The Expanded Program on Immunisation has made it possible to prevent more than 3 million deaths in children under 5 years. The objectives of this study were to estimate the vaccination coverage of children from 0 to 59 months and identify factors associated with incomplete vaccination coverage.
A cross-sectional study was carried out in a dispensary in Conakry, Guinea between January and February 2020. Sociodemographic and vaccination information was collected from mothers of 380 randomly select children aged 0 to 59 months. Information on immunisation coverage was gathered from records vaccination cards and maternal reports. Logistic regression was used to identify factors independently associated with incomplete immunisation coverage.
Most (66.5%) children aged < 12 months were up-to-date with their vaccinations. Factors associated with incomplete vaccination in this age group included: unavailability of vaccination cards (adjusted odds ratio [aOR] 7.58; 95% confidence interval [CI]: 2.56–22.44) and lack of prenatal consultation attendance (aOR 2.93; 95% CI: 1.15–7.48). In contrast only 19.8% (95% CI: 13.9–26.7) of children aged 12–59 months were fully immunised. Factors associated with incomplete vaccination coverage in children aged 12–59 months included high birth order (aOR 10.23; 95% CI: 2.06–19.43), and lack of prenatal consultation attendance (aOR 5.34; 95% CI: 1.48–19.23).
Child immunisation coverage is low in Guinea. These results highlight the need to develop strategies based on an integrated approach to overcome obstacles to childhood immunisation in Guinea.
Vaccination is recognised as one of the most effective measures to prevent mortality, morbidity and complications from many infectious diseases in children. It is estimated that around 3 million deaths are prevented each year worldwide through vaccination, and it allows 750 000 children each year avoid suffering from serious physical, mental or neurological disabilities.
Despite considerable progress in achieving high immunisation coverage, one in five children in Africa does not receive these essential vaccines.
Few countries in Africa have achieved this goal. For instance, only 27 countries have succeeded in introducing the pneumococcal conjugate vaccines (PCV), and the Rotavirus vaccine has been induced by 11 countries.
In Guinea, the EPI recommends that infants be vaccinated with the following vaccines: one dose of Bacillus Calmette-Guerin (BCG) vaccine at birth; three doses of pentavalent vaccine at 6, 10 and 14 weeks; at least three doses of oral polio vaccine (OPV) administered at birth 6, 10 and 14 weeks of age and a dose of measles and yellow fever vaccine at 9 months of age
The main EPI donors in Guinea are the Global Alliance for Vaccines and Immunisation (GAVI) and other international partners including WHO and United Nations of International Children’s Emergency Fund (UNICEF).
From 2012 to 2018, vaccination coverage fell by 35% (from 37% to 24%) according to DHS data with an increase (from 11% to 22%) in the proportion of children who had not received any dose of vaccine since birth.
Determinants of immunisation coverage in children have been little studied in Guinea. To our knowledge, the available evidence was published in 1990 and 1991, where the socio-demographic factors of the mother were associated with a decline in vaccination coverage of children.
In this study, we aimed to estimate the vaccination coverage of children aged 0 to 59 months attending a health centre and identify factors that were associated with incomplete vaccination coverage.
The study was carried out at the Saint Gabriel dispensary of Matoto in the Guinea’s capital Conakry. The dispensary was established in 1987 and provides maternity services or prenatal consultation, vaccination services for children and adults, emergency, nutritional supportive care, laboratory and pharmaceutically services to an estimated population of 48 651 inhabitants, amongst which approximately 13 625 (2.8%) children were under 1 year of age.
In this study, we included all children aged 0 to 59 months who attended primary curative consultations or at the EPI service inform 13 January to 15 February 2020 at the Saint Gabriel dispensary and whose parents gave an informed consent to participate. The children were included according to a systematic random sampling strategy.
Children aged 0 to 59 months who were admitted to emergency rooms, hospitalised or awaiting referral, as well as those accompanying their parents for reasons other than a health visit, were not accounted for in this survey.
The data were collected by a trained interviewer using a pre-tested standardised questionnaire.
