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Determinants of vaccination in an urban population in Conakry, Guinea
F T Cutts1, S Diallo, E R Zell
1Division of Immunization, Centers for Disease Control, Atlanta, GA 30333.
Insights
Low vaccination coverage in Guinea was linked to missed immunization opportunities and health system issues. Improving services, adherence to schedules, and reducing wait times can significantly boost vaccination rates.
Area of Science:
- Public Health
- Epidemiology
- Vaccinology
Background:
- Low vaccination coverage in Conakry, Guinea, necessitates understanding contributing factors.
- A 1989 community survey aimed to identify barriers to childhood immunization.
Purpose of the Study:
- To determine factors associated with low vaccination coverage in children aged 12-23 months in Conakry, Guinea.
- To identify predictors for initiating and completing the diphtheria/pertussis/tetanus/oral polio vaccine (DPT/OPV) series.
Main Methods:
- A community-based survey of 377 children and their guardians in Conakry, Guinea.
- Analysis of vaccination records and multivariate logistic regression to identify associated factors.
- Assessment of maternal education, socioeconomic status, and healthcare service experiences.
Main Results:
- Only 19% of children with records were fully vaccinated; 19% of incompletely vaccinated children experienced missed immunization opportunities.
- Maternal education, owning a television, hospital birth, and perceived affordability influenced DPT/OPV initiation.
- Maternal education, employment, and positive past experiences with vaccination services (e.g., short waits, no refusal) were key for DPT/OPV completion.
Conclusions:
- Improving health service delivery to prevent missed opportunities is crucial for increasing vaccination coverage.
- Addressing factors like waiting times, service accessibility, and potential adverse event management can enhance immunization program effectiveness.
- Targeted interventions based on socioeconomic and educational factors can improve vaccine uptake in similar settings.
Abstract:
A community survey was conducted in 1989 in Conakry, Guinea to determine reasons for low vaccination coverage. Some 377 children aged 12-23 months and their guardians were studied, of whom 204 (54%) had vaccination records. According to their records 19% of children were fully and correctly vaccinated. Thirty-nine incompletely vaccinated children (19% of those with records) had sufficient documented contacts with health services to be fully vaccinated, but at least one immunization opportunity was missed. Multivariate analyses were conducted to identify factors associated with receipt of first dose diphtheria/pertussis/tetanus/oral polio vaccine (DPT/OPV) and with completion of the DPT/OPV series. Factors determining initiation of the series included maternal education (assessed by ability to speak French), household possession of a television, maternal age less than 35 years, child's birth in hospital, and, for non-French speakers, the mother considering vaccination to be affordable. Factors determining completion of the DPT/OPV series, among children who began vaccination, included maternal education, employment, and past positive experience with vaccination services (short waiting times, not having been turned away from vaccination, and not knowing a child with a post-vaccine 'abscess'). Vaccination coverage can be substantially increased in Conakry by improving health services to avoid missed opportunities, following the vaccination schedule correctly, reducing waiting times and avoiding abscesses.