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Childhood immunization in rural Malawi: time of administration and predictors of non-compliance
M Vaahtera1, T Kulmala, K Maleta
1University of Tampere Medical School, PO Box 607, FIN-33101 Tampere, Finland. merimaaria.vaahtera@kolumbus.fi
Insights
In rural Malawi, childhood vaccination rates were high but delayed, especially measles vaccines. Non-compliance was linked to remote villages and home births, highlighting the need for outreach.
Area of Science:
- Public Health
- Pediatrics
- Epidemiology
Background:
- Childhood vaccinations are crucial for disease prevention.
- Understanding vaccination timeliness and compliance is vital for public health initiatives.
- Rural settings present unique challenges to healthcare access and service delivery.
Purpose of the Study:
- To assess the timeliness of childhood vaccinations in rural Malawi.
- To identify factors associated with non-compliance with national vaccination schedules.
- To evaluate vaccination coverage rates at 1 and 2 years of age.
Main Methods:
- Prospective cohort study of 760 newborns followed for 2 years.
- Data collection on vaccination administration dates and coverage.
- Analysis of predictors for non-compliance with vaccination recommendations.
Main Results:
- High vaccination coverage achieved by age 2: tuberculosis (99%), polio (93%), diphtheria-pertussis-tetanus (93%), and measles (84%).
- Vaccinations were administered 1-3 months later than recommended on average.
- Delayed measles vaccinations were often administered through supplementary campaigns.
- Non-compliance associated with lack of mobile vaccination teams, birth season (April-June), and home births.
Conclusions:
- While overall vaccination coverage is high in rural Malawi, significant delays exist.
- Targeted outreach programs are essential to improve measles vaccination coverage and address access barriers.
- Addressing factors like remote village access and promoting facility births can enhance vaccination compliance.
Abstract:
A cohort of 760 newborns was followed prospectively for 2 years to ascertain the time of administration of childhood vaccinations in rural Malawi and to study predictors of non-compliance with national vaccination recommendations. At 1 year of age, 99% of the infants were fully vaccinated against tuberculosis, 91% against polio, 90% against diphtheria, pertussis and tetanus and 64% against measles. At 2 years, the corresponding vaccination coverages were 99%, 93%, 93% and 84%. On average, all vaccinations were given 1-3 months later than recommended. Many of the delayed measles vaccinations were given during a separate vertical campaign, during which 25% of previously unvaccinated 21-23-month-old children were identified and immunized. Non-compliance with vaccination recommendations was associated with living in villages with no access to mobile vaccination teams, birth between April and June and birth at home. In this rural Malawian area, most vaccination services were functioning well. To increase measles vaccination coverage, regular outreach activities should be encouraged.
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