Two sources of information include the vaccination card shown by mothers to interviewers and the mother’s recall of vaccination. If the health card was available, information regarding the date of administration was directly collected from the vaccination card which normally records dates of all routine vaccinations. If no card was presented, the interviewer would ask the mother to recall all vaccination received by their child and when appropriate, the number of doses received without asking for the dates. We collected the socio-demographic characteristics of the child (age, sex, birth order, place of birth, reason for consultation (vaccine appointment or disease) and those of the mother (age, profession, marital status, number of prenatal consultations).
Data were collected using Kobo collect software, exported to Excel for cleaning and analysed using Stata version 14. In the descriptive analysis, we calculated frequencies and constructed cross-tabulations for qualitative variables; medians of quantitative variables, as appropriate were computed and reported.
Factors associated with incomplete vaccination coverage were analysed using univariate and multivariate logistic regression. Variables with
The study was approved by the research committee of the public health department of Gamal Abdel Nasser University in Conakry. This article followed all ethical standards for research without direct contact with human or animal subjects.
During the study period, data from 380 children aged 0 to 59 months including 218 children aged 0 to 11 months (57.4%) and 162 children aged 12 to 59 months old were collected. In our study, 248 (65%) children had a health record. The median age of children was 9 months (interquartile range [IQR]: 3 to 20 months). Information on vaccinations status was collected the vaccination records (65.3%) and maternal report (34.7%). The median age of the mothers was 26 years (IQR: 23 to 30 years). The majority (353/380; 92.9%) of the mothers were married and 46.1% had more four prenatal consultation. Most of the mothers (83.4%) were not aware of the next vaccination schedule and the EPI target diseases (
Characteristics of study participants and their mothers.
Variables | ( |
% |
---|---|---|
0 to 11 months | 218 | 57.4 |
12 to 59 months | 162 | 42.6 |
Male | 200 | 52.6 |
Female | 180 | 47.4 |
Health structure | 342 | 90.0 |
Home | 38 | 10.0 |
First | 89 | 23.4 |
Second | 115 | 30.9 |
Third and more | 176 | 46.3 |
Matoto | 234 | 61.6 |
Other towns in Conakry | 80 | 21.1 |
(Matam, Ratoma, Dixinn) Coyah or Dubréka | 66 | 17.4 |
Vaccination appointment | 130 | 34.2 |
Disease | 250 | 65.8 |
Sick child | 172 | 45.3 |
Child not sick | 280 | 54.7 |
Under 25 | 205 | 53.9 |
25 years and over | 175 | 46.1 |
Married | 353 | 92.9 |
Divorcee | 3 | 0.8 |
Single | 22 | 5.8 |
Widow | 2 | 0.5 |
Muslim | 343 | 90.3 |
Christian | 37 | 9.7 |
With source of income | 192 | 50.6 |
Without source of income | 188 | 49.4 |
One to two prenatal consultation | 138 | 36.3 |
Three prenatal consultation | 67 | 17.6 |
Four or more prenatal consultation | 175 | 46.1 |
Yes | 63 | 16.6 |
No | 317 | 83.4 |
Yes | 211 | 55.5 |
No | 169 | 44.5 |
One-hundred forty-five (66.5%; 95% confidence interval [CI]: 59.8–72.7) of 218 infants aged 0 to 11 months were up-to-date with their immunisations. Two-hundred ten (96%; 95% CI: 92.9–98.4) infants of 218 or 96% 95% CI (92.9–98.4) had received the first doses of BCG and OPV vaccines at birth. Six (2.8%) of the children in this age group had not received a vaccine (
Attrition in vaccination coverage over time amongst study participants.
In the 162 children aged 12 to 59 months, vaccination coverage was complete in 19.8% 95% CI (13.9–26.7) and two (1.2%) of them had not received any vaccine. Most 97.5%; 95% CI (93.8–99.3) of these children receive birth doses of BCG and OPV vaccines, 50% (95% CI: 42.0–57.9) received the first dose of pentavalent vaccine and OPV1 and 22% (95% CI: 16.1–29.4) received the third dose of pentavalent vaccine and OPV3.
