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

Sanne Marie Thysen · Stine Byberg · Amabélia Rodrigues · Henrik Ravn · Cesário Lorenco Martins · Christine Stabell Benn +2 more

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Vaccine Coverage and Hesitancy Tuberculosis Research and Epidemiology Global Maternal and Child Health

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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References

2009WHO and UNICEF estimates of national infant immunization coverage: methods and processes 2009Timing of children's vaccinations in 45 low-income and middle-income countries: an analysis of survey data 2011Timeliness of childhood vaccinations in 31 low and middle-income countries 1993Studies of missed opportunities for immunization in developing and industrialized countries.2011Vaccination coverage and timeliness in three South African areas: a prospective study 2011Is vaccination coverage a good indicator of age-appropriate vaccination? A prospective study from Uganda 2014Effects of the introduction of new vaccines in Guinea-Bissau on vaccine coverage, vaccine timeliness, and child survival: an observational study

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