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BCG coverage and barriers to BCG vaccination in Guinea-Bissau: an observational study.

Thysen SM, Byberg S, Pedersen M, Rodrigues A, Ravn H, Martins C, Benn CS, Aaby P, Fisker AB - BMC Public Health (2014)

Bottom Line: If BCG had been given at first contact with the health system, 1-week coverage would have been 35% and 1-month coverage 54%.When monthly visits were introduced in intervention regions, 1-month coverage was higher in intervention regions (88%) than in control regions (51%), the prevalence ratio being 1.74 (1.53-2.00).BCG coverage during the first months of life is low in Guinea-Bissau.

View Article: PubMed Central - PubMed

Affiliation: Bandim Health Project, INDEPTH network, Apartado 861, 1004 Bissau Codex, Guinea-Bissau. smthysen@gmail.com.

ABSTRACT

Background: BCG vaccination is recommended at birth in low-income countries, but vaccination is often delayed. Often 20-dose vials of BCG are not opened unless at least ten children are present for vaccination ("restricted vial-opening policy"). BCG coverage is usually reported as 12-month coverage, not disclosing the delay in vaccination. Several studies show that BCG at birth lowers neonatal mortality. We assessed BCG coverage at different ages and explored reasons for delay in BCG vaccination in rural Guinea-Bissau.

Methods: Bandim Health Project (BHP) runs a health and demographic surveillance system covering women and their children in 182 randomly selected village clusters in rural Guinea-Bissau. BCG coverage was assessed for children born in 2010, when the restricted vial-opening policy was universally implemented, and in 2012-2013, where BHP provided BCG to all children at monthly visits in selected intervention regions. Factors associated with delayed BCG vaccination were evaluated using logistic regression models. Coverage between intervention and control regions were evaluated in log-binomial regression models providing prevalence ratios.

Results: Among 3951 children born in 2010, vaccination status was assessed for 84%. BCG coverage by 1 week of age was 11%, 38% by 1 month, and 92% by 12 months. If BCG had been given at first contact with the health system, 1-week coverage would have been 35% and 1-month coverage 54%. When monthly visits were introduced in intervention regions, 1-month coverage was higher in intervention regions (88%) than in control regions (51%), the prevalence ratio being 1.74 (1.53-2.00). Several factors, including socioeconomic factors, were associated with delayed BCG vaccination in the 2010-birth cohort. When BCG was available at monthly visits these factors were no longer associated with delayed BCG vaccination, only region of residence was associated with delayed BCG vaccination.

Conclusion: BCG coverage during the first months of life is low in Guinea-Bissau. Providing BCG at monthly vaccination visits removes the risk factors associated with delayed BCG vaccination.

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Related in: MedlinePlus

Observed BCG coverage by different ages in intervention and control regions. Bandim Health Project, Guinea-Bissau, 2012 cohort.
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Fig2: Observed BCG coverage by different ages in intervention and control regions. Bandim Health Project, Guinea-Bissau, 2012 cohort.

Mentions: In the 2010-birth cohort, BCG coverage did not differ significantly between the regions which subsequently became intervention regions compared with the control regions (PR = 1.03 (0.85-1.24)) (data not shown). After implementation of monthly visits, we assessed BCG coverage among a total of 2812 children (Additional file2). Coverage by 1 month of age was 88% (769/872) in intervention regions and 51% (141/279) in control regions (Figure 2), the PR being 1.74 (1.53-2.00). The 3-months coverage was 99% (769/776) in intervention regions and 85% (304/359) in control regions. By 12 months of age, it had increased to 99% (257/259) in intervention regions and 95% (284/299) in control regions. The potential 1-month coverage if BCG vaccine had been given at first contact with the healthcare system was 93% in intervention regions and 65% in control regions.Figure 2


BCG coverage and barriers to BCG vaccination in Guinea-Bissau: an observational study.

Thysen SM, Byberg S, Pedersen M, Rodrigues A, Ravn H, Martins C, Benn CS, Aaby P, Fisker AB - BMC Public Health (2014)

Observed BCG coverage by different ages in intervention and control regions. Bandim Health Project, Guinea-Bissau, 2012 cohort.
© Copyright Policy - open-access
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4195857&req=5

Fig2: Observed BCG coverage by different ages in intervention and control regions. Bandim Health Project, Guinea-Bissau, 2012 cohort.
Mentions: In the 2010-birth cohort, BCG coverage did not differ significantly between the regions which subsequently became intervention regions compared with the control regions (PR = 1.03 (0.85-1.24)) (data not shown). After implementation of monthly visits, we assessed BCG coverage among a total of 2812 children (Additional file2). Coverage by 1 month of age was 88% (769/872) in intervention regions and 51% (141/279) in control regions (Figure 2), the PR being 1.74 (1.53-2.00). The 3-months coverage was 99% (769/776) in intervention regions and 85% (304/359) in control regions. By 12 months of age, it had increased to 99% (257/259) in intervention regions and 95% (284/299) in control regions. The potential 1-month coverage if BCG vaccine had been given at first contact with the healthcare system was 93% in intervention regions and 65% in control regions.Figure 2

Bottom Line: If BCG had been given at first contact with the health system, 1-week coverage would have been 35% and 1-month coverage 54%.When monthly visits were introduced in intervention regions, 1-month coverage was higher in intervention regions (88%) than in control regions (51%), the prevalence ratio being 1.74 (1.53-2.00).BCG coverage during the first months of life is low in Guinea-Bissau.

View Article: PubMed Central - PubMed

Affiliation: Bandim Health Project, INDEPTH network, Apartado 861, 1004 Bissau Codex, Guinea-Bissau. smthysen@gmail.com.

ABSTRACT

Background: BCG vaccination is recommended at birth in low-income countries, but vaccination is often delayed. Often 20-dose vials of BCG are not opened unless at least ten children are present for vaccination ("restricted vial-opening policy"). BCG coverage is usually reported as 12-month coverage, not disclosing the delay in vaccination. Several studies show that BCG at birth lowers neonatal mortality. We assessed BCG coverage at different ages and explored reasons for delay in BCG vaccination in rural Guinea-Bissau.

Methods: Bandim Health Project (BHP) runs a health and demographic surveillance system covering women and their children in 182 randomly selected village clusters in rural Guinea-Bissau. BCG coverage was assessed for children born in 2010, when the restricted vial-opening policy was universally implemented, and in 2012-2013, where BHP provided BCG to all children at monthly visits in selected intervention regions. Factors associated with delayed BCG vaccination were evaluated using logistic regression models. Coverage between intervention and control regions were evaluated in log-binomial regression models providing prevalence ratios.

Results: Among 3951 children born in 2010, vaccination status was assessed for 84%. BCG coverage by 1 week of age was 11%, 38% by 1 month, and 92% by 12 months. If BCG had been given at first contact with the health system, 1-week coverage would have been 35% and 1-month coverage 54%. When monthly visits were introduced in intervention regions, 1-month coverage was higher in intervention regions (88%) than in control regions (51%), the prevalence ratio being 1.74 (1.53-2.00). Several factors, including socioeconomic factors, were associated with delayed BCG vaccination in the 2010-birth cohort. When BCG was available at monthly visits these factors were no longer associated with delayed BCG vaccination, only region of residence was associated with delayed BCG vaccination.

Conclusion: BCG coverage during the first months of life is low in Guinea-Bissau. Providing BCG at monthly vaccination visits removes the risk factors associated with delayed BCG vaccination.

Show MeSH
Related in: MedlinePlus