Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

At a glance: The STEP trials

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.
ADVANCED SEARCH
Log in
Top
BMC Public Health
Published in: BMC Public Health 1/2014

Open Access 01-12-2014 | Research article

BCG coverage and barriers to BCG vaccination in Guinea-Bissau: an observational study

Authors: Sanne Marie Thysen, Stine Byberg, Marie Pedersen, Amabelia Rodrigues, Henrik Ravn, Cesario Martins, Christine Stabell Benn, Peter Aaby, Ane Bærent Fisker

Published in: BMC Public Health | Issue 1/2014

Login to get access

Abstract

Background

BCG vaccination is recommended at birth in low-income countries, but vaccination is often delayed. Often 20-dose vials of BCG are not opened unless at least ten children are present for vaccination (“restricted vial-opening policy”). BCG coverage is usually reported as 12-month coverage, not disclosing the delay in vaccination. Several studies show that BCG at birth lowers neonatal mortality. We assessed BCG coverage at different ages and explored reasons for delay in BCG vaccination in rural Guinea-Bissau.

Methods

Bandim Health Project (BHP) runs a health and demographic surveillance system covering women and their children in 182 randomly selected village clusters in rural Guinea-Bissau. BCG coverage was assessed for children born in 2010, when the restricted vial-opening policy was universally implemented, and in 2012–2013, where BHP provided BCG to all children at monthly visits in selected intervention regions. Factors associated with delayed BCG vaccination were evaluated using logistic regression models. Coverage between intervention and control regions were evaluated in log-binomial regression models providing prevalence ratios.

Results

Among 3951 children born in 2010, vaccination status was assessed for 84%. BCG coverage by 1 week of age was 11%, 38% by 1 month, and 92% by 12 months. If BCG had been given at first contact with the health system, 1-week coverage would have been 35% and 1-month coverage 54%. When monthly visits were introduced in intervention regions, 1-month coverage was higher in intervention regions (88%) than in control regions (51%), the prevalence ratio being 1.74 (1.53-2.00). Several factors, including socioeconomic factors, were associated with delayed BCG vaccination in the 2010-birth cohort. When BCG was available at monthly visits these factors were no longer associated with delayed BCG vaccination, only region of residence was associated with delayed BCG vaccination.

