Sesay Umaru, Osborne Augustus, Benya Hassan, Bangura Camilla, Ahinkorah Bright Opoku
Sierra Leone Field Epidemiology Training Program, National Public Health Agency, Western Area, Freetown, Sierra Leone.
Africa Field Epidemiology Network, Western Area, Freetown, Sierra Leone.
PLoS One. 2025 Sep 12;20(9):e0329572. doi: 10.1371/journal.pone.0329572. eCollection 2025.
Immunization is a cornerstone of public health, preventing numerous vaccine-preventable diseases. However, disparities in immunization coverage persist globally, particularly in low-income countries like Sierra Leone. This study aims to examine the trends and socioeconomic and geographic inequalities in full immunization coverage among two-year-olds in Sierra Leone between 2008 and 2019.
This study utilised data from the Sierra Leone Demographic Health Surveys conducted in 2008, 2013, and 2019. The Health Equity Assessment Toolkit software developed by the World Health Organisation was used to calculate various inequality measures, including Difference, Ratio, Population-Attributable Risk, and Population-Attributable Fraction. An assessment of inequality was conducted across six stratifiers: maternal age, maternal economic status, maternal education level, place of residence, child sex, and sub-national province.
Between 2008 and 2013, the coverage of full immunization coverage among two-year-olds in Sierra Leone increased from 41.1% in 2008 to 73.1% in 2013; however, the coverage decreased to 50.4% in 2019. The inequality associated with maternal age, sex of the child, and sub-national level increased between 2008 and 2019. However, the results were not statistically significant for maternal age and sex of the child. Similarly, inequalities existed with economic status, education, and place of residence steadily decreased over the same period, but the results were also not statistically significant.
The study's findings highlight the need for sustained efforts to improve immunization coverage in Sierra Leone. While there was progress between 2008 and 2013, the subsequent decline emphasizes the importance of maintaining vital immunization programs. Addressing the significant regional disparities, particularly the gap between the southern and northern regions, is recommended. This requires targeted interventions to improve access to immunization services, strengthen health systems, and address the northern region's underlying social and economic factors. Additionally, ongoing monitoring and evaluation are essential to identify and address emerging challenges and ensure equitable access to immunization for all children in Sierra Leone.
免疫接种是公共卫生的基石，可预防众多疫苗可预防疾病。然而，全球免疫接种覆盖率存在差异，特别是在像塞拉利昂这样的低收入国家。本研究旨在探讨2008年至2019年期间塞拉利昂两岁儿童全程免疫接种覆盖率的趋势以及社会经济和地理不平等情况。
本研究利用了2008年、2013年和2019年进行的塞拉利昂人口与健康调查的数据。使用世界卫生组织开发的健康公平评估工具包软件来计算各种不平等指标，包括差异、比率、人群归因风险和人群归因分数。在六个分层因素中进行了不平等评估：母亲年龄、母亲经济状况、母亲教育水平、居住地点、儿童性别和国家以下省份。
2008年至2013年期间，塞拉利昂两岁儿童的全程免疫接种覆盖率从2008年的41.1%上升至2013年的73.1%；然而，2019年覆盖率降至50.4%。2008年至2019年期间，与母亲年龄、儿童性别和国家以下层面相关的不平等有所增加。然而，母亲年龄和儿童性别的结果无统计学意义。同样，经济状况、教育和居住地点方面的不平等在同一时期稳步下降，但结果也无统计学意义。
该研究结果凸显了在塞拉利昂持续努力提高免疫接种覆盖率的必要性。虽然2008年至2013年取得了进展，但随后的下降强调了维持重要免疫接种计划的重要性。建议解决显著的地区差异，特别是南部和北部地区之间的差距。这需要有针对性的干预措施，以改善免疫接种服务的可及性、加强卫生系统并解决北部地区潜在的社会和经济因素。此外，持续的监测和评估对于识别和应对新出现的挑战以及确保塞拉利昂所有儿童公平获得免疫接种至关重要。
