Complete Child Immunisation: A Cluster Analysis of Positive Deviant Regions in Ghana

Abstract

Background: The Global Vaccine Action Plan sets a target of 90% child immunisation coverage, a rare achievement in the Global South. Yet two of the poorest of Ghana’s 10 regions have accomplished this feat-what can policy-makers and public health authorities learn from these ‘positive deviant’ regions (PDRs), to inform immunisation strategies elsewhere in the South? Methods: Using cluster analysis and data from the 2008 Ghana DHS, seven regional-level factors were investigated that might account for differences in immunisation coverage: ethnicity/religion, socioeconomic status, maternal health literacy and decision latitude, use of maternal health facilities, participation in child vaccination campaigns, and availability of community health infrastructure. Rank orders of the 10 regions on these factors were examined for the degree to which the PDRs were similar to each other, and dissimilar to the other eight regions. Results: The PDRs were not similar to each other on any of the regional-level factors. Contrariwise, the PDRs clustered only at the highest stage of agglomeration in the analyses. Thus, the two PDRs do not closely share regional-level characteristics that might explain their PD status, with the study thus failing to differentiate the PDRs from the other regions. Conclusions: The heterogeneity exhibited by the PDRs is actually reason for optimism, suggesting that even the poorest regions in the South, with disparate characteristics and social situations, can achieve excellent child immunisation coverage. It may be that nation-wide ‘one-size-fits-all’ government campaigns to encourage child immunisation should be supplemented, or even replaced, by small area, targeted efforts fit-to-purpose and fit-tolocal- conditions.