Vaccination card availability and childhood immunization in Senegal

Valérie Seror,Mouhamadou Fall,Patrick Peretti-Watel,Samba Ndiaye,Elhadji Yaya Ly,Sébastien Cortaredona,Ibrahima Gaye

doi:10.1186/s12889-020-08792-5

Abstract

BackgroundThe World Health Organization recommends recording vaccination status according to maternal recall in countries where administrative reporting systems are insufficiently reliable, as maternal recall in developing countries has been shown to be quite reliable compared with data from vaccination cards. This study aimed to investigate childhood vaccination coverage and its determinants according to the mothers’ presentation of vaccination cards.MethodsThe data come from the 2017 Senegalese Demographic and Health Survey, a nationally representative household survey of women aged 15–49 years, with a questionnaire focusing on children’s health. This analysis was restricted to children aged 12–35 months (n = 4032) and it assessed vaccination coverage and associated sociodemographic factors with weighted multivariate logistic regressions. Stratified multivariate logistic regressions were also performed to investigate factors associated with routine childhood immunization uptake of the Bacillus Calmette-Guérin (BCG) vaccine, recommended for administration shortly after birth, as well as of the vaccines against yellow fever and measles (recommended at 9 months).ResultsComparison of vaccination coverage estimates according to the vaccination card or parental recall resulted in a 5–10% difference in estimated coverage for the BCG, pentavalent, measles, and yellow fever vaccines, but a huge difference for the polio vaccine (93.0% with the card, 32.0% without it). Presentation of the vaccination card was correlated with mothers’ attendance at health facilities (suggesting it serves as a concrete manifestation of a bond between mothers and the healthcare system) and their region of residence, but it was not correlated with usually strong predictors of childhood vaccination, such as maternal education level. Factors associated with vaccinations differed depending on whether they were administered shortly after birth or later on.ConclusionsMaternal recall was found to be quite reliable except for oral polio vaccination, which raises the possibility that complete immunization coverage rates could have been significantly underestimated due to potential confusion between injection and vaccination. Considering the ability to present vaccination cards as the materialization of a bond with the healthcare system, the decision path leading to vaccination among those who lack such a bond appears longer and more likely to be driven by supply-side effects.

Highlights

The World Health Organization recommends recording vaccination status according to maternal recall in countries where administrative reporting systems are insufficiently reliable, as maternal recall in developing countries has been shown to be quite reliable compared with data from vaccination cards
This study presents a secondary analysis of the 2017 Demographic and Health Survey (DHS), a nationally representative household survey conducted by the Senegalese National Agency of Statistics and Demography (ANSD), which collected data about childhood vaccination coverage and its determinants [15]
In developing countries, quantitative surveys conducted to estimate childhood vaccination coverage rely on maternal recall when mothers are unable to present their child’s vaccination card to interviewers

Summary

Introduction

The World Health Organization recommends recording vaccination status according to maternal recall in countries where administrative reporting systems are insufficiently reliable, as maternal recall in developing countries has been shown to be quite reliable compared with data from vaccination cards. Only a few studies rely exclusively on parental recall [3], and the lack of a written vaccination record is frequently considered an exclusion criterion for data analysis [4, 5] since parental recall of young children’s immunization histories has been found to be relatively poor [6,7,8]. The main source of inaccurate reporting may relate to poor initial encoding of the memory of the relevant events during the interaction between parents and health professionals: parents may not understand the information provided about the vaccines being administered, or they may be too distracted to absorb this information properly. The health professionals involved in the vaccination process may not take the time to clearly identify the shots administered during the visit [7]

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