Abstract:
Background: Africa has the lowest childhood vaccination coverage worldwide. If the
full benefits of childhood vaccination programmes are to be enjoyed in sub-Saharan
Africa, all countries need to improve on vaccine delivery to achieve and sustain high
coverage. In this paper, we review trends in vaccination coverage, dropouts between
vaccine doses and explored the country-specific predictors of complete vaccination in
West Africa. Methods: We utilized datasets from the Demographic and Health Surveys
Program, available for Benin, Burkina Faso, The Gambia, Ghana, Guinea, Cote d'Ivoire,
Liberia, Mali, Niger, Nigeria, Senegal, Sierra Leone and Togo, to obtain coverage for
Bacillus Calmette-Guerin, polio, measles, and diphtheria, pertussis and tetanus (DPT)
vaccines in children aged 12 - 23 months. We also calculated the DPT1-to-DPT3 and
DPT1-to-measles dropouts, and proportions of the fully immunised child (FIC). Factors
predictive of FIC were explored using Chi-squared tests and multivariable logistic
regression. Results: Overall, there was a trend of increasing vaccination coverage. The
proportion of FIC varied significantly by country (range 24.1-81.4%, mean 49%). DPT1-
to-DPT3 dropout was high (range 5.1% -33.9%, mean 16.3%). Similarly, DPT1-measles
dropout exceeded 10% in all but four countries. Although no single risk factor was
consistently associated with FIC across these countries, maternal education, delivery in a
health facility, possessing a vaccine card and a recent post delivery visit to a health
facility were the key predictors of complete vaccination. Conclusions: The low numbers
of fully immunised children and high dropout between vaccine doses highlights
weaknesses and the need to strengthen the healthcare and routine immunization delivery
systems in this region. Country-specific correlates of complete vaccination should be
explored further to identify interventions required to increase vaccination coverage.
Despite the promise of an increasing trend in vaccination coverage in West African
countries, more effort is required to attain and maintain global vaccination coverage
targets.