title: Feasibility study of enforcing immunization certificate check before primary school or kindergarten enrollment in Guizhou Province, China.
abstract: OBJECTIVE
  To study the feasibility of enforcing immunization certificate check before children enroll in primary schools or kindergartens in Guizhou Province.
  
  
  METHODS
  Quantitative and qualitative studies were conducted. The multi-stage and cluster sampling approach was adopted for the quantitative part of the study. A questionnaire was designed and 996 children and their keepers were interviewed. Principals, doctors or teachers of the primary schools, directors and child care nurses of kindergarten, and staff of immunization agencies were invited to take part in 12 focus group discussions; meanwhile, face-to-face individual in-depth interviews with 16 officials of the Health, Education and Governmental Departments at various levels were conducted.
  
  
  RESULTS
  The total number of subjects was 996. 16.7% of the children in the study completed all the procedures of the National Immunization Programme. 34.3% of them had immunization certificates while the remainder 44.7% registered in immunization agencies. Factors, including the migrant children, doubt about vaccine efficiency, mother's occupation and educational background, knowledge of the National Immunization Programme on targeted vaccines, played an important role in obtaining or not immunization certificates. 95% of the keepers interviewed thought the immunization certificates were useful; 94.8% of them considered the check was critical while only 3.6% of them thought it unnecessary. The first reason from those who found it unnecessary was that they feared that repeated immunization might affect their children's health. The second reason was the cost of immunization, which some of them could not afford to pay. However, the Health Department expressed a favorable attitude to the checking scheme. Though the Education Department agreed that the scheme was essential, they worried that it would affect the enrollment rate.
  
  
  CONCLUSIONS
  In spite of the difficulty in administering immunization certificate check, the effort would be rewarding for raising the immunization coverage rate among the children in Guizhou Province.
authors.affiliation: Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing 100005, China. shengli909@163.com
authors.forename: Li
authors.initials: L
authors.lastname: Sheng
authors.forename: Shu-Yan
authors.initials: SY
authors.lastname: Zuo
authors.forename: Jing
authors.initials: J
authors.lastname: Xie
authors.forename: Ya-Li
authors.initials: YL
authors.lastname: Qi
authors.forename: Yi-Bing
authors.initials: YB
authors.lastname: Tong
authors.forename: Guang-Peng
authors.initials: GP
authors.lastname: Tang
authors.forename: Jun
authors.initials: J
authors.lastname: Zhou
authors.forename: Da-Yong
authors.initials: DY
authors.lastname: Zhang
authors.forename: Chang-Bing
authors.initials: CB
authors.lastname: Long
authors.forename: Wen
authors.initials: W
authors.lastname: Du
authors.forename: Zi-Jian
authors.initials: ZJ
authors.lastname: Feng
mesh_terms: D017677:Age Distribution; D002675:Child, Preschool; D002681:China / Q000453:epidemiology; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D007114:Immunization / Q000331:legislation & jurisprudence*; D008297:Male; D008499:Medical Records / Q000331:legislation & jurisprudence*; D012574:Schools / Q000331:legislation & jurisprudence*; D013334:Students / Q000331:legislation & jurisprudence*; D011795:Surveys and Questionnaires; D014171:Transients and Migrants; D014611:Vaccination / Q000331:legislation & jurisprudence