State of equity: childhood immunization in the World Health Organization African Region

Introduction In 2010, the Global Vaccine Action Plan called on all countries to reach and sustain 90% national coverage and 80% coverage in all districts for the third dose of diphtheria-tetanus-pertussis vaccine (DTP3) by 2015 and for all vaccines in national immunization schedules by 2020. The aims of this study are to analyze recent trends in national vaccination coverage in the World Health Organization African Region andto assess how these trends differ by country income category. Methods We compared national vaccination coverage estimates for DTP3 and the first dose of measles-containing vaccine (MCV) obtained from the World Health Organization (WHO)/United Nations Children’s Fund (UNICEF) joint estimates of national immunization coverage for all African Region countries. Using United Nations (UN) population estimates of surviving infants and country income category for the corresponding year, we calculated population-weighted average vaccination coverage by country income category (i.e., low, lower middle, and upper middle-income) for the years 2000, 2005, 2010 and 2015. Results DTP3 coverage in the African Region increased from 52% in 2000 to 76% in 2015,and MCV1 coverage increased from 53% to 74% during the same period, but with considerable differences among countries. Thirty-six African Region countries were low income in 2000 with an average DTP3 coverage of 50% while 26 were low income in 2015 with an average coverage of 80%. Five countries were lower middle-income in 2000 with an average DTP3 coverage of 84% while 12 were lower middle-income in 2015 with an average coverage of 69%. Five countries were upper middle-income in 2000 with an average DTP3 coverage of 73% and eight were upper middle-income in 2015 with an average coverage of 76%. Conclusion Disparities in vaccination coverage by country persist in the African Region, with countries that were lower middle-income having the lowest coverage on average in 2015. Monitoring and addressing these disparities is essential for meeting global immunization targets.

[1]  Dale A. Rhoda,et al.  Measuring Coverage in MNCH: Design, Implementation, and Interpretation Challenges Associated with Tracking Vaccination Coverage Using Household Surveys , 2013, PLoS medicine.

[2]  A. Barros,et al.  Inequalities in full immunization coverage: trends in low- and middle-income countries , 2016, Bulletin of the World Health Organization.

[3]  Rouslan Karimov,et al.  WHO and UNICEF estimates of national infant immunization coverage: methods and processes. , 2009, Bulletin of the World Health Organization.

[4]  V. Dietz,et al.  Strengthening routine immunization systems to improve global vaccination coverage. , 2015, British medical bulletin.

[5]  A. Aslam,et al.  The state of the world's children 2013: children with disabilities. , 2013 .

[6]  C. Karema,et al.  Successive introduction of four new vaccines in Rwanda: High coverage and rapid scale up of Rwanda's expanded immunization program from 2009 to 2013. , 2016, Vaccine.

[7]  A. Nandi,et al.  Monitoring equity in vaccination coverage: A systematic analysis of demographic and health surveys from 45 Gavi-supported countries. , 2017, Vaccine.

[8]  V. Dietz,et al.  Overview of global, regional, and national routine vaccination coverage trends and growth patterns from 1980 to 2009: implications for vaccine-preventable disease eradication and elimination initiatives. , 2014, The Journal of infectious diseases.

[9]  Stephen S Lim,et al.  Tracking progress towards universal childhood immunisation and the impact of global initiatives: a systematic analysis of three-dose diphtheria, tetanus, and pertussis immunisation coverage , 2008, The Lancet.

[10]  A. Isaacs.  Immunization in practice, a practical guide for health staff , 2005, Archives of Disease in Childhood.

[11]  Sonja Fagernäs,et al.  Birth registration and access to health care: an assessment of Ghana's campaign success. , 2013, Bulletin of the World Health Organization.

[12]  David Holmes.  Rwanda: an injection of hope , 2010, The Lancet.

[13]  A. Hosseinpoor,et al.  Monitoring inequality: an emerging priority for health post-2015 , 2015, Bulletin of the World Health Organization.

[14]  N. Schwalbe,et al.  An analysis of how the GAVI alliance and low- and middle-income countries can share costs of new vaccines. , 2011, Health affairs.