Limits...
Pattern and determinants of BCG immunisation delays in a sub-Saharan African community.

Olusanya BO - Health Res Policy Syst (2010)

Bottom Line: A significantly higher proportion of infants born in hospitals were vaccinated in the first six weeks compared to those born outside hospitals.Undernourishment was predictive of delays beyond 2 and 6 weeks while treated hyperbilirubinaemia was associated with decreased odds for any delays.BCG immunisation is associated with significant delays in this setting and infants at increased risk of delays can be identified and supported early possibly through improved maternal uptake of antenatal care.

View Article: PubMed Central - HTML - PubMed

Affiliation: Maternal and Child Health Unit, Department of Community Health and Primary Care, College of Medicine, University of Lagos, Surulere, Lagos, Nigeria. boolusanya@aol.com

ABSTRACT

Background: Childhood immunisation is recognised worldwide as an essential component of health systems and an indispensable indicator of quality of care for vaccine-preventable diseases. While performance of immunisation programmes is more commonly measured by coverage, ensuring that every child is immunised at the earliest/appropriate age is an important public health goal. This study therefore set out to determine the pattern and predictors of Bacille de Calmette-Guérin (BCG) immunisation delays in the first three months of life in a Sub-Saharan African community where BCG is scheduled at birth in order to facilitate necessary changes in current policy and practices for improved services.

Methods: A cross-sectional study in which immunisation delays among infants aged 0-3 months attending community-based BCG clinics in Lagos, Nigeria over a 2-year period from July 2005 to June 2007 were assessed by survival analysis and associated factors determined by multivariable logistic regression. Population attributable risk (PAR) was computed for the predictors of delays.

Results: BCG was delayed beyond three months in 31.6% of all eligible infants. Of 5171 infants enrolled, 3380 (65.4%) were immunised within two weeks and a further 1265 (24.5%) by six weeks. A significantly higher proportion of infants born in hospitals were vaccinated in the first six weeks compared to those born outside hospitals. Undernourishment was predictive of delays beyond 2 and 6 weeks while treated hyperbilirubinaemia was associated with decreased odds for any delays. Lack of antenatal care and multiple gestations were also predictive of delays beyond 6 weeks. Undernourishment was associated with the highest PAR for delays beyond 2 weeks (18.7%) and 6 weeks (20.8%).

Conclusions: BCG immunisation is associated with significant delays in this setting and infants at increased risk of delays can be identified and supported early possibly through improved maternal uptake of antenatal care. Combining BCG with subsequent immunisation(s) at 6 weeks for infants who missed the BCG may be considered.

No MeSH data available.


Related in: MedlinePlus

Proportion of infants aged 0 - 3 months that received BCG immunisation in Lagos, Nigeria (n = 5171).
© Copyright Policy - open-access
Related In: Results  -  Collection

License
getmorefigures.php?uid=PMC2821326&req=5

Figure 2: Proportion of infants aged 0 - 3 months that received BCG immunisation in Lagos, Nigeria (n = 5171).

Mentions: The proportion of infants ≤3 months old vaccinated each week across the place of delivery is shown in Figure 2. The log-rank test (p = 0.029) indicated that there were significant variations in the age of immunisation among the four groups of infants based on place of birth when unadjusted for potential confounding factors. The highest proportion of infants with age-appropriate immunisation was among hospital deliveries and the least proportion came from infants delivered in church premises or before arrival in hospitals. There was a sharp increase from birth till two weeks of age, with at least 65% coverage regardless of the place of delivery. Using a benchmark of 85%, there was at least 4 weeks delay from birth in this cohort. The longest delay from birth was potentially 52 weeks or 50 weeks from the age-appropriate limit of 2 weeks based on the data from the health authorities.


Pattern and determinants of BCG immunisation delays in a sub-Saharan African community.

Olusanya BO - Health Res Policy Syst (2010)

Proportion of infants aged 0 - 3 months that received BCG immunisation in Lagos, Nigeria (n = 5171).
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC2821326&req=5

Figure 2: Proportion of infants aged 0 - 3 months that received BCG immunisation in Lagos, Nigeria (n = 5171).
Mentions: The proportion of infants ≤3 months old vaccinated each week across the place of delivery is shown in Figure 2. The log-rank test (p = 0.029) indicated that there were significant variations in the age of immunisation among the four groups of infants based on place of birth when unadjusted for potential confounding factors. The highest proportion of infants with age-appropriate immunisation was among hospital deliveries and the least proportion came from infants delivered in church premises or before arrival in hospitals. There was a sharp increase from birth till two weeks of age, with at least 65% coverage regardless of the place of delivery. Using a benchmark of 85%, there was at least 4 weeks delay from birth in this cohort. The longest delay from birth was potentially 52 weeks or 50 weeks from the age-appropriate limit of 2 weeks based on the data from the health authorities.

Bottom Line: A significantly higher proportion of infants born in hospitals were vaccinated in the first six weeks compared to those born outside hospitals.Undernourishment was predictive of delays beyond 2 and 6 weeks while treated hyperbilirubinaemia was associated with decreased odds for any delays.BCG immunisation is associated with significant delays in this setting and infants at increased risk of delays can be identified and supported early possibly through improved maternal uptake of antenatal care.

View Article: PubMed Central - HTML - PubMed

Affiliation: Maternal and Child Health Unit, Department of Community Health and Primary Care, College of Medicine, University of Lagos, Surulere, Lagos, Nigeria. boolusanya@aol.com

ABSTRACT

Background: Childhood immunisation is recognised worldwide as an essential component of health systems and an indispensable indicator of quality of care for vaccine-preventable diseases. While performance of immunisation programmes is more commonly measured by coverage, ensuring that every child is immunised at the earliest/appropriate age is an important public health goal. This study therefore set out to determine the pattern and predictors of Bacille de Calmette-Guérin (BCG) immunisation delays in the first three months of life in a Sub-Saharan African community where BCG is scheduled at birth in order to facilitate necessary changes in current policy and practices for improved services.

Methods: A cross-sectional study in which immunisation delays among infants aged 0-3 months attending community-based BCG clinics in Lagos, Nigeria over a 2-year period from July 2005 to June 2007 were assessed by survival analysis and associated factors determined by multivariable logistic regression. Population attributable risk (PAR) was computed for the predictors of delays.

Results: BCG was delayed beyond three months in 31.6% of all eligible infants. Of 5171 infants enrolled, 3380 (65.4%) were immunised within two weeks and a further 1265 (24.5%) by six weeks. A significantly higher proportion of infants born in hospitals were vaccinated in the first six weeks compared to those born outside hospitals. Undernourishment was predictive of delays beyond 2 and 6 weeks while treated hyperbilirubinaemia was associated with decreased odds for any delays. Lack of antenatal care and multiple gestations were also predictive of delays beyond 6 weeks. Undernourishment was associated with the highest PAR for delays beyond 2 weeks (18.7%) and 6 weeks (20.8%).

Conclusions: BCG immunisation is associated with significant delays in this setting and infants at increased risk of delays can be identified and supported early possibly through improved maternal uptake of antenatal care. Combining BCG with subsequent immunisation(s) at 6 weeks for infants who missed the BCG may be considered.

No MeSH data available.


Related in: MedlinePlus