Conclusion

BCG coverage during the first months of life is low in Guinea-Bissau. Providing BCG at monthly vaccination visits removes the risk factors associated with delayed BCG vaccination.
Appendix
Available only for authorised users
Literature
1.
2.
Drain PK, Nelson CM, Lloyd JS: Singe-dose versus multi-dose vaccine vials for immunization programmes in developing countries. Bull World Health Organ. 2003, 81 (10): 726-731.PubMedPubMedCentral
3.
Hutchins SS, Jansen HA, Robertson SE, Evans P, Kim-Farley RJ: Studies of missed opportunities for immunization in developing and industrialized countries. Bull World Health Organ. 1993, 71 (5): 549-560.PubMedPubMedCentral
4.
5.
Fisker AB, Hornshoj L, Rodrigues A, Balde I, Fernandes M, Benn CS, Aaby P: Effects of the introduction of new vaccines in Guinea-Bissau on vaccine coverage, vaccine timeliness, and child survival: an observational study. Lancet Global Health. 2014, 2 (8): e478-e487. 10.1016/S2214-109X(14)70274-8.CrossRefPubMed
6.
Biering-Sorensen S, Aaby P, Napirna BM, Roth A, Ravn H, Rodrigues A, Whittle H, Benn CS: Small randomized trial among low-birth-weight children receiving bacillus Calmette-Guerin vaccination at first health center contact. Pediatr Infect Dis J. 2012, 31 (3): 306-308. 10.1097/INF.0b013e3182458289.CrossRefPubMed
7.
Aaby P, Roth A, Ravn H, Napirna BM, Rodrigues A, Lisse IM, Stensballe L, Diness BR, Lausch KR, Lund N, Biering-Sørensen S, Whittle H, Benn CS: Randomized trial of BCG vaccination at birth to low-birth-weight children: beneficial nonspecific effects in the neonatal period?. J Infect Dis. 2011, 204 (2): 245-252. 10.1093/infdis/jir240.CrossRefPubMed
8.
Shann F: Commentary: BCG vaccination halves neonatal mortality. Pediatr Infect Dis J. 2012, 31 (3): 308-309. 10.1097/INF.0b013e3182465be8.CrossRefPubMed
9.
Roth A, Jensen H, Garly M-L, Djana Q, Martins CL, Sodemann M, Rodrigues A, Aaby P: Low birth weight infants and calmette-guerin bacillus vaccination at birth: community study from Guinea-Bissau. Pediatr Infect Dis J. 2004, 23 (6): 544-550. 10.1097/01.inf.0000129693.81082.a0.CrossRefPubMed
10.
Roth A, Sodemann M, Jensen H, Poulsen A, Gustafson P, Weise C, Gomes J, Djana Q, Jakobsen M, Garly ML, Rodrigues A, Aaby P: Tuberculin reaction, BCG scar, and lower female mortality. Epidemiology. 2006, 17 (5): 562-568. 10.1097/01.ede.0000231546.14749.ab.CrossRefPubMed
11.
Garly ML, Martins CL, Bale C, Balde MA, Hedegaard KL, Gustafson P, Lisse IM, Whittle HC, Aaby P: BCG scar and positive tuberculin reaction associated with reduced child mortality in West Africa. a non-specific beneficial effect of BCG?. Vaccine. 2003, 21 (21–22): 2782-2790.CrossRefPubMed
12.
Velema JP, Alihonou EM, Gandaho T, Hounye FH: Childhood mortality among users and non-users of primary health care in a rural west African community. Int J Epidemiol. 1991, 20 (2): 474-479. 10.1093/ije/20.2.474.CrossRefPubMed
13.
Niobey FM, Duchiade MP, Vasconcelos AG, de Carvalho ML, Leal Mdo C, Valente JG: Risk factors for death caused by pneumonia in children younger than 1 year old in a metropolitan region of southeastern Brazil. a case- control study. Rev Saude Publica. 1992, 26 (4): 229-238.CrossRefPubMed
14.
Kristensen I, Aaby P, Jensen H: Routine vaccinations and child survival: follow up study in Guinea-Bissau, West Africa. BMJ. 2000, 321 (7274): 1435-1438. 10.1136/bmj.321.7274.1435.CrossRefPubMedPubMedCentral
15.
Aaby P, Vessari H, Nielsen J, Maleta K, Benn CS, Jensen H, Ashorn P: Sex differential effects of routine immunizations and childhood survival in rural Malawi. Pediatr Infect Dis J. 2006, 25 (8): 721-727. 10.1097/01.inf.0000227829.64686.ae.CrossRefPubMed
16.
Netea MG, Quintin J, van der Meer JW: Trained immunity: a memory for innate host defense. Cell Host Microbe. 2011, 9 (5): 355-361. 10.1016/j.chom.2011.04.006.CrossRefPubMed
17.
Kleinnijenhuis J, Quintin J, Preijers F, Joosten LAB, Ifrim DC, Saeed S, Jacobs C, van Loenhout J, de Jong D, Stunnenberg HG, Xavier RJ, van der Meer JW, van Crevel R, Netea MG: Bacille Calmette-Guerin induces NOD2-dependent nonspecific protection from reinfection via epigenetic reprogramming of monocytes. Proc Natl Acad Sci U S A. 2012, 109 (43): 17537-17542. 10.1073/pnas.1202870109.CrossRefPubMedPubMedCentral
18.
Lawn JE, Cousens S, Zupan J: 4 million neonatal deaths: when? where? why?. Lancet. 2005, 365: 891-900. 10.1016/S0140-6736(05)71048-5.CrossRefPubMed
19.
Akmatov MK, Mikolajczyk RT: Timeliness of childhood vaccinations in 31 low and middle-income countries. J Epidemiol Community Health. 2012, 66 (7): e14-10.1136/jech.2010.124651.CrossRefPubMed
20.
Burton A, Monasch R, Lautenbach B, Gacic-Dobo M, Neill M, Karimov R, Wolfson L, Jones G, Birmingham M: WHO and UNICEF estimates of national infant immunization coverage: methods and processes. Bull World Health Organ. 2009, 87 (7): 535-541. 10.2471/BLT.08.053819.CrossRefPubMedPubMedCentral
21.
22.
Clark A, Sanderson C: Timing of children’s vaccinations in 45 low-income and middle-income countries: an analysis of survey data. Lancet. 2009, 373 (9674): 1543-1549. 10.1016/S0140-6736(09)60317-2.CrossRefPubMed
23.
Fadnes L, Nankabirwa V, Sommerfelt H, Tylleskär T, Tumwine J, Engebretsen I: Is vaccination coverage a good indicator of ageappropriate vaccination? a prospective study from Uganda. Vaccine. 2011, 29 (19): 3564-3570. 10.1016/j.vaccine.2011.02.093.CrossRefPubMed
24.
Fadnes LT, Jackson D, Engebretsen IM, Zembe W, Sanders D, Sommerfelt H, Tylleskar T, Group P-ES: Vaccination coverage and timeliness in three South African areas: a prospective study. BMC Public Health. 2011, 11: 404-10.1186/1471-2458-11-404.CrossRefPubMedPubMedCentral
25.
Moyer CA, Tadesse L, Fisseha S: The relationship between facility delivery and infant immunization in Ethiopia. Int J Gynecol Obstet. 2013, 123 (3): 217-220. 10.1016/j.ijgo.2013.06.030.CrossRef
Metadata
Title
BCG coverage and barriers to BCG vaccination in Guinea-Bissau: an observational study
Authors
Sanne Marie Thysen
Stine Byberg
Marie Pedersen
Amabelia Rodrigues
Henrik Ravn
Cesario Martins
Christine Stabell Benn
Peter Aaby
Ane Bærent Fisker
Publication date
01-12-2014
Publisher
BioMed Central
Published in
BMC Public Health / Issue 1/2014
Electronic ISSN: 1471-2458
DOI
https://doi.org/10.1186/1471-2458-14-1037

Other articles of this Issue 1/2014

BMC Public Health 1/2014 Go to the issue

Study protocol

Improving lifetime trajectories for vulnerable young children and families living with significant stress and social disadvantage: the early years education program randomised controlled trial

Research article

Food items contributing most to variation in antioxidant intake; a cross-sectional study among Norwegian women

Research article

Herpes zoster vaccine (HZV): utilization and coverage 2009 – 2013, Alberta, Canada

Research article

Prevalence and validity of self-reported smoking in Indigenous and non-Indigenous young adults in the Australian Northern Territory

Research article

Conversation about Serostatus decreases risk of acquiring HIV: results from a case control study comparing MSM with recent HIV infection and HIV negative controls

Research article

Tuberculosis case finding and isoniazid preventive therapy among people living with HIV at public health facilities of Addis Ababa, Ethiopia: a cross-sectional facility based study