Factors affecting vaccination coverage in univariate analyses are shown in
Characteristics of study participants stratified by vaccination status.
Variables | Immunisation schedule status |
||||
---|---|---|---|---|---|
Up to date |
Not up to date |
||||
% | % | ||||
< 0.001 | |||||
Yes | 150 | 85.7 | 98 | 47.8 | |
No | 25 | 14.3 | 107 | 52.2 | |
0.010 | |||||
Male | 104 | 59.4 | 96 | 46.8 | |
Female | 71 | 40.6 | 109 | 53.2 | |
0.050 | |||||
Health structure | 163 | 93.1 | 179 | 87.3 | |
Home | 12 | 6.9 | 26 | 12.7 | |
< 0.001 | |||||
First | 61 | 34.9 | 28 | 13.7 | |
Second | 72 | 41.1 | 43 | 13.7 | |
Third or higher | 42 | 24.0 | 134 | 65.4 | |
0.030 | |||||
Matoto | 120 | 68.6 | 114 | 55.6 | |
Other towns | 30 | 17.1 | 50 | 24.4 | |
Coyah/Dubréka | 25 | 14.3 | 41 | 20.0 | |
< 0.001 | |||||
Sick child | 26 | 14.9 | 146 | 71.2 | |
Child not sick | 149 | 85.1 | 59 | 28.8 | |
< 0.001 | |||||
Vaccination appointment | 113 5 | 65.6 | 17 | 8.3 | |
Disease | 62 | 35.4 | 188 | 91.7 | |
0.730 | |||||
Under 25 | 85 | 48.6 | 96 | 46.8 | |
Over 25 years | 90 | 51.4 | 109 | 53.2 | |
0.230 | |||||
Married | 167 | 95.4 | 186 | 90.7 | |
Divorcee | 1 | 0.6 | 2 | 1.0 | |
Single | 7 | 4.0 | 15 | 7.3 | |
Widow | 0 | - | 2 | 1.0 | |
0.870 | |||||
Muslim | 153 | 87.4 | 190 | 92.7 | |
Christian | 22 | 12.6 | 15 | 7.3 | |
0.070 | |||||
Mother’s activity | 105 | 60.0 | 141 | 68.8 | |
With source of income | 70 | 40.0 | 64 | 31.2 | |
< 0.001 | |||||
Four or more prenatal consultation | 114 | 65.1 | 61 | 29.8 | |
Three prenatal consultation | 35 | 20.0 | 32 | 15.6 | |
One to two prenatal consultation | 26 | 14.9 | 112 | 54.6 | |
< 0.001 | |||||
Yes | 58 | 33.1 | 5 | 2.4 | |
No | 117 | 66.9 | 200 | 97.6 |
Two factors were associated with incomplete immunisation coverage in children aged 0 to 11 months (
Factors associated with incomplete vaccination coverage in children aged 0 to 11 months, Guinea, January–February 2020.
