Coverage and Timing of Children's Vaccination: An Evaluation of the Expanded Programme on Immunisation in The Gambia

Abstract

ObjectiveTo evaluate the coverage and timeliness of the Expanded Programme on Immunisation (EPI) in The Gambia.MethodsVaccination data were obtained between January 2005 and December 2012 from the Farafenni Health and Demographic Surveillance System (FHDSS), the Basse Health and Demographic Surveillance System (BHDSS), the Kiang West Demographic surveillance system (KWDSS), a cluster survey in the more urban Western Health Region (WR) and a cross sectional study in four clinics in the semi-urban Greater Banjul area of WR. Kaplan-Meier survival function was used to estimate the proportion vaccinated by age and to assess timeliness to vaccination.FindingsBCG vaccine uptake was over 95% in all regions. Coverage of DPT1 ranged from 93.2% in BHDSS to 99.8% in the WR. Coverage decreased with increasing number of DPT doses; DPT3 coverage ranged from 81.7% in BHDSS to 99.0% in WR. Measles vaccination coverage ranged from 83.3% in BHDSS to 97.0% in WR. DPT4 booster coverage was low and ranged from 43.9% in the WR to 82.8% in KWDSS. Across all regions, delaying on previous vaccinations increased the likelihood of being delayed for the subsequent vaccination.ConclusionsThe Gambia health system achieves high vaccine coverage in the first year of life. However, there continues to be a delay to vaccination which may impact on the introduction of new vaccines. Examples of effectively functioning EPI programmes such as The Gambia one may well be important models for other low income countries struggling to achieve high routine vaccination coverage.

Invasive bacterial infections in Gambians with sickle cell anemia in an era of widespread pneumococcal and hemophilus influenzae type b vaccination

“…[14–16] Therefore, it is highly likely that the prevalence of S pneumoniae and Hib infections is lower than other countries. A study conducted at MRCG before introduction of the PCV (2003–2005) found that S pneumoniae accounted for 45.2% of community acquired bacteremia in children, followed by S aureus (18.3%), E coli (9.7%), and NTS (8.6%).…”

“…[13] The Gambia is relatively unique in that Hib and pneumococcal conjugate vaccines are well established as part of the Expanded Program on Immunization. [14] The 7-valent pneumococcal conjugate vaccine (PCV7) was introduced in 2009, followed by the 13-valent vaccine (PCV13) in 2011 [15] and the estimated proportion of Gambian infants receiving all 3 pentavalent vaccines (containing Hib) and PCV 13 is 89.3%. [16] …”

Recall and decay of consent information among parents of infants participating in a randomized controlled clinical trial using an audio-visual tool in The Gambia

“…This is a critical requirement for participation in biomedical research and should include a demonstration of recall of the purpose of the trial, potential benefits and harm, and participants' obligations and responsibilities. 1 The informed consent process does not end at signing off the consent form, but continues throughout the trial, 2,3 and participants need to understand their rights including withdrawal at any time without the need to give a reason for doing so.…”

Evaluation of Knowledge and Psychomotor Skills of Lady Health Visitors about Immunization

“…7 According to CJ Morrel, health visitors in UK have been trained to provide psychologically informed intervention as well. 8 A research conducted in India showed that 23.34% of Lady Health Visitors showed "excellent knowledge", 52.32% of them had "good knowledge" and 23.34% had "average knowledge" on majority of the subjects taught to them. 9 A research paper stated that 78% had adequate knowledge to practice individually.…”