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BMC Pediatrics
Published in: BMC Pediatrics 1/2018

Open Access 01-12-2018 | Research article

BCG vaccination in southern rural Mozambique: an overview of coverage and its determinants based on data from the demographic and health surveillance system in the district of Manhiça

Authors: Elena Marbán-Castro, Charfudin Sacoor, Ariel Nhacolo, Orvalho Augusto, Edgar Jamisse, Elisa López-Varela, Aina Casellas, John J. Aponte, Quique Bassat, Betuel Sigauque, Eusebio Macete, Alberto L. Garcia-Basteiro

Published in: BMC Pediatrics | Issue 1/2018

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Abstract

Background

Over the past four decades, the World Health Organization established the Expanded Programme on Immunization (EPI) to foster universal access to all relevant vaccines for all children at risk. The success of this program has been undeniable, but requires periodic monitoring to ensure that coverage rates remain high. The aim of this study was to measure the BCG vaccination coverage in Manhiça district, a high TB burden rural area of Southern Mozambique and to investigate factors that may be associated with BCG vaccination.

Methods

We used data from the Health and Demographic Surveillance System (HDSS) run by the Manhiça Health Research Centre (CISM) in the district of Manhiça. A questionnaire was added in the annual HDSS round visits to retrospectively collect the vaccination history of children under the age of 3 years. Vaccinations are registered in the National Health Cards which are universally distributed at birth. This information was collected for children born from 2011 to 2014. Data on whether a child was vaccinated for BCG were collected from these National Health Cards and/or BCG scar assessment.

Results

A total of 10,875 number of children were eligible for the study and 7903 presented the health card. BCG coverage was 97.4% for children holding a health card. A BCG-compatible scar was observed in 99.0% of all children and in 99.6% of children with recorded BCG in the card. A total of 93.4% of children had been vaccinated with BCG within their first 28 days of life. None of the factors analysed were found to be associated with lack of BCG vaccination except for living in the municipality of Maluana compared to living in the municipality of Manhiça; (OR = 1.89, 95% CI: 1.18-3.00). Coverage for other EPI vaccines during the first year of life was similarly high, but decreased for subsequent doses.

Conclusions

BCG coverage is high and timely administered. Almost all vaccinated infants develop scar, which is a useful proxy for monitoring BCG vaccine implementation.
Appendix
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Literature
1.
2.
Roth A, Garly ML, Jensen H, Nielsen J, Aaby P. Bacillus Calmette-Guerin vaccination and infant mortality. Exp Rev Vaccines. 2006;5(2):277–93.CrossRef
3.
4.
Van-Dunem JC, Rodrigues LC, Alencar LC, Militao-Albuquerque Mde F, Ximenes RA. Effectiveness of the first dose of BCG against tuberculosis among HIV-infected, predominantly immunodeficient children. Biomed Res Int. 2015;2015:275029.CrossRefPubMedPubMedCentral
5.
Dhanawade SS, Kumbhar SG, Gore AD, Patil VN. Scar formation and tuberculin conversion following BCG vaccination in infants: a prospective cohort study. J Family Med Prim Care. 2015;4(3):384–7.CrossRefPubMedPubMedCentral
6.
Abubakar I, Pimpin L, Ariti C, Beynon R, Mangtani P, Sterne JA, et al. Systematic review and meta-analysis of the current evidence on the duration of protection by bacillus Calmette-Guerin vaccination against tuberculosis. Health Technol Assess. 2013;17(37):1–372. v-viCrossRefPubMedPubMedCentral
7.
Roy A, Eisenhut M, Harris RJ, Rodrigues LC, Sridhar S, Habermann S, et al. Effect of BCG vaccination against mycobacterium tuberculosis infection in children: systematic review and meta-analysis. BMJ (Clinical research ed). 2014;349:g4643.
8.
9.
Nguipdop-Djomo P, Heldal E, Rodrigues LC, Abubakar I, Mangtani P. Duration of BCG protection against tuberculosis and change in effectiveness with time since vaccination in Norway: a retrospective population-based cohort study. Lancet Infect Dis. 2016;16(2):219–26.CrossRefPubMed
10.
Storgaard L, Rodrigues A, Martins C, Nielsen BU, Ravn H, Benn CS, et al. Development of BCG scar and subsequent morbidity and mortality in rural Guinea-Bissau. Clin Infect Dis. 2015;61(6):950–9.CrossRefPubMed
11.
Roth A, Gustafson P, Nhaga A, Djana Q, Poulsen A, Garly ML, et al. BCG vaccination scar associated with better childhood survival in Guinea-Bissau. Int J Epidemiol. 2005;34(3):540–7.CrossRefPubMed
12.
Consonni D, Montenegro Agorostos Karagianis MM, Bufardeci G. Immunisation with BCG in the Maringue District, Sofala Province, Mozambique. Tuberc Res Treat. 2013;2013:312065.PubMedPubMedCentral
13.
Pang Y, Kang W, Zhao A, Liu G, Du W, Xu M, et al. The effect of bacille Calmette-Guerin vaccination at birth on immune response in China. Vaccine. 2015;33(1):209–13.CrossRefPubMed
14.
Animaw W, Taye W, Merdekios B, Tilahun M, Ayele G. Expanded program of immunization coverage and associated factors among children age 12-23 months in Arba Minch town and Zuria District, southern Ethiopia, 2013. BMC Public Health. 2014;14:464.CrossRefPubMedