Background Child 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. Methods In 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. Results About 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). Conclusions Strategies 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.
References
[1]
United Nations Inter-agency Group for Child Mortality Estimation (2011) Levels and trends in child mortality. Available: http://www.unicef.org/media/files/Child_？Mortality_Report_2011_Final.pdf. Accessed 2011 Nov 23.
[2]
Levine OS, Bloom DE, Cherian T, de Quadros C, Sow S, et al. (2011) The future of immunisation policy, implementation, and financing. Lancet 378: 439–448.
[3]
WHO, UNICEF, World Bank (2009) State of the world's vaccines and immunization. 3rd edition. Geneva: World Health Organization. ISBN 978 92 4 156386 4. Accessed 2010 Feb 2.
[4]
Bloom DE (2011) The value of vaccination. Adv Exp Med Biol 697: 1–8.
[5]
Bloom DE, Mahal A, O'Flaherty B (2005) Economic perspectives on injecting drug use. Adv Health Econ Health Serv Res 16: 371–395.
[6]
Akmatov MK, Kretzschmar M, Kramer A, Mikolajczyk RT (2008) Timeliness of vaccination and its effects on fraction of vaccinated population. Vaccine 26: 3805–3811.
[7]
Fadnes LT, Nankabirwa V, Sommerfelt H, Tylleskar T, Tumwine JK, et al. (2011) Is vaccination coverage a good indicator of age-appropriate vaccination? A prospective study from Uganda. Vaccine 29: 3564–3570.
[8]
Luman ET, Barker LE, Shaw KM, McCauley MM, Buehler JW, et al. (2005) Timeliness of childhood vaccinations in the United States: days undervaccinated and number of vaccines delayed. JAMA 293: 1204–1211.
[9]
HMIS (2007–2008) Health Management Information Systems. Kampala District Profile Annual Report. Office of the District Director of Health services. Kampala.
[10]
Mbabazi WB, Nanyunja M, Makumbi I, Braka F, Baliraine FN, et al. (2009) Achieving measles control: lessons from the 2002-06 measles control strategy for Uganda. Health Policy Plan 24: 261–269.
[11]
Moxon ER, Siegrist CA (2011) The next decade of vaccines: societal and scientific challenges. Lancet 378: 348–359.
[12]
UDHS (2006) Uganda Demographic and Health Survey 2006. Uganda Bureau of Statistics (UBOS) and Macro International Inc. Calverton, Maryland, USA: UBOS and Macro International Inc.
[13]
Bennett S, Woods T, Liyanage WM (1991) A simplified general method for cluster-sample surveys of health in developing countries. World Health Stat Q 44: 98–106.
[14]
Uganda government (2008) Uganda Bureau of Statistics-Sub-national projections report central region: 2008–2012. pp. 5–7. Uganda Bureau of Statistics. Kampala.
[15]
WHO (1995) Physical status: The use and interpretation of anthropometry. Geneva.
[16]
Garza C, de Onis M (2004) Rationale for developing a new international growth reference. Food Nutr Bull 25: S5–14.
[17]
Filmer D, Pritchett LH (2001) Estimating wealth effects without expenditure data–or tears: an application to educational enrollments in states of India. Demography 38: 115–132.
[18]
Clark A, Sanderson C (2009) Timing of children's vaccinations in 45 low-income and middle-income countries: an analysis of survey data. Lancet 373: 1543–1549.
[19]
Fadnes LT, Jackson D, Engebretsen IM, Zembe W, Sanders D, et al. (2011) Vaccination coverage and timeliness in three South African areas: a prospective study. BMC Public Health 11: 404.
[20]
Luman ET, Chu SY (2009) When and why children fall behind with vaccinations: missed visits and missed opportunities at milestone ages. Am J Prev Med 36: 105–111.
[21]
Sadoh AE, Eregie CO (2009) Timeliness and completion rate of immunization among Nigerian children attending a clinic-based immunization service. J Health Popul Nutr 27: 391–395.
[22]
Mupere E, Karamagi C, Zirembuzi G, Grabowsky M, de Swart RL, et al. (2006) Measles vaccination effectiveness among children under 5 years of age in Kampala, Uganda. Vaccine 24: 4111–4115.
[23]
Mutua MK, Kimani-Murage E, Ettarh RR (2011) Childhood vaccination in informal urban settlements in Nairobi, Kenya: who gets vaccinated? BMC Public Health 11: 6.
[24]
Nankabirwa V, Tylleskar T, Tumwine JK, Sommerfelt H (2010) Maternal education is associated with vaccination status of infants less than 6 months in Eastern Uganda: a cohort study. BMC Pediatr 10: 92.
[25]
Takum T, Padung D, Joshua V, Manickam P, Murhekar MV (2011) Programmatic and beneficiary-related factors for low vaccination coverage in Papum Pare district, Arunachal Pradesh, India. J Trop Pediatr 57: 251–257.
[26]
Babirye JN, Rutebemberwa E, Kiguli J, Wamani H, Nuwaha F, et al. (2011) More support for mothers: a qualitative study on factors affecting immunisation behaviour in Kampala, Uganda. BMC Public Health 11: 723.
[27]
Ndiritu M, Cowgill KD, Ismail A, Chiphatsi S, Kamau T, et al. (2006) Immunization coverage and risk factors for failure to immunize within the Expanded Programme on Immunization in Kenya after introduction of new Haemophilus influenzae type b and hepatitis b virus antigens. BMC Public Health 6: 132.
[28]
Rahman M, Obaida-Nasrin S (2010) Factors affecting acceptance of complete immunization coverage of children under five years in rural Bangladesh. Salud Publica Mex 52: 134–140.
[29]
Burgess DC, Burgess MA, Leask J (2006) The MMR vaccination and autism controversy in United Kingdom 1998–2005: inevitable community outrage or a failure of risk communication? Vaccine 24: 3921–3928.
