Socio-economic determinants and inequities in coverage and timeliness of early childhood immunisation in rural Ghana.


Gram, L; Soremekun, S; ten Asbroek, A; Manu, A; O'Leary, M; Hill, Z; Danso, S; Amenga-Etego, S; Owusu-Agyei, S; Kirkwood, BR; (2014) Socio-economic determinants and inequities in coverage and timeliness of early childhood immunisation in rural Ghana. Tropical medicine & international health, 19 (7). pp. 802-11. ISSN 1360-2276 DOI: https://doi.org/10.1111/tmi.12324

Full text not available from this repository. (Request a copy)

Abstract

OBJECTIVES: To assess the extent of socio-economic inequity in coverage and timeliness of key childhood immunisations in Ghana.<br/> METHODS: Secondary analysis of vaccination card data collected from babies born between January 2008 and January 2010 who were registered in the surveillance system supporting the ObaapaVita and Newhints Trials was carried out. 20 251 babies had 6 weeks' follow-up, 16 652 had 26 weeks' follow-up, and 5568 had 1 year's follow-up. We performed a descriptive analysis of coverage and timeliness of vaccinations by indicators for urban/rural status, wealth and educational attainment. The association of coverage with socio-economic indicators was tested using a chi-square-test and the association with timeliness using Cox regression.<br/> RESULTS: Overall coverage at 1 year of age was high (&gt;95%) for Bacillus Calmette-Guérin (BCG), all three pentavalent diphtheria-pertussis-tetanus-haemophilus influenzae B-hepatitis B (DPTHH) doses and all polio doses except polio at birth (63%). Coverage against measles and yellow fever was 85%. Median delay for BCG was 1.7 weeks. For polio at birth, the median delay was 5 days; all other vaccine doses had median delays of 2-4 weeks. We found substantial health inequity across all socio-economic indicators for all vaccines in terms of timeliness, but not coverage at 1 year. For example, for the last DPTHH dose, the proportion of children delayed more than 8 weeks were 27% for urban children and 31% for rural children (P &lt; 0.001), 21% in the wealthiest quintile and 41% in the poorest quintile (P &lt; 0.001), and 9% in the most educated group and 39% in the least educated group (P &lt; 0.001). However, 1-year coverage of the same dose remained above 90% for all levels of all socio-economic indicators.<br/> CONCLUSIONS: Ghana has substantial health inequity across urban/rural, socio-economic and educational divides. While overall coverage was high, most vaccines suffered from poor timeliness. We suggest that countries achieving high coverage should include timeliness indicators in their surveillance systems.<br/>

Item Type: Article
Faculty and Department: Faculty of Epidemiology and Population Health > Dept of Population Health (2012- ) > Dept of Nutrition and Public Health Interventions Research (2003-2012)
Faculty of Epidemiology and Population Health > Dept of Population Health (2012- )
Faculty of Infectious and Tropical Diseases > Dept of Disease Control
Faculty of Epidemiology and Population Health > Dept of Infectious Disease Epidemiology
Research Centre: Centre for Maternal, Reproductive and Child Health (MARCH)
Maternal and Child Health Intervention Research Group
Leishmaniasis Group
Neglected Tropical Diseases Network
PubMed ID: 24766425
Web of Science ID: 337796400006
URI: http://researchonline.lshtm.ac.uk/id/eprint/1692938

Statistics


Download activity - last 12 months
Downloads since deposit
0Downloads
315Hits
Accesses by country - last 12 months
Accesses by referrer - last 12 months
Impact and interest
Additional statistics for this record are available via IRStats2

Actions (login required)

Edit Item Edit Item