Socio‐economic determinants and inequities in coverage and timeliness of early childhood immunisation in rural Ghana

Abstract

Abstractobjectives To assess the extent of socio-economic inequity in coverage and timeliness of key childhood immunisations in Ghana.methods Secondary analysis of vaccination card data collected from babies born between January 2008 and January 2010 who were registered in the surveillance system supporting the ObaapaVita and Newhints Trials was carried out. 20 251 babies had 6 weeks' follow-up, 16 652 had 26 weeks' follow-up, and 5568 had 1 year's follow-up. We performed a descriptive analysis of coverage and timeliness of vaccinations by indicators for urban/rural status, wealth and educational attainment. The association of coverage with socio-economic indicators was tested using a chi-square-test and the association with timeliness using Cox regression.results Overall coverage at 1 year of age was high (>95%) for Bacillus Calmette-Gu erin (BCG), all three pentavalent diphtheria-pertussis-tetanus-haemophilus influenzae B-hepatitis B (DPTHH) doses and all polio doses except polio at birth (63%). Coverage against measles and yellow fever was 85%. Median delay for BCG was 1.7 weeks. For polio at birth, the median delay was 5 days; all other vaccine doses had median delays of 2-4 weeks. We found substantial health inequity across all socioeconomic indicators for all vaccines in terms of timeliness, but not coverage at 1 year. For example, for the last DPTHH dose, the proportion of children delayed more than 8 weeks were 27% for urban children and 31% for rural children (P < 0.001), 21% in the wealthiest quintile and 41% in the poorest quintile (P < 0.001), and 9% in the most educated group and 39% in the least educated group (P < 0.001). However, 1-year coverage of the same dose remained above 90% for all levels of all socio-economic indicators.conclusions Ghana has substantial health inequity across urban/rural, socio-economic and educational divides. While overall coverage was high, most vaccines suffered from poor timeliness. We suggest that countries achieving high coverage should include timeliness indicators in their surveillance systems.

Coverage and timeliness of vaccination and the validity of routine estimates: Insights from a Vaccine Registry in Kenya

“…(27,33) Many studies have shown marked differences in age-appropriate and 'upto-date coverage' by socioeconomic status. (34,35) In this relatively homogenous study setting, we also find significant location-specific and year-to-year variation in timeliness.…”

“…Socio-economic factors also contribute to inequities in coverage and time to vaccination. (34,35) though these are hard to characterise reliably in a relatively homogenous rural population.…”

Do maternal knowledge and attitudes towards childhood immunizations in rural Uganda correlate with complete childhood vaccination?

“…Studies in SSA analyzing parental characteristics associated with the vaccination status of their respective children have largely focused on other socio-demographic factors. Variables such as parental education [4,[17][18][19][20][21][22][23], mothers' age [18,19], household income or wealth [4,11,17,19,22,24], family size or mothers' parity [4,[17][18][19], religion of caregivers [25,26], and location of labor and delivery [23] are well documented as correlates with the vaccination status of a child. We are only aware of four published studies conducted in SSA in the past 15 years that assessed KATCI [18,[27][28][29].…”

Neonatal vaccination of low birthweight infants in Ghana

“…The resulting AORs for this less frequent outcome thus approximated more closely to risk or rate ratios. Model building was informed by a hierarchical framework5 of the determinants of vaccination identified a priori 3 4 13 14. We initially fit a model comprising distal determinants (religion, ethnicity, socioeconomic status (SES), maternal occupation, maternal education, vaccine due in wet season, infant sex); then added intermediate determinants (maternal age/family size, maternal illness in the year before delivery, distance to the nearest health facility, place of delivery, multiple birth), followed by birth weight and, finally, infant illness, a possible mediator of the association between birth weight and vaccination.…”

“…Substantive socio-demographic inequities in vaccination remain 2. Many infants are vaccinated late 3 4. The latest global vaccination policy highlights the need to identify and target those underserved by vaccination in order to increase equity and uptake 2…”