Variables | Univariate regression |
Multivariate regression |
||||||
---|---|---|---|---|---|---|---|---|
Odds ratio | 95% | Confidence interval | Odds ratio | 95% | Confidence interval | |||
Male | 1 | - | - | - | 1 | - | - | - |
Female | - | 1.30 | 0.74–2.30 | 0.350 | - | 1.27 | 0.60–2.69 | 0.510 |
Health structure | 1 | - | - | - | 1 | - | - | - |
Home | - | 1.17 | 0.44–3.12 | 0.740 | - | 0.90 | 0.22–3.61 | 0.890 |
First | 1 | - | - | - | 1 | - | - | - |
Second | - | 0.90 | 0.43–1.87 | 0.780 | - | 1.23 | 0.48–3.19 | 0.650 |
Third and more | - | 2.55 | 1.25–5. 21 | 0.010 | - | 1.58 | 0.44–5.67 | 0.480 |
Yes | 1 | - | - | - | 1 | - | - | - |
No | - | 10.90 | 4.44–26.76 | < 0.001 | - | 7.58 | 2.56–22.44 | < 0.001 |
Sick child | 1 | - | - | - | 1 | - | - | - |
Child not sick | - | 0.10 | 0.05–0.20 | < 0.001 | - | 0.12 | 0.05–0.29 | < 0.001 |
Under 25 | 1 | - | - | - | 1 | - | - | - |
25 years and over | - | 0.90 | 0.51–1.60 | 0.740 | - | 0.45 | 0.16–1.22 | 0.110 |
With source of income | 1 | - | - | - | 1 | - | - | - |
Without source of income | - | 1.97 | 1.11–3.49 | 0.020 | - | 1.15 | 0.51–2.55 | 0.720 |
Four prenatal consultation or more | 1 | - | - | - | 1 | - | - | - |
Three prenatal consultation | - | 1.71 | 0.78–3.74 | 0.170 | - | 1.27 | 0.50–3.21 | 0.600 |
One to two prenatal consultation | - | 6.50 | 3.23–13.09 | < 0.001 | - | 2.93 | 1.15–7.48 | 0.020 |
Factors associated with incomplete vaccination coverage in children aged 12 to 59 months in Matoto, Guinea January to February 2020.
Variables | Univariate regression |
Multivariate regression |
||||||
---|---|---|---|---|---|---|---|---|
Odds ratio | 95% | Confidence interval | Odds ratio | 95% | Confidence interval | |||
Male | 1 | - | - | - | 1 | - | - | - |
Female | - | 1.45 | 0.66–3.15 | 0.340 | - | 2.38 | 0.80–7.03 | 0.110 |
Health structure | 1 | - | - | - | 1 | - | - | - |
Home | - | 4.98 | 0.64–38.80 | 0.120 | - | 2.47 | 0.19–22.11 | 0.480 |
First | 1 | - | - | - | 1 | - | - | - |
Second | - | 2.13 | 0.69–6.62 | 0.180 | - | 1.78 | 0.37–8.59 | 0.470 |
Third and more | - | 13.58 | 4.44–20.37 | < 0.001 | - | 10.29 | 2.06–19.43 | < 0.001 |
Yes | 1 | - | - | - | 1 | - | - | - |
No | - | 1.28 | 0.58–2.81 | 0.520 | - | 1.23 | 0.41–3.68 | 0.700 |
Yes | 1 | - | - | - | 1 | - | - | - |
No | - | 0.58 | 0.02–0.16 | < 0.001 | - | 0.17 | 0.05–0.54 | 0.003 |
Under 25 | 1 | - | - | - | 1 | - | - | - |
25 years and over | - | 0.75 | 0.34–1.64 | 0.470 | - | 0.253 | 0.17–2.29 | 0.480 |
Yes | 1 | - | - | - | 1 | - | - | - |
No | - | 3.48 | 1.49–8.11 | 0.004 | - | 1.78 | 0.33–3.89 | < 0.310 |
Four or more prenatal consultation | 1 | - | - | - | 1 | - | - | - |
Three prenatal consultation | - | 6.15 | 1.31–28.83 | 0.021 | - | 3.13 | 0.49–19.66 | 0.220 |
One to two prenatal consultation | - | 12.65 | 4.11–38.91 | < 0.001 | - | 5.34 | 1.48–19.23 | 0.010 |
Factors associated with incomplete immunisation coverage in children 12 to 59 months of age were third birth order aOR = 10.29; (95% CI: 2.06–19.43), lack of prenatal consultation attendance (aOR = 5.34; 95% CI: 1.48–19.23). If the child was well in the preceding month, vaccination coverage was, on an average, 86% (95% CI: 51–96) better (
Of the 380 children aged 0 to 59 months included in this study, 65.3% had a vaccination record, whereas 34.7% had their vaccination status determined through maternal report of those with available vaccination records and 80% 5304/380) were less than 1 year old. Absence of a vaccination record was strongly associated with incomplete vaccination in this study. This factor has been found to be a predictor of non-compliance with the vaccination schedule in various studies. The results of a study carried out in Senegal
Another study performed in Cameroon yielded the same results.
