Abstract
BackgroundChild survival is dependent on several factors including high vaccination coverage. Timely receipt of vaccines ensures optimal immune response to the vaccines. Yet timeliness is not usually emphasized in estimating population immunity. In addition to examining timeliness of the recommended Expanded Programme for Immunisation (EPI) vaccines, this paper identifies predictors of untimely vaccination among children aged 10 to 23 months in Kampala.MethodsIn addition to the household survey interview questions, additional data sources for variables included data collection of child's weight and length. Vaccination dates were obtained from child health cards. Timeliness of vaccinations were assessed with Kaplan–Meier time-to-event analysis for each vaccine based on the following time ranges (lowest–highest target age): BCG (birth–8 weeks), polio 0 (birth–4 weeks), three polio and three pentavalent vaccines (4 weeks–2 months; 8 weeks–4 months; 12 weeks–6 months) and measles vaccine (38 weeks–12 months). Cox regression analysis was used to identify factors associated with vaccination timeliness.ResultsAbout half of 821 children received all vaccines within the recommended time ranges (45.6%; 95% CI 39.8–51.2). Timely receipt of vaccinations was lowest for measles (67.5%; 95% CI 60.5–73.8) and highest for BCG vaccine (92.7%: 95% CI 88.1–95.6). For measles, 10.7% (95% CI 6.8–16.4) of the vaccinations were administered earlier than the recommended time. Vaccinations that were not received within the recommended age ranges were associated with increasing number of children per woman (adjusted hazard ratio (AHR); 1.84, 95% CI 1.29–2.64), non-delivery at health facilities (AHR 1.58, 95% CI 1.02–2.46), being unmarried (AHR 1.49, 95% CI 1.15–1.94) or being in the lowest wealth quintile (AHR 1.38, 95% CI 1.11–1.72).ConclusionsStrategies to improve vaccination practices among the poorest, single, multiparous women and among mothers who do not deliver at health facilities are necessary to improve timeliness of vaccinations.
Highlights
Vaccine preventable diseases account for about a quarter of the 8 million deaths occurring annually among children under five years of age especially in low-income countries such as Uganda [1,2]
Some studies show that high vaccination coverage rates for individual vaccines do not necessarily imply timely vaccination or population immunity [6,7,8]
Some sub-Saharan African countries report less than optimal vaccination coverage rates and some including the district health office in Kampala report coverage rates above 100% [9], and still record epidemics for diseases such as measles [10]
Summary
Vaccine preventable diseases account for about a quarter of the 8 million deaths occurring annually among children under five years of age especially in low-income countries such as Uganda [1,2]. As more ambitious goals for immunisation and disease control are set in response to the declaration of the decade of vaccines such as introduction of established and new vaccines mainly in developing countries, pressures to meet short-term goals need to be balanced with substantial efforts to establish and sustain strong health systems for vaccine delivery, surveillance, and monitoring [2]. This is important in Uganda where a child receives nine vaccine doses for complete vaccination and there are plans to introduce other vaccines such as the pneumococcal vaccine. In addition to examining timeliness of the recommended Expanded Programme for Immunisation (EPI) vaccines, this paper identifies predictors of untimely vaccination among children aged 10 to 23 months in Kampala
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