青少年母亲子女的疫苗接种覆盖率和及时性：南非东开普省的一项社区研究。

Vaccine coverage and timeliness among children of adolescent mothers: A community-based study in the Eastern Cape, South Africa.

作者信息

Wittesaele Camille, Toska Elona, Cluver Lucie, Weiss Helen A, Collins Courteney, Amponsah-Dacosta Edina, Doyle Aoife M

机构信息

MRC International Statistics and Epidemiology Group, Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine; Centre for Social Science Research, Department of Sociology, University of Cape Town; Department of Social Policy & Intervention, University of Oxford.

Centre for Social Science Research, Department of Sociology, University of Cape Town; Department of Social Policy & Intervention, University of Oxford.

出版信息

Vaccine. 2024 Dec 2;42(26):126318. doi: 10.1016/j.vaccine.2024.126318. Epub 2024 Sep 17.

DOI:10.1016/j.vaccine.2024.126318

PMID:39293297

Abstract

BACKGROUND

Children born to adolescent mothers are more vulnerable to infant mortality and morbidity than those born to adult mothers. HIV-exposed children have lower antibody protection against vaccine-preventable diseases at birth compared to unexposed children. In South Africa, 17 % of adolescent girls aged 15-19 years are mothers, yet vaccination coverage and timeliness among their children is underreported.

METHODS

This study estimated age-appropriate vaccination coverage and timeliness among children (n = 1080) of adolescent mothers (n = 1015) in the Eastern Cape, South Africa. Mother-child dyads were recruited through healthcare and community-based sampling strategies. Vaccination data were abstracted from 1013 home-based child health records (2017-2019). Coverage is reported for Diphtheria-Tetanus-Pertussis 3rd dose (DTP3), under-1 vaccination among children over 12 months (n = 613) and measles 2nd dose (MCV2) among children over 24 months (n = 382) using proportions with 95 % confidence intervals (95 %CI). Timeliness is defined as receiving each vaccination within 4 weeks of recommended age. Findings are disaggregated by maternal HIV-status.

RESULTS

Overall, 27.3 % of adolescent mothers were living with HIV. Coverage of DTP3 was 85.6 % (95 %CI: 82.6-88.3 %), under-1 coverage was 53.2 % (95 %CI: 49.1-57.2 %), and MCV2 coverage was 62.3 % (95 %CI: 57.2-67.2 %). Vaccination coverage was lower among children of adolescent mothers living with HIV (AMLHIV) than unexposed children (DTP3 80.3 % vs 88.2 % p-value: 0.01; under-1 46.5 % vs 56.4 % p-value: 0.02; MCV2 55.4 % vs 67.1 % p-value: 0.02). Timeliness of vaccinations declined over time from 98.0 % at birth, 70.7 % at 14 weeks, 71.9 % at 9 months and 37.3 % at 18 months.

CONCLUSION

Vaccination coverage among children of adolescent mothers in the Eastern Cape are below national targets. Children of AMLHIV had lower coverage than HIV-unexposed children. Further research is needed to identify risk factors associated with incomplete and delayed vaccinations among this group, particularly among HIV-exposed children. Enhanced vaccination campaigns may be required for children of adolescent mothers.

摘要

背景

与成年母亲所生子女相比，青少年母亲所生子女更容易出现婴儿死亡和发病情况。与未接触艾滋病毒的儿童相比，接触艾滋病毒的儿童在出生时对疫苗可预防疾病的抗体保护较低。在南非，15至19岁的青少年女孩中有17%是母亲，但其子女的疫苗接种覆盖率和及时性报告不足。

方法

本研究估计了南非东开普省青少年母亲（n = 1015）的子女（n = 1080）中适合年龄的疫苗接种覆盖率和及时性。通过医疗保健和基于社区的抽样策略招募母婴二元组。从1013份家庭儿童健康记录（2017 - 2019年）中提取疫苗接种数据。使用95%置信区间（95%CI）的比例报告白喉 - 破伤风 - 百日咳第三剂（DTP3）、12个月以上儿童的1岁以下疫苗接种（n = 613）以及24个月以上儿童的麻疹第二剂（MCV2）的覆盖率。及时性定义为在推荐年龄的4周内接种每种疫苗。研究结果按母亲的艾滋病毒感染状况进行分类。

结果

总体而言，27.3%的青少年母亲感染了艾滋病毒。DTP3的覆盖率为85.6%（95%CI：82.6 - 88.3%），1岁以下覆盖率为53.2%（95%CI：49.1 - 57.2%），MCV2覆盖率为62.3%（95%CI：57.2 - 67.2%）。感染艾滋病毒的青少年母亲（AMLHIV）的子女的疫苗接种覆盖率低于未接触艾滋病毒的儿童（DTP3 80.3%对88.2%，p值：0.01；1岁以下46.5%对56.4%，p值：0.02；MCV2 55.4%对67.1%，p值：0.02）。疫苗接种的及时性随时间下降，出生时为98.0%，14周时为70.7%，9个月时为71.9%，18个月时为37.3%。