In our study, male children had higher immunisation coverage than female children (
A high birth order was associated with poor vaccination coverage in our study, in which 46.3% of the children were the third child or greater. This may reflect family or maternal focus on immunising their first- or second-born children but failure to ensure adequate immunisation coverage in subsequent children, possibly as a result of complacency, or fall-out because of fatigue in attending routine clinic appointments. Birth order has been associated with childhood immunisation incompleteness in other studies.
Childhood immunisation coverage of mothers over 25 was better than children of younger mothers. Mohamed et al. in Ethiopia
Prenatal consultations are an ideal time not only to prepare for childbirth but also to create the conditions for better health of the future child. The WHO recommends that women have at least four or more prenatal consultations during pregnancy. In our study, less than half (46.1%) of mothers attend four or more prenatal consultation appointments. prenatal has been described in several studies.
In this study, 145 (66.5%) infants aged 0 to 11 months had received all vaccines according to the vaccination schedule at the time of the survey. This coverage is lower than that found in South Africa (73%),
Lack of immunisation in infancy is concerning, as infants, who have relatively reduced immunity, are at risk of diseases targeted by immunisation programs.
Delays in accessing vaccination services may be because of concerns about post-vaccination side effects in some children, neglect or forgetting the date of the EPI appointments.
Only, 19.8% (32/162) of children aged 12 to 59 months were fully immunised in our study.
This result corroborates the findings of the Guinea Demographic and Health Survey 2018 (DHS) in which 24% of children were completely vaccinated,
Coverage for children aged 12 to 23 months between the two previous DHS in Guinea and administrative coverage is still higher than the results of one of surveys because of the lack of updated data on the target population and calculation of immunisation coverage based on the number of vaccine doses used.
Immunisation coverage was inversely proportional to the child’s age in our study. Most children (98%) received a birth dose of BCG and OPV, 50% received the first dose of pentavalent vaccine and OPV1 and 22% received the third dose of pentavalent vaccine and OPV3. High rates of omission of the last doses of pentavalent vaccine and doses of measles and yellow fever vaccines were concerning.
Higher rates of immunisation coverage (BCG-OVP0 99%, first dose of pentavalent vaccine-OVP1 98%, third dose of pentavalent vaccine-OVP3 95%) were noted by Saker et al.
We assessed maternal knowledge of EPI and vaccine preventable diseases in large proportion (83%) and did not know which diseases children should be immunised against. This finding is lower than that of Etana and Deressa
Immunisation coverage of children under five remains low in Guinea, and coverage decreases with age whith. children more likely to receive vaccines at birth than 9 months of age. Mothers are not made aware of the vaccination schedule and appear to receive little information on adverse events following immunisation. Factors that were significantly associated with low immunisation coverage in our study were included. Incomplete vaccination record, low attendance of prenatal care by mother, increasing, birth order, missing child health records and lack of income. It is, therefore, important that hospital health workers educate mothers about the childhood immunisation program and potential side effects of vaccines.
Moreover, the government should aim at increasing the use of health services during pregnancy and postpartum.
The authors would like to thank all the health personnel of the Saint Gabriel Paediatric Hospital for accepting and facilitating our work.
The authors declare that they have no financial or personal relationships that may have inappropriately influenced them in writing this article.
A.T., I.C., A.C., M.S., M.S.S. and A.K.K. all contributed equally in this work, read and approved the final article.
The authors received no financial support for the research, authorship, and/or publication of this article.
The data that support the findings of this study are available from the corresponding author, A.T., upon reasonable request.
The views and opinions expressed in this article are those of the authors and do not necessarily reflect the official policy or position of any affiliated agency of the authors.
Area under ROC curve, logistic regression for factors associated with incomplete vaccination coverage in children aged 0 to 11 months.
Area under ROC curve logistic regression for factors associated with incomplete vaccination coverage in children aged 0 to 12 months.