Ascertainment of childhood vaccination histories in northern Malawi

Jahn, Andreas; Floyd, Sian; Mwinuka, Venance; Mwafilaso, Johnbosco; Mwagomba, D.; Mkisi, Rouden; Katsulukuta, Agnes; Khunga, A.; Crampin, Amelia C.; Branson, Keith; McGrath, Nuala; Fine, Paul E. M.

doi:10.1111/j.1365-3156.2007.01982.x

Cited by 36 publications

(36 citation statements)

References 14 publications

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“…A similar pattern was reported in one study from Malawi [29] while another from China found home birth to be independently predictive of immunisation delays [28]. It is not uncommon for birth order to be associated with immunisation delays [6,7,28,34,35] but no such evidence was found in this study in line with some other studies [29]. …”

Section: Discussionsupporting

confidence: 92%

“…Some of the prominent risk factors in this study are rarely reported possibly because of the younger age profile and method of recruitment for this study compared with similar studies [5,6,8,15,28,29]. For instance, the protective effect of treated neonatal hyperbilirubinaemia is unlikely to be detected or of interest in studies among older infants.…”

Section: Discussionmentioning

confidence: 80%

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Pattern and determinants of BCG immunisation delays in a sub-Saharan African community

Olusanya

2010

Health Res Policy Sys

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BackgroundChildhood immunisation is recognised worldwide as an essential component of health systems and an indispensable indicator of quality of care for vaccine-preventable diseases. While performance of immunisation programmes is more commonly measured by coverage, ensuring that every child is immunised at the earliest/appropriate age is an important public health goal. This study therefore set out to determine the pattern and predictors of Bacille de Calmette-Guérin (BCG) immunisation delays in the first three months of life in a Sub-Saharan African community where BCG is scheduled at birth in order to facilitate necessary changes in current policy and practices for improved services.MethodsA cross-sectional study in which immunisation delays among infants aged 0-3 months attending community-based BCG clinics in Lagos, Nigeria over a 2-year period from July 2005 to June 2007 were assessed by survival analysis and associated factors determined by multivariable logistic regression. Population attributable risk (PAR) was computed for the predictors of delays.ResultsBCG was delayed beyond three months in 31.6% of all eligible infants. Of 5171 infants enrolled, 3380 (65.4%) were immunised within two weeks and a further 1265 (24.5%) by six weeks. A significantly higher proportion of infants born in hospitals were vaccinated in the first six weeks compared to those born outside hospitals. Undernourishment was predictive of delays beyond 2 and 6 weeks while treated hyperbilirubinaemia was associated with decreased odds for any delays. Lack of antenatal care and multiple gestations were also predictive of delays beyond 6 weeks. Undernourishment was associated with the highest PAR for delays beyond 2 weeks (18.7%) and 6 weeks (20.8%).ConclusionsBCG immunisation is associated with significant delays in this setting and infants at increased risk of delays can be identified and supported early possibly through improved maternal uptake of antenatal care. Combining BCG with subsequent immunisation(s) at 6 weeks for infants who missed the BCG may be considered.

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Section: Discussionsupporting

confidence: 92%

Section: Discussionmentioning

confidence: 80%

Pattern and determinants of BCG immunisation delays in a sub-Saharan African community

Olusanya

2010

Health Res Policy Sys

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“…12,28 It may be because 81% of the population in Nyanza Province lives within 5 km of a public health facility, suggesting that access may be less of a barrier to vaccination uptake than in areas where health facilities may be farther away. 29 Additionally, mothers may go to multiple facilities for vaccination depending on the perceived availability of vaccinations and quality of care at the facilities.…”

Section: Discussionmentioning

confidence: 99%

Determinants and Coverage of Vaccination in Children in Western Kenya from a 2003 Cross-Sectional Survey

Calhoun¹,

Eijk²,

Lindblade³

et al. 2014

The American Society of Tropical Medicine and Hygiene

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Abstract. This study assesses full and timely vaccination coverage and factors associated with full vaccination in children ages 12-23 months in Gem, Nyanza Province, Kenya in 2003. A simple random sample of 1,769 households was selected, and guardians were invited to bring children under 5 years of age to participate in a survey. Full vaccination coverage was 31.1% among 244 children. Only 2.2% received all vaccinations in the target month for each vaccination. In multivariate logistic regression, children of mothers of higher parity (odds ratio [OR] = 0.27, 95% confidence interval [95% CI] = 0.13-0.65, P 0.01), children of mothers with lower maternal education (OR = 0.35, 95% CI = 0.13-0.97, P 0.05), or children in households with the spouse absent versus present (OR = 0.40, 95% CI = 0.17-0.91, P 0.05) were less likely to be fully vaccinated. These data serve as a baseline from which changes in vaccination coverage will be measured as interventions to improve vaccination timeliness are introduced.

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“…A study from Malawi showed a BCG scar rate of 70% among children without documents, making it clear how vaccination coverage can be underestimated if children without vaccination cards are classified as unvaccinated. 26 We also registered pregnancies and births and could thereby determine date of birth fairly precisely if there was no written record.…”

Section: Strengths and Weaknessesmentioning

confidence: 99%

Vaccination coverage and out-of-sequence vaccinations in rural Guinea-Bissau: an observational cohort study

et al. 2012

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ObjectiveThe WHO aims for 90% coverage of the Expanded Program on Immunization (EPI), which in Guinea-Bissau included BCG vaccine at birth, three doses of diphtheria−tetanus−pertussis vaccine (DTP) and oral polio vaccine (OPV) at 6, 10 and 14 weeks and measles vaccine (MV) at 9 months when this study was conducted. The WHO assesses coverage by 12 months of age. The sequence of vaccines may have an effect on child mortality, but is not considered in official statistics or assessments of programme performance. We assessed vaccination coverage and frequency of out-of-sequence vaccinations by 12 and 24 months of age.DesignObservational cohort study.Setting and participantsThe Bandim Health Project's (BHP) rural Health and Demographic Surveillance site covers 258 randomly selected villages in all regions of Guinea-Bissau. Villages are visited biannually and vaccination cards inspected to ascertain vaccination status. Between 2003 and 2009 vaccination status by 12 months of age was assessed for 5806 children aged 12–23 months; vaccination status by 24 months of age was assessed for 3792 children aged 24–35 months.Outcome measuresCoverage of EPI vaccinations and frequency of out-of-sequence vaccinations.ResultsHalf of 12-month-old children and 65% of 24-month-old children had completed all EPI vaccinations. Many children received vaccines out of sequence: by 12 months of age 54% of BCG-vaccinated children had received DTP with or before BCG and 28% of measles-vaccinated children had received DTP with or after MV. By 24 months of age the proportion of out-of-sequence vaccinations was 58% and 35%, respectively, for BCG and MV.ConclusionsIn rural Guinea-Bissau vaccination coverage by 12 months of age was low, but continued to increase beyond 12 months of age. More than half of all children received vaccinations out of sequence. This highlights the need to improve vaccination services.

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Ascertainment of childhood vaccination histories in northern Malawi

Cited by 36 publications

References 14 publications

Pattern and determinants of BCG immunisation delays in a sub-Saharan African community

Pattern and determinants of BCG immunisation delays in a sub-Saharan African community

Determinants and Coverage of Vaccination in Children in Western Kenya from a 2003 Cross-Sectional Survey

Vaccination coverage and out-of-sequence vaccinations in rural Guinea-Bissau: an observational cohort study

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