Incomplete immunization and its determinants among children in Africa: Systematic review and meta-analysis

Gebeyehu, Natnael Atnafu; Gelaw, Kelemu Abebe; Adella, Getachew Asmare; Tegegne, Kirubel Dagnaw; Admass, Biruk Adie; Gesese, Molalegn Mesele

doi:10.1080/21645515.2023.2202125

Cited by 3 publications

(2 citation statements)

References 62 publications

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“…The global coverage of DTP3 decreased from 86% in 2019 to 83% in 2020 [ 51 , 88 ]. Similar declines had been found in Africa and Asia [ 44 , 89 ]. In contrast to other regions, Europe experienced a minor reduction in vaccination coverage.…”

Section: Discussionsupporting

confidence: 82%

Has COVID-19 Affected DTP3 Vaccination in the Americas?

Aguinaga-Ontoso,

Guillén-Aguinaga,

Guillén-Aguinaga

et al. 2024

Vaccines

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Background: In the Americas, deaths by diseases avoidable with vaccines are a significant contributor to child mortality. An essential means of reducing this is through broad vaccine coverage. The COVID-19 pandemic has posed a potential disruption to vaccine coverage due to its effects on the healthcare system. Objectives: this study aims to evaluate the impact of the COVID-19 pandemic on DTP3 vaccination coverage in the Americas, investigating trends from 2012 to 2022 to identify significant changes, regional disparities, and the overall effect of the pandemic on progress towards global immunization targets. Methods: This study used the coverage data for the third dose of the diphtheria, tetanus, and pertussis vaccine (DTP3) pulled from UNICEF databases spanning 2012 to 2022. We conducted a Joinpoint regression to identify points of significant trend changes. The annual percentage change (APC) and 95% confidence intervals (95% CIs) were calculated for America and its regions. We also used segmented regression analysis. Using the Chi-square test, we compared DTP3 vaccination coverage for each country between 2019 and 2022. Results: Overall, America saw a decrease in vaccine coverage during this period, with an APC of −1.4 (95% CI −1.8; −1.0). This trend varied across regions. In North America, the decrease was negligible (−0.1% APC). South America showed the steepest decrease, with an APC of −2.5%. Central America also declined, with an APC of −1.3%. Our findings suggest a concerning trend of declining DTP-vaccination rates in the Americas, exacerbated in certain regions, in the wake of the COVID-19 pandemic. The absolute decrease in vaccine coverage in the Americas was −4% between 2019 and 2022, with the most important drop being in Central America (−7%). However, six countries reported increased vaccination rates post-COVID-19, led by Brazil, with a 7% increase. Conversely, twenty-two countries registered a decline in DTP3 vaccine coverage, with the average decrease being −7.37%. This decline poses an important challenge to achieving the WHO’s target of 90% coverage for the third dose of DTP by 2030, as evidenced by the reduction in the number of countries meeting this target from 2019 to 2022. Conclusions: The COVID-19 pandemic has impacted vaccine coverage in America, leading to a decrease, especially across Central America.

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Section: Discussionsupporting

confidence: 82%

Has COVID-19 Affected DTP3 Vaccination in the Americas?

Aguinaga-Ontoso,

Guillén-Aguinaga,

Guillén-Aguinaga

et al. 2024

Vaccines

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“…A recent meta-analysis has found that the prevalence of incomplete immunization (failing to receive any vaccination doses) in Africa was 35.5%. The main risk factors were home birth, rural residence, lack of antenatal care visits, knowledge of immunizations, and maternal illiteracy [ 47 ].…”

Section: Discussionmentioning

confidence: 99%

COVID-19 Impact on DTP Vaccination Trends in Africa: A Joinpoint Regression Analysis

