Barriers to timely administration of birth dose vaccines in The Gambia, West Africa

Abstract

ObjectiveAlthough vaccine coverage in infants in sub-Saharan Africa is high, this is estimated at the age of 6–12 months. There is little information on the timely administration of birth dose vaccines. The objective of this study was to assess the timing of birth dose vaccines (hepatitis B, BCG and oral polio) and reasons for delayed administration in The Gambia.MethodsWe used vaccination data from the Farafenni Health and Demographic Surveillance System (FHDSS) between 2004 and 2014. Coverage was calculated at birth (0–1 day), day 7, day 28, 6 months and 1 year of age. Logistic regression models were used to identify demographic and socio-economic variables associated with vaccination by day 7 in children born between 2011 and 2014.ResultsMost of the 10,851 children had received the first dose of hepatitis B virus (HBV) vaccine by the age of 6 months (93.1%). Nevertheless, only 1.1% of them were vaccinated at birth, 5.4% by day 7, and 58.4% by day 28. Vaccination by day 7 was associated with living in urban areas (West rural: adjusted OR (AOR) = 6.13, 95%CI: 3.20–11.75, east rural: AOR = 6.72, 95%CI: 3.66–12.33) and maternal education (senior-educations: AOR = 2.43, 95%CI: 1.17–5.06); and inversely associated with distance to vaccination delivery points (≧2 km: AOR = 0.41, 95%CI: 0.24–0.70), and Fula ethnicity (AOR = 0.60, 95%CI: 0.40–0.91).ConclusionVaccine coverage in The Gambia is high but infants are usually vaccinated after the neonatal period. Interventions to ensure the implementation of national vaccination policies are urgently needed.

Barriers to Childhood Immunization in Sub-Saharan Africa: A Systematic Review

“…Forty-eight articles met all inclusion criteria for this study; 28 articles were excluded for various reasons. [See supplementary materials 3] Nine articles employed second-hand data analysis [7,12,18,27,37,40,41,47,42]; thirty-six used cross-sectional design [1-3, 11, 13-17, 19, 21-26, 28-36, 38-39, 42, 45-46, 48-51, 53, 54] and three used case-control study [20,[43][44]. All described studies were conducted on Africa populations (103,655 adults and 76,327 children).…”

“…The place of delivery of a baby was reported as determinants of full immunization of a child. Delivery at health facility enhances full immunization [18,20,22,27,28,40,48]. Long waiting time at health facilities was frequently and consistency noted [11,12,31,35,36,45].…”

Maternal Knowledge of Tuberculosis and Bacillus Calmette Guerin Vaccination in Pediatric Health Services in Kinshasa

“…Miyahara et al [30] found that vaccination by day 7 was associated with living in urban areas (west rural: (OR = 1.42, 95%CI 1.06 -1.89), but there was no effect of the age of the mother [31]. Globally, most authors agree that the socioeconomic and educational levels have an influence on the lack of knowledge of TB and vaccination.…”

Mother‐to‐child transmission of hepatitis B: What more needs to be done to eliminate it around the world?

“…Moreover, even in countries that integrated BDV, studies have revealed the lack of compliance with the timeliness. For example, a study in the Gambia found that, between 2004 and 2014, despite BDV being part of the EPI, only 1.1% of newborns received their first dose of hepatitis B vaccine within 24 hours of birth, 5.4% by day 7 and 58.4% by day 28 . This finding was replicated by another study, which found that only 7% of Gambian infants received timely BDV, and the median time to ‘birth dose’ vaccination was 11 days (IQR 6‐16 days) …”