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Ascertainment of childhood vaccination histories in northern Malawi

Ascertainment of childhood vaccination histories in northern Malawi
Ascertainment of childhood vaccination histories in northern Malawi
OBJECTIVE: To assess factors related to recorded vaccine uptake, which may confound the evaluation of vaccine impact.

METHODS: Analysis of documented vaccination histories of children under 5 years and demographic and socio-economic characteristics collected by a demographic surveillance system in Karonga District, Malawi. Associations between deviations from the standard vaccination schedule and characteristics that are likely to be associated with increased mortality were determined by multivariate logistic regression.

RESULTS: Approximately 78% of children aged 6-23 months had a vaccination document, declining to <50% by 5 years of age. Living closer to an under-5 clinic, having a better educated father, and both parents being alive were associated with having a vaccination document. For a small percentage of children, vaccination records were incomplete and/or faulty. Vaccination uptake was high overall, but delayed among children living further from the nearest under-5 clinic or from poorer socio-economic backgrounds. Approximately 9% of children had received their last dose of DPT with or after measles vaccine. These children were from relatively less educated parents, and were more likely to have been born outside the health services.

CONCLUSIONS: Though overall coverage in this community was high and variation in coverage according to child or parental characteristics small, there was strong evidence of more timely coverage among children from better socio-economic conditions and among those who lived closer to health facilities. These factors are likely to be strong confounders in the association of vaccinations with mortality, and may offer an alternative explanation for the non-specific mortality impact of vaccines described by other studies.
1360-2276
129-138
Jahn, A.
75299d2a-929b-48fa-ab3f-5511268cebbf
Floyd, S.
982a6a32-cec8-4cea-893b-e04b983c9050
Mwinuka, V.
3cfbded1-c5e7-4bee-8b64-dae61a9743d6
Mwafilaso, J.
d66d0912-755b-41e8-b78c-d61438a9a3db
Mwagomba, D.
4bba5195-1f8e-440e-a00d-c73c1ecc0a9a
Mkisi, R.E.
b7c94e03-7f30-4b99-b7b0-5d6d1eb92fb9
Karsulukuta, A.
73d8a8fc-83d0-4048-8845-620df779c537
Khunga, A.
811f37b6-9c57-40e1-8b6c-faf426398c28
Crampin, A.C.
79d516bb-98a6-4b0c-a1c2-2406f13f4649
Branson, K.
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McGrath, N.
b75c0232-24ec-443f-93a9-69e9e12dc961
Fine, P.E.M.
6ca7d274-0337-4e28-9e87-34e42c99da8e
Jahn, A.
75299d2a-929b-48fa-ab3f-5511268cebbf
Floyd, S.
982a6a32-cec8-4cea-893b-e04b983c9050
Mwinuka, V.
3cfbded1-c5e7-4bee-8b64-dae61a9743d6
Mwafilaso, J.
d66d0912-755b-41e8-b78c-d61438a9a3db
Mwagomba, D.
4bba5195-1f8e-440e-a00d-c73c1ecc0a9a
Mkisi, R.E.
b7c94e03-7f30-4b99-b7b0-5d6d1eb92fb9
Karsulukuta, A.
73d8a8fc-83d0-4048-8845-620df779c537
Khunga, A.
811f37b6-9c57-40e1-8b6c-faf426398c28
Crampin, A.C.
79d516bb-98a6-4b0c-a1c2-2406f13f4649
Branson, K.
54a1e04d-bb1c-4f02-a6e0-a31c720285b7
McGrath, N.
b75c0232-24ec-443f-93a9-69e9e12dc961
Fine, P.E.M.
6ca7d274-0337-4e28-9e87-34e42c99da8e

Jahn, A., Floyd, S., Mwinuka, V., Mwafilaso, J., Mwagomba, D., Mkisi, R.E., Karsulukuta, A., Khunga, A., Crampin, A.C., Branson, K., McGrath, N. and Fine, P.E.M. (2008) Ascertainment of childhood vaccination histories in northern Malawi. Tropical Medicine & International Health, 13 (1), 129-138. (doi:10.1111/j.1365-3156.2007.01982.x). (PMID:18291011)

Record type: Article

Abstract

OBJECTIVE: To assess factors related to recorded vaccine uptake, which may confound the evaluation of vaccine impact.

METHODS: Analysis of documented vaccination histories of children under 5 years and demographic and socio-economic characteristics collected by a demographic surveillance system in Karonga District, Malawi. Associations between deviations from the standard vaccination schedule and characteristics that are likely to be associated with increased mortality were determined by multivariate logistic regression.

RESULTS: Approximately 78% of children aged 6-23 months had a vaccination document, declining to <50% by 5 years of age. Living closer to an under-5 clinic, having a better educated father, and both parents being alive were associated with having a vaccination document. For a small percentage of children, vaccination records were incomplete and/or faulty. Vaccination uptake was high overall, but delayed among children living further from the nearest under-5 clinic or from poorer socio-economic backgrounds. Approximately 9% of children had received their last dose of DPT with or after measles vaccine. These children were from relatively less educated parents, and were more likely to have been born outside the health services.

CONCLUSIONS: Though overall coverage in this community was high and variation in coverage according to child or parental characteristics small, there was strong evidence of more timely coverage among children from better socio-economic conditions and among those who lived closer to health facilities. These factors are likely to be strong confounders in the association of vaccinations with mortality, and may offer an alternative explanation for the non-specific mortality impact of vaccines described by other studies.

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Published date: January 2008
Organisations: Faculty of Health Sciences

Identifiers

Local EPrints ID: 350457
URI: http://eprints.soton.ac.uk/id/eprint/350457
ISSN: 1360-2276
PURE UUID: fb184a93-456b-4dc6-bacd-c3b47fb02bad
ORCID for N. McGrath: ORCID iD orcid.org/0000-0002-1039-0159

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Date deposited: 25 Mar 2013 13:05
Last modified: 15 Mar 2024 03:46

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Contributors

Author: A. Jahn
Author: S. Floyd
Author: V. Mwinuka
Author: J. Mwafilaso
Author: D. Mwagomba
Author: R.E. Mkisi
Author: A. Karsulukuta
Author: A. Khunga
Author: A.C. Crampin
Author: K. Branson
Author: N. McGrath ORCID iD
Author: P.E.M. Fine

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