Determinants of Vaccination Status in Rural Guinea-Bissau. Linda Hornshøj

Transcription

1 Determinants of Vaccination Status in Rural Guinea-Bissau Linda Hornshøj

2 Background In1974 World Health organization (WHO) launched the Expanded Program on Immunization (EPI) to provide routine vaccinations to all children against 6 major diseases: tuberculosis, polio, diphtheria, tetanus, pertussis and measles. At the time less than 5% of children worldwide were vaccinated against these diseases, in % in Africa, 90% worldwide. Around 23 million children are still not being reached. It is estimated that 1.7 million children under the age of 5 still die every year from vaccine preventable diseases.

3 Background The WHO/Unicef goal was for all countries to reach 90% national coverage by Vaccination coverage estimates from the WHO only include coverage at one year of age without considering vaccine sequence or age of vaccination. Studies have shown that vaccinations out-of-sequence may effect child morbidity and mortality.

4 Expanded Program on Immunization (EPI) vaccines in Guinea-Bissau: BCG 3 OPV (1-3) MV OPV0 3 DTP (1-3) weeks 9 months BCG, bacillus Calmette-Guérin vaccine, OPV, Oral polio vaccine, DTP, diphtheria+tetanus+pertussis vaccine, MV, measles vaccine. (In 2008 Penta, (DTP+haemophilus influenzae type B+hepatitis B) and YF, yellow fever vaccine were introduced.)

5 Aim Part One - Assess EPI vaccination coverage - Assess frequency of out-of-sequence vaccination Part Two - Assess determinants of vaccination

6 Setting The Bandim Health Project s (BHP) rural Health and Demographic Surveillance System (HDSS) covers all teen regions of Guinea-Bissau. Two mobile teams visit 258 villages biannually. Senegal São Domingos Cacheu Biombo Oio Bafata Gabu GUINEA-BISSAU Bolama Quinara Bijagós Tombali Guinea

7 Part One: Inclusion One year old children born Two year old children born visited at the age of months 6873 visited at the age of months 7338 (71%) children included 6873 (66%) children included

8 Part One: Vaccination coverage Age group n Fully vaccinated excl. OPV0 Completely unvaccinated One year old children (48%) 508 (7%) Two year old children (63%) 210 (5%)

9 Part One: Vaccine coverage One year old children vs. Two year old children % BCG OPV1 OPV2 OPV3 DTP1 DTP2 DTP3 MV By 1 year of age By 2 years of age

10 Part One: Out-of-Sequence Vaccinations DTP with BCG Among all one year old children who received BCG 48% Among all two year old children who received BCG 51% DTP with or after MV Among all one year old children who received MV 27% Among all two year old children who received MV 36%

11 Part One: Conclusions In the rural regions less then half of the children were fully vaccinated at one year of age. Only determining vaccination coverage at one year of age underestimates the vaccination coverage significantly. Many children received vaccinations out-of-sequence.

12 Part Two: Determinants of Vaccination? Function of vaccination practices Experiences with vaccination SES of the mothers/families Accessibility

13 Part Two: How do we assess the determinants? Function of vaccination practices Interviews with mothers and health workers Experiences with vaccination More extensive interviews with selected mothers SES of the mothers/families HDSS data Accessibility Interviews with mothers and health workers GPS measurements of distances to vaccination facilities

14 Conducted in Part Two: Interviews One in each village with a randomly selected mother/mothers (n255). One at the corresponding vaccination facility with the person in charge of vaccination (n258). One in each household with a randomly selected mother of a child aged months at our visit (n1242).

15 Access Part Two: Village Interviews Vaccination facility in the village Vaccination facility outside the village - 60% of the villages - 72% had fixed intervals - 33% of villages - 92% had fixed intervals

16 80 70 Part Two: Village Interviews Where did the mothers take their children? % Health centre Health outpost Temorary post Hospital Other Facility in the village Facility outside the village If the mothers used both facilities in the village and outside it, 66% preferred the one outside the village.

17 Part Two: Village Interviews How long did it take to have a child vaccinated? % < 2h < half a day half a day- a day > a day

18 Part Two: Vaccination Facility Interviews Where did they vaccinated the children? % At facility and outreach Only at facility Only outreach

19 Vaccination Facility interviews Storage of vaccines (Hospitals & Health Centres) 53% had all vaccines in stock 83% had a refrigerator 37% had more than once during the past year been unable to charge the refrigerator Number of children to open a vial BCG 20 dose vial: 63% > 10 MV/YF 10 dose vial: 86% > 5

20 Do you vaccinate children with a fever? 64 % yes 28 % no Do you vaccinate underweight children? 72% yes 21% no Most important vaccine? 30% BCG 4% OPV 21% Penta 10% MV Vaccination Facility Interviews

21 Vaccination Interviews What vaccines did the mothers know? % BCG OPV DTP/PENTA MV

22 Vaccination Interviews Would you take your child to be vaccinated if it had a fever? 46% yes 53% no Would you take your child to be vaccinated if it was underweight? 59% yes 39% no Have you ever taken your child to be vaccinated in vain? 52% yes 47% no Cost of vaccinations 73% paid 500 cfa or more for the vaccination card 11% had paid for vaccinations

23 Part Two: Vaccination Interviews Vaccination coverage among interviewed children % Oio Biombo Gabu Cacheu Bafata Quinara Tombali Bijagós Bolama São Domingos All Coverage <12 months Coverage >12 months Had tried in vain Paid 500 cfa or more

24 Part Two: Determinants of Vaccination Coverage Vaccination card cost of >500 cfa IRR = 1.18 ( ) coverage >12 months of age IRR = 1.15 ( ) coverage <12 months of age Had taken the child in vain to vaccination IRR = 1.04 ( ) coverage >12 months of age IRR = 0.96 ( ) coverage <12 months of age Less than 2h time expenditure IRR = 1.03 ( ) coverage >12 months of age IRR = 1.04 ( ) coverage <12 months of age

25 Part Two: Determinants of Vaccination Coverage Not having fixed time intervals for services in the village IRR = 0.82 ( ) coverage >12 months of age IRR = 0.68 ( ) coverage <12 months of age Not having fixed time intervals for services outside the village IRR = 0.47 ( ) coverage >12 months of age IRR = 0.34 ( ) coverage <12 months of age

26 Still to come Getting data from rough estimates to real estimates The GPS measurements in ArcGis SES data The semi-qualitative data from the interviews