Department of Paediatrics and Child Health, College of Health Sciences, Makerere University, Kampala, Uganda.
Mulago National Referral Hospital, Kampala, Uganda.
PLoS One. 2019 Sep 6;14(9):e0221902. doi: 10.1371/journal.pone.0221902. eCollection 2019.
Preterm infants are at increased risk of infections including vaccine preventable diseases. Therefore, timely vaccination is crucial to ensure adequate disease protection. Information on whether preterm infants are vaccinated according to chronological age as recommended is limited in low-income countries.
We evaluated the timeliness of vaccination and associated factors among preterm infants at Mulago hospital, Uganda.
We conducted a mixed methods study between July 2016 and April 2017. Vaccination dates of preterm infants aged 6-24 months were obtained from child health cards. Additional data were collected using a questionnaire. Five key informant interviews with health workers and two focus group discussions with caregivers were conducted. Cox regression analysis was used to identify factors associated with vaccination timeliness. Qualitative data was transcribed and analysed manually using content thematic approach.
We enrolled 350 preterm infants, with a median age of 8.4 months (IQR 6.8-10.8). Less than half, 149/350 (42.6%) of infants received all vaccines within the recommended time range. Timely vaccination was highest for BCG (92%) and lowest for OPV (45.4%). Untimely vaccination was highest for vaccines administered at 6 weeks (DPT 1, PCV 1 and OPV 1) compared to other vaccines in the EPI schedule. Delivering from home or private clinics and vaccine stock-out were significantly associated with untimely BCG and OPV 0 vaccination. Low maternal education level and being very preterm were associated with untimely DPT 1 and DPT 3 receipt. Admission and long stay in the neonatal unit were associated with untimely DPT 1 receipt while extreme low birth weight was associated with untimely DPT 3 vaccination. Increasing parity was associated with untimely measles vaccination. Qualitative findings revealed that lack of knowledge and poor attitudes of health workers and caregivers, gaps in documentation of vaccination status and inadequate communication by health workers hindered timely vaccination.
More than half of preterm infants attending a specialised clinic at Mulago National Referral hospital in Uganda did not receive vaccines within the recommended time range. Specific strategies to improve vaccination timeliness in preterm infants are needed especially among the extremely low birth weight, very preterm and those with prolonged hospitalisation.
早产儿感染的风险增加，包括可通过疫苗预防的疾病。因此，及时接种疫苗对于确保充分的疾病保护至关重要。关于早产儿是否按照推荐的年龄及时接种疫苗的信息在低收入国家有限。
我们评估了乌干达穆拉戈医院早产儿的疫苗接种及时性及其相关因素。
我们在 2016 年 7 月至 2017 年 4 月期间进行了一项混合方法研究。从儿童健康卡中获取 6-24 个月龄早产儿的疫苗接种日期。使用问卷收集了其他数据。对 5 名卫生工作者进行了关键知情人访谈，并对 2 名照顾者进行了 2 次焦点小组讨论。使用 Cox 回归分析确定与疫苗接种及时性相关的因素。对定性数据进行转录，并使用内容主题方法进行手动分析。
我们纳入了 350 名早产儿，中位年龄为 8.4 个月（IQR 6.8-10.8）。不到一半的婴儿（149/350，42.6%）在推荐的时间范围内接受了所有疫苗。BCG 的及时接种率最高（92%），OPV 最低（45.4%）。与 EPI 计划中的其他疫苗相比，6 周时接种的疫苗（DPT1、PCV1 和 OPV1）的未及时接种率最高。在家或私人诊所分娩以及疫苗缺货与 BCG 和 OPV0 的未及时接种显著相关。母亲教育程度低和早产是 DPT1 和 DPT3 未及时接种的相关因素。新生儿重症监护病房的住院和长期住院与 DPT1 未及时接种有关，而极低出生体重与 DPT3 接种未及时有关。产次增加与麻疹未及时接种有关。定性研究结果表明，卫生工作者和照顾者缺乏知识和不良态度、疫苗接种状况记录存在差距以及卫生工作者沟通不足，这些都阻碍了及时接种疫苗。
乌干达穆拉戈国家转诊医院专门诊所中，超过一半的早产儿没有在推荐的时间范围内接种疫苗。需要制定专门的策略来提高早产儿的疫苗接种及时性，特别是针对极低出生体重儿、非常早产儿和长期住院的早产儿。
