Tracking coverage, dropout and multidimensional equity gaps in immunisation systems in West Africa, 2000–2017

Abstract

BackgroundSeveral West African countries are unlikely to achieve the recommended Global Vaccine Action Plan (GVAP) immunisation coverage and dropout targets in a landscape beset with entrenched intra-country equity gaps in immunisation. Our aim was to assess and compare the immunisation coverage, dropout and equity gaps across 15 West African countries between 2000 and 2017.MethodsWe compared Bacille Calmette Guerin (BCG) and the third dose of diphtheria–tetanus–pertussis (DTP3) containing vaccine coverage between 2000 and 2017 using the WHO and Unicef Estimates of National Immunisation Coverage for 15 West African countries. Estimated subregional median and weighted average coverages, and dropout (DTP1–DTP3) were tracked against the GVAP targets of ≥90% coverage (BCG and DTP3), and ≤10% dropouts. Equity gaps in immunisation were assessed using the latest disaggregated national health survey immunisation data.ResultsThe weighted average subregional BCG coverage was 60.7% in 2000, peaked at 83.2% in 2009 and was 65.7% in 2017. The weighted average DTP3 coverage was 42.3% in 2000, peaked at 70.3% in 2009 and was 61.5% in 2017. As of 2017, 46.7% of countries (7/15) had met the GVAP targets on DTP3 coverage. Average weighted subregional immunisation dropouts consistently reduced from 16.4% in 2000 to 7.4% in 2017, meeting the GVAP target in 2008. In most countries, inequalities in BCG, and DTP3 coverage and dropouts were mainly related to equity gaps of more than 20% points between the wealthiest and the poorest, high coverage regions and low coverage regions, and between children of mothers with at least secondary education and those with no formal education. A child’s sex and place of residence (urban or rural) minimally determined equity gaps.ConclusionsThe West African subregion made progress between 2000 and 2017 in ensuring that its children utilised immunisation services, however, wide equity gaps persist.

Access to skilled attendant at birth and the coverage of the third dose of diphtheria-tetanus-pertussis vaccine across 14 West African countries – an equity analysis

“…Our findings agree with those of other authors who have identified Mali, Niger and Nigeria as having large equity gaps in SAB and DTP3 coverage [11,12,20]. Indeed, these gaps are similar to the large gaps found in other countries such as Ethiopia, Bangladesh and Haiti outside our study region [12].…”

Geographic location of health facility and immunization program performance in Hoima district, western Uganda, a facility level assessment

“…Several studies in sub Saharan Africa have reported less than the targeted levels for vaccination coverage. [21][22][23] Our data showed the health facilities that were located more remotely from the district headquarters or the more rural part of the district were likely to perform better than those located closer to the district headquarters. This inverse distance and performance relationship is striking and needed to be explained.…”

Geographic location of health facility and immunization program performance in Hoima district, western Uganda, a Health Facility level assessment

“…Several studies in sub Saharan Africa have reported less than the targeted levels for vaccination coverage. [22][23][24] Our data showed the health facilities that were located more remotely from the district headquarters or the more rural part of the district were likely to perform better than those located closer to the district headquarters. This inverse distance and performance relationship is striking and needs to be explained.…”