Aguinaga-Ontoso

Guillen-Aguinaga

et al. 2023

Vaccines

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Background: Deaths due to vaccine-preventable diseases are one of the leading causes of death among African children. Vaccine coverage is an essential measure to decrease infant mortality. The COVID-19 pandemic has affected the healthcare system and may have disrupted vaccine coverage. Methods: DTP third doses (DTP3) Vaccine Coverage was extracted from UNICEF databases from 2012 to 2021 (the last available date). Joinpoint regression was performed to detect the point where the trend changed. The annual percentage change (APC) with 95% confidence intervals (95% CI) was calculated for Africa and the regions. We compared DTP3 vaccination coverage in 2019–2021 in each country using the Chi-square test. Result: During the whole period, the vaccine coverage in Africa increased with an Annual Percent change of 1.2% (IC 95% 0.9–1.5): We detected one joinpoint in 2019. In 2019–2021, there was a decrease in DTP3 coverage with an APC of −3.5 (95% −6.0; −0,9). (p < 0.001). Vaccination rates decreased in many regions of Sub-Saharan Africa, especially in Eastern and Southern Africa. There were 26 countries (Angola, Cabo Verde, Comoros, Congo, Côte d’Ivoire, Democratic Republic of the Congo, Djibouti, Ethiopia, Eswatini, The Gambia, Guinea-Bissau, Liberia, Madagascar, Malawi, Mauritania, Mauritius, Mozambique, Rwanda, Senegal, Seychelles, Sierra Leone, Sudan, Tanzania, Togo, Tunisia, Uganda, and Zimbabwe) where the vaccine coverage during the two years decreased. There were 10 countries (Angola, Cabo Verde, Comoros, Democratic Republic of the Congo, Eswatini, The Gambia, Mozambique, Rwanda, Senegal, and Sudan) where the joinpoint regression detected a change in the trend. Conclusions. COVID-19 has disrupted vaccine coverage, decreasing it all over Africa.

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Prediction of incomplete immunization among under-five children in East Africa from recent demographic and health surveys: a machine learning approach

Tadese,

Nigatu,

Yehuala

et al. 2024

Sci Rep

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The World Health Organization as part of the goal of universal vaccination coverage by 2030 for all individuals. The global under-five mortality rate declined from 59% in 1990 to 38% in 2019, due to high immunization coverage. Despite the significant improvements in immunization coverage, about 20 million children were either unvaccinated or had incomplete immunization, making them more susceptible to mortality and morbidity. This study aimed to identify predictors of incomplete vaccination among children under-5 years in East Africa. An analysis of secondary data from six east African countries using Demographic and Health Survey dataset from 2016 to the recent 2021 was performed. A total weighted sample of 27,806 children aged (12–35) months was included in this study. Data were extracted using STATA version 17 statistical software and imported to a Jupyter notebook for further analysis. A supervised machine learning algorithm was implemented using different classification models. All analysis and calculations were performed using Python 3 programming language in Jupyter Notebook using imblearn, sklearn, XGBoost, and shap packages. XGBoost classifier demonstrated the best performance with accuracy (79.01%), recall (89.88%), F1-score (81.10%), precision (73.89%), and AUC 86%. Predictors of incomplete immunization are identified using XGBoost models with help of Shapely additive eXplanation. This study revealed that the number of living children during birth, antenatal care follow-up, maternal age, place of delivery, birth order, preceding birth interval and mothers’ occupation were the top predicting factors of incomplete immunization. Thus, family planning programs should prioritize the number of living children during birth and the preceding birth interval by enhancing maternal education. In conclusion promoting institutional delivery and increasing the number of antenatal care follow-ups by more than fourfold is encouraged.

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Incomplete immunization and its determinants among children in Africa: Systematic review and meta-analysis

Cited by 3 publications

References 62 publications

Has COVID-19 Affected DTP3 Vaccination in the Americas?

Has COVID-19 Affected DTP3 Vaccination in the Americas?

COVID-19 Impact on DTP Vaccination Trends in Africa: A Joinpoint Regression Analysis

Prediction of incomplete immunization among under-five children in East Africa from recent demographic and health surveys: a machine learning approach

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