An assessment of PCV13 vaccine coverage using a repeated cross-sectional household survey in Malawi

Abstract

The 13-valent pneumococcal conjugate vaccine (PCV13) was Background: introduced in Malawi from November 2011 using a three dose primary series at 6, 10, and 14 weeks of age to reduce -related Streptococcus pneumoniae diseases. To date, PCV13 paediatric coverage in Malawi has not been rigorously assessed. We used household surveys to longitudinally track paediatric PCV13 coverage in rural Malawi.Samples of 60 randomly selected children (30 infants aged 6 weeks Methods: to 4 months and 30 aged 4-16 months) were sought in each of 20 village clinic catchment 'basins' of Kabudula health area, Lilongwe, Malawi between March 2012 and June 2014. Child health information was reviewed and mothers interviewed to determine each child's PCV13 dose status and vaccine timing. The survey was completed six times in 4-8 month intervals. Survey inference was used to assess PCV13 dose coverage in each basin for each age group. All 20 basins were pooled to assess area-wide vaccination coverage over time, by age in months, and adherence to the vaccination schedule.We surveyed a total of 8,562 children in six surveys; 82% were in the Results: older age group. Overall, in age-eligible children, two-dose and three-dose coverage increased from 30% to 85% and 10% to 86%, respectively, between March 2012 and June 2014. PCV13 coverage was higher in the older age group in all surveys. Although it varied by basin, PCV13 coverage was consistently delayed: median ages at first, second and third doses were 9, 15 and 21 weeks, respectively.In our rural study area, PCV13 introduction did not meet the Conclusion: Malawi Ministry of Health one-year three-dose 90% coverage target, but after 2 years reached levels likely to reduce the prevalence of both invasive and non-invasive paediatric pneumococcal diseases. Better adherence to the PCV13 schedule may reduce pneumococcal disease in younger Malawian

Haemophilus influenzae type b and pneumococcal conjugate vaccination coverage in children aged 2-59 months in Malawi

“…Similar to the 2012–2014 findings from the Lilongwe cross-sectional household survey, 6 our data show lower reported vaccination rates among enrolled ITIP children compared to the data from the Malawi Ministry of Health national vaccination coverage reports. 7 Differences in methods and systems of data collection could contribute to these differences.…”

“…In an assessment of PCV13 vaccine coverage using a repeated cross-sectional household survey to longitudinally track pediatric PCV13 coverage in rural Lilongwe, Malawi, a total of 8,562 children were surveyed in 6 surveys, and showed that despite large increases in two- and three-dose coverage among age-eligible children between March 2012 and June 2014, PCV13 coverage was consistently delayed and did not meet the Malawi Ministry of Health one-year three-dose 90% coverage target. 6 This is in contrast to the Malawi Ministry of Health national vaccination coverage reports which showed the percentage of surviving infants who received the third doses of the Hib conjugate vaccine and PCV13 in 2018 to be 92% for both these vaccines. 7…”

“…For the ITIP vaccination data, a dose of a vaccine was only recorded as received if documentation of the vaccination was noted in the child’s health passport; otherwise, it was recorded by the ITIP study team as unknown. Other reports use caregiver verbal reports 6 or facility-level data that report the number of doses of vaccines administered per facility. 7 A 2018 GAVI Joint Appraisal report for Malawi’s Expanded Program on Immunization noted that registers at vaccination sites were not user-friendly, resulting in poor data capture and data loss.…”

What is associated with reported acute respiratory infection in children under 5 and PCV vaccination in children aged 1–36 months in Malawi? A secondary data analysis using the Malawi 2014 MICS survey

“…Although great improvements have been made, our results and other existing evidence shows that by April 2014, PCV coverage did not meet the Malawi Ministry of Health threedose coverage target of 90% before 12 months. Our nationally representative study of children aged 1-36 months estimated that 77.0% of children had received all 3 PCV doses, less than the 86.0% estimated by Bondo et al [13], in rural children only, in one area (Kabadula) of one district (Lilongwe) of Malawi, aged between 6 weeks and 16 months. This could be explained by this studies findings in univariable logistic regression analysis that rural children have 0.82 reduced odds of receiving all 3 PCV vaccinations when compared to urban (p = 0.003, CI 0.71-0.93, however in multivariable regression there was no difference found, perhaps because of confounding of rural dwelling with other explanatory variables e.g.…”

“…Malawian coverage estimates for all 3 PCV doses by 12 months old from data collected between 2012-2014 vary from 86% [13] 76% [7] increasing to 89.2% in 2015 [14] all just below the target for full immunisation set at >90% [15]. Munthali [16] stated that in Malawi it is considered the responsibility of a child's mother to ensure they are vaccinated.…”