Timeliness of Childhood Vaccinations in Kampala Uganda: A Community-Based Cross-Sectional Study

Abstract

BackgroundChild survival is dependent on several factors including high vaccination coverage. Timely receipt of vaccines ensures optimal immune response to the vaccines. Yet timeliness is not usually emphasized in estimating population immunity. In addition to examining timeliness of the recommended Expanded Programme for Immunisation (EPI) vaccines, this paper identifies predictors of untimely vaccination among children aged 10 to 23 months in Kampala.MethodsIn addition to the household survey interview questions, additional data sources for variables included data collection of child's weight and length. Vaccination dates were obtained from child health cards. Timeliness of vaccinations were assessed with Kaplan–Meier time-to-event analysis for each vaccine based on the following time ranges (lowest–highest target age): BCG (birth–8 weeks), polio 0 (birth–4 weeks), three polio and three pentavalent vaccines (4 weeks–2 months; 8 weeks–4 months; 12 weeks–6 months) and measles vaccine (38 weeks–12 months). Cox regression analysis was used to identify factors associated with vaccination timeliness.ResultsAbout half of 821 children received all vaccines within the recommended time ranges (45.6%; 95% CI 39.8–51.2). Timely receipt of vaccinations was lowest for measles (67.5%; 95% CI 60.5–73.8) and highest for BCG vaccine (92.7%: 95% CI 88.1–95.6). For measles, 10.7% (95% CI 6.8–16.4) of the vaccinations were administered earlier than the recommended time. Vaccinations that were not received within the recommended age ranges were associated with increasing number of children per woman (adjusted hazard ratio (AHR); 1.84, 95% CI 1.29–2.64), non-delivery at health facilities (AHR 1.58, 95% CI 1.02–2.46), being unmarried (AHR 1.49, 95% CI 1.15–1.94) or being in the lowest wealth quintile (AHR 1.38, 95% CI 1.11–1.72).ConclusionsStrategies to improve vaccination practices among the poorest, single, multiparous women and among mothers who do not deliver at health facilities are necessary to improve timeliness of vaccinations.

Suboptimal vaccination rates in rural Ghana despite positive caregiver attitudes towards vaccination

“…However, there are also substantial knowledge gaps regarding the benefits of the practice and poor adherence to recommended vaccine schedules, especially beyond the neonatal period. Timeliness of vaccine uptake has been associated with hospital delivery [28], a time when the initial vaccines are given, and, in general, vaccination schedule adherence tends to decrease subsequently with later vaccines [21][22][23] as was found to be the case in our study. Common sources of vaccination awareness were the hospitals/ clinics or the media (radio and television stations) or community announcements with a Public Address System.…”

“…Various studies have identified that adherence to vaccine schedules tend to be highest at birth for hospital deliveries, but subsequently fall due to various factors, including low levels of knowledge of vaccine specific schedules and gaps between awareness and adherence to vaccine schedules [21][22][23]. Due to suboptimal vaccination rates, we aimed to evaluate current knowledge, attitudes, and practices of parents and caregivers of children between 1 month and 5 years old in the Barekese subdistrict of Ghana regarding immunizations; through a mixed quantitative-qualitative survey as part of the Barekuma Community Collaborative Development Programme (BCCDP) [24].…”

Factors contributing to delay in commencement of immunization in Nigerian infants

“…High socioeconomic status, having a maternal education above secondary school and delivery in a health facility were significantly associated with receiving immunisation in the first week of life. These factors have previously been identified as being associated with timeliness of receipt of immunisation (Luman et al, 2005;Feemster et al, 2009;Akmatov & Mikolajczyk, 2012;Babirye et al, 2012).…”

“…A study of timeliness of childhood vaccination in 31 low and middle income countries reported substantial vaccination delays (Akmatov & Mikolajczyk, 2012). In Uganda less than half of all children received all vaccines within the recommended time (Babirye et al, 2012).…”

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

“…There is growing awareness of the importance of timeliness of childhood immunizations when assessing actual protection from VPDs [11][12][13][14]. We therefore made timeliness of vaccination a requirement for full vaccination status with the following cutoffs: Polio "at birth" by 30 days after birth, BCG + second dose of polio + first dose of DPT-HB-Hib by 2 months, third dose of polio + second dose of DPT-HB-Hib by 4 months, fourth dose of polio + third dose of DPT-HB-Hib by 6 months, and measles vaccine by 12 months.…”