe a statistically significant association between the increasing frequency of vaccine stockout and infant and under 5 mortality rates.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjopen-2023-072364","type":"journal-article","created":{"date-parts":[[2023,7,31]],"date-time":"2023-07-31T14:56:33Z","timestamp":1690815393000},"page":"e072364","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":9,"title":["Association of vaccine stockout with immunisation coverage in low-income and middle-income countries: a retrospective cohort study"],"prefix":"10.1136","volume":"13","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-8590-4089","authenticated-orcid":false,"given":"Donghoon","family":"Lee","sequence":"first","affiliation":[{"name":"UNICEF, Copenhagen, Denmark"},{"name":"Department of Health Systems and Population Health, University of Washington, Seattle, Washington, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Manuel Celestino","family":"Lavayen","sequence":"additional","affiliation":[{"name":"UNICEF, Copenhagen, Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Taeksoo Ted","family":"Kim","sequence":"additional","affiliation":[{"name":"UNICEF, Copenhagen, Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ken","family":"Legins","sequence":"additional","affiliation":[{"name":"UNICEF, Copenhagen, Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michelle","family":"Seidel","sequence":"additional","affiliation":[{"name":"UNICEF, Copenhagen, Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2023,7,31]]},"reference":[{"key":"2025120618445808000_13.7.e072364.1","doi-asserted-by":"crossref","unstructured":"Feikin DR , Flannery B , Hamel MJ , et al . Chapter 10: vaccines for children in Low- and middle-income countries. In: Black RE , Laxminarayan R , M M , et al , eds. Reproductive, maternal, newborn, and child health: disease control priorities, Third Edition (Volume 2). The International Bank for Reconstruction and Development \/ The World Bank, 2016. doi:10.1596\/978-1-4648-0348-2_ch10","DOI":"10.1596\/978-1-4648-0348-2_ch10"},{"key":"2025120618445808000_13.7.e072364.2","doi-asserted-by":"publisher","DOI":"10.1377\/hlthaff.2015.1086"},{"key":"2025120618445808000_13.7.e072364.3","doi-asserted-by":"crossref","first-page":"398","DOI":"10.1016\/S0140-6736(20)32657-X","article-title":"Estimating the health impact of vaccination against ten pathogens in 98 low-income and middle-income countries from 2000 to 2030: a modelling study","volume":"397","author":"Li","year":"2021","journal-title":"Lancet"},{"key":"2025120618445808000_13.7.e072364.4","doi-asserted-by":"crossref","first-page":"937","DOI":"10.1016\/S1473-3099(18)30478-X","article-title":"Vaccine-preventable diseases in lower-middle-income countries","volume":"18","author":"Turner","year":"2018","journal-title":"Lancet Infect Dis"},{"key":"2025120618445808000_13.7.e072364.5","doi-asserted-by":"crossref","DOI":"10.1186\/s12913-017-2626-0","article-title":"Determinants of effective vaccine coverage in low and middle-income countries: a systematic review and interpretive synthesis","volume":"17","author":"Phillips","year":"2017","journal-title":"BMC Health Serv Res"},{"key":"2025120618445808000_13.7.e072364.6","doi-asserted-by":"crossref","first-page":"376","DOI":"10.1093\/inthealth\/ihy036","article-title":"Impact of vaccine stock-outs on infant vaccination coverage: a hospital-based survey from South Africa","volume":"10","author":"Burnett","year":"2018","journal-title":"Int Health"},{"key":"2025120618445808000_13.7.e072364.7","doi-asserted-by":"crossref","first-page":"5104","DOI":"10.1016\/j.vaccine.2019.06.006","article-title":"Impact of vaccine stockouts on immunization coverage in Nigeria","volume":"37","author":"Gooding","year":"2019","journal-title":"Vaccine"},{"key":"2025120618445808000_13.7.e072364.8","doi-asserted-by":"crossref","first-page":"170","DOI":"10.1093\/inthealth\/ihz091","article-title":"Vaccine stockouts and vaccination rate: examination of unique administrative data from Nigeria","volume":"12","author":"Sato","year":"2020","journal-title":"Int Health"},{"key":"2025120618445808000_13.7.e072364.9","doi-asserted-by":"crossref","DOI":"10.1186\/s12916-016-0685-4","article-title":"The potential impact of BCG vaccine supply shortages on global paediatric tuberculosis mortality","volume":"14","author":"Harris","year":"2016","journal-title":"BMC Med"},{"key":"2025120618445808000_13.7.e072364.10","doi-asserted-by":"crossref","first-page":"B73","DOI":"10.1016\/j.vaccine.2012.11.036","article-title":"The imperative for stronger vaccine supply and logistics systems","volume":"31 Suppl 2","author":"Zaffran","year":"2013","journal-title":"Vaccine"},{"key":"2025120618445808000_13.7.e072364.11","doi-asserted-by":"crossref","first-page":"2121","DOI":"10.1016\/j.vaccine.2016.12.071","article-title":"Vaccine stockouts around the world: are essential vaccines always available when needed?","volume":"35","author":"Lydon","year":"2017","journal-title":"Vaccine"},{"key":"2025120618445808000_13.7.e072364.12","doi-asserted-by":"crossref","first-page":"5364","DOI":"10.1016\/j.vaccine.2020.05.003","article-title":"Global vaccine action plan lessons learned I: recommendations for the next decade","volume":"38","author":"MacDonald","year":"2020","journal-title":"Vaccine"},{"key":"2025120618445808000_13.7.e072364.13","unstructured":"World Health Organization . 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