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Socio‐economic determinants and inequities in coverage and timeliness of early childhood immunisation in rural G hana
Author(s) -
Gram Lu,
Soremekun Seyi,
ten Asbroek Augustinus,
Manu Alexander,
O'Leary Maureen,
Hill Zelee,
Danso Samuel,
AmengaEtego Seeba,
OwusuAgyei Seth,
Kirkwood Betty R.
Publication year - 2014
Publication title -
tropical medicine and international health
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.056
H-Index - 114
eISSN - 1365-3156
pISSN - 1360-2276
DOI - 10.1111/tmi.12324
Subject(s) - medicine , measles , poliomyelitis , polio vaccine , diphtheria , hepatitis b vaccine , vaccination , environmental health , pediatrics , hepatitis b , rubella , tetanus , rural area , socioeconomic status , demography , population , immunology , hbsag , hepatitis b virus , virus , sociology , pathology
Objectives To assess the extent of socio‐economic inequity in coverage and timeliness of key childhood immunisations in G hana. Methods Secondary analysis of vaccination card data collected from babies born between J anuary 2008 and J anuary 2010 who were registered in the surveillance system supporting the O baapa V ita and N ewhints T rials 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 C ox regression. Results Overall coverage at 1 year of age was high (>95%) for B acillus C almette– G uérin ( 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 < 0.001), 21% in the wealthiest quintile and 41% in the poorest quintile ( P < 0.001), and 9% in the most educated group and 39% in the least educated group ( P < 0.001). However, 1‐year coverage of the same dose remained above 90% for all levels of all socio‐economic indicators. 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.