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Publication Details
AFRICAN RESEARCH NEXUS
SHINING A SPOTLIGHT ON AFRICAN RESEARCH
Tracking coverage, dropout and multidimensional equity gaps in immunisation systems in West Africa, 2000-2017
BMJ Global Health, Volume 4, No. 5, Article e001713, Year 2019
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Description
Background Several West African countries are unlikely to achieve the recommended Global Vaccine Action Plan (GVAP) immunisation coverage and dropout targets in a landscape beset with entrenched intra-country equity gaps in immunisation. Our aim was to assess and compare the immunisation coverage, dropout and equity gaps across 15 West African countries between 2000 and 2017. Methods We compared Bacille Calmette Guerin (BCG) and the third dose of diphtheria-tetanus-pertussis (DTP3) containing vaccine coverage between 2000 and 2017 using the WHO and Unicef Estimates of National Immunisation Coverage for 15 West African countries. Estimated subregional median and weighted average coverages, and dropout (DTP1-DTP3) were tracked against the GVAP targets of ≥90% coverage (BCG and DTP3), and ≤10% dropouts. Equity gaps in immunisation were assessed using the latest disaggregated national health survey immunisation data. Results The weighted average subregional BCG coverage was 60.7% in 2000, peaked at 83.2% in 2009 and was 65.7% in 2017. The weighted average DTP3 coverage was 42.3% in 2000, peaked at 70.3% in 2009 and was 61.5% in 2017. As of 2017, 46.7% of countries (7/15) had met the GVAP targets on DTP3 coverage. Average weighted subregional immunisation dropouts consistently reduced from 16.4% in 2000 to 7.4% in 2017, meeting the GVAP target in 2008. In most countries, inequalities in BCG, and DTP3 coverage and dropouts were mainly related to equity gaps of more than 20% points between the wealthiest and the poorest, high coverage regions and low coverage regions, and between children of mothers with at least secondary education and those with no formal education. A child's sex and place of residence (urban or rural) minimally determined equity gaps. Conclusions The West African subregion made progress between 2000 and 2017 in ensuring that its children utilised immunisation services, however, wide equity gaps persist. © 2019 Author(s).
Authors & Co-Authors
Wariri, Oghenebrume
United Kingdom, London
London School of Hygiene & Tropical Medicine
Edem, Bassey E.
United Kingdom, London
London School of Hygiene & Tropical Medicine
Nkereuwem, Esin
United Kingdom, London
London School of Hygiene & Tropical Medicine
Nkereuwem, Oluwatosin O.
United Kingdom, London
London School of Hygiene & Tropical Medicine
Umeh, Gregory C.
Switzerland, Geneva
Organisation Mondiale de la Santé
Idoko, Olubukola T.
United Kingdom, London
London School of Hygiene & Tropical Medicine
Germany, Munich
Ludwig-maximilians-universität München
Nomhwange, Terna Ignatius
Switzerland, Geneva
Organisation Mondiale de la Santé
Kampmann, Beate B.
United Kingdom, London
London School of Hygiene & Tropical Medicine
Statistics
Citations: 21
Authors: 8
Affiliations: 3
Identifiers
Doi:
10.1136/bmjgh-2019-001713
ISSN:
20597908
Research Areas
Health System And Policy
Maternal And Child Health
Study Design
Cross Sectional Study
Study Approach
Quantitative
Study Locations
Multi-countries