Mbengue Mouhamed Abdou Salam, Mboup Aminata, Ly Indou Deme, Faye Adama, Camara Fatou Bintou Niang, Thiam Moussa, Ndiaye Birahim Pierre, Dieye Tandakha Ndiaye, Mboup Souleymane
Institut de Recherche en Santé, de Surveillance Epidémiologique et de Formations (IRESSEF).
University of the Witwatersrand, Faculty of Health Sciences, School of Public Health, Johannesburg- South Africa.
Pan Afr Med J. 2017 Jun 21;27(Suppl 3):8. doi: 10.11604/pamj.supp.2017.27.3.11534. eCollection 2017.
Expanded programme on immunizations in resource-limited settings currently measure vaccination coverage defined as the proportion of children aged 12-23 months that have completed their vaccination. However, this indicator does not address the important question of when the scheduled vaccines were administered. We assessed the determinants of timely immunization to help the national EPI program manage vaccine-preventable diseases and impact positively on child survival in Senegal.
Vaccination data were obtained from the Demographic and Health Survey (DHS) carried out across the 14 regions in the country. Children were aged between 12-23 months. The assessment of vaccination coverage was done with the health card and/or by the mother's recall of the vaccination act. For each vaccine, an assessment of delay in age-appropriate vaccination was done following WHO recommendations. Additionally, Kaplan-Meier survival function was used to estimate the proportion vaccinated by age and cox-proportional hazards models were used to examine risk factors for delays.
A total of 2444 living children between 12-23 months of age were included in the analysis. The country vaccination was below the WHO recommended coverage level and, there was a gap in timeliness of children immunization. While BCG vaccine uptake was over 95%, coverage decreased with increasing number of Pentavalent vaccine doses (Penta 1: 95.6%, Penta 2: 93.5%: Penta 3: 89.2%). Median delay for BCG was 1.7 weeks. For polio at birth, the median delay was 5 days; all other vaccine doses had median delays of 2-4 weeks. For Penta 1 and Penta 3, 23.5% and 15.7% were given late respectively. A quarter of measles vaccines were not administered or were scheduled after the recommended age. Vaccinations that were not administered within the recommended age ranges were associated with mothers' poor education level, multiple siblings, low socio-economic status and living in rural areas.
A significant delay in receipt of infant vaccines is found in Senegal while vaccine coverage is suboptimal. The national expanded program on immunization should consider measuring age at immunization or using seroepidemiological data to better monitor its impact.
资源有限地区的扩大免疫规划目前衡量的是疫苗接种覆盖率，即12至23个月龄儿童完成疫苗接种的比例。然而，这一指标并未解决何时接种计划疫苗这一重要问题。我们评估了及时免疫的决定因素，以帮助塞内加尔国家扩大免疫规划管理疫苗可预防疾病，并对儿童生存产生积极影响。
疫苗接种数据来自于在该国14个地区开展的人口与健康调查（DHS）。儿童年龄在12至23个月之间。通过健康卡和/或母亲对疫苗接种行为的回忆来评估疫苗接种覆盖率。对于每种疫苗，按照世界卫生组织的建议对适龄疫苗接种延迟情况进行评估。此外，使用Kaplan-Meier生存函数按年龄估计接种疫苗的比例，并使用Cox比例风险模型检查延迟的风险因素。
共有2444名12至23个月龄的在世儿童纳入分析。该国的疫苗接种率低于世界卫生组织建议的覆盖率水平，儿童免疫及时性存在差距。虽然卡介苗接种率超过95%，但随着五价疫苗剂量的增加，覆盖率下降（五价疫苗1：95.6%，五价疫苗2：93.5%，五价疫苗3：89.2%）。卡介苗的中位延迟时间为1.7周。出生时接种脊髓灰质炎疫苗的中位延迟时间为5天；所有其他疫苗剂量的中位延迟时间为2至4周。五价疫苗1和五价疫苗3分别有23.5%和15.7%接种延迟。四分之一的麻疹疫苗未接种或在建议年龄之后接种。未在建议年龄范围内接种疫苗与母亲教育水平低、多子女、社会经济地位低以及居住在农村地区有关。
在塞内加尔发现婴儿疫苗接种存在显著延迟，同时疫苗接种覆盖率不理想。国家扩大免疫规划应考虑测量免疫年龄或使用血清流行病学数据，以更好地监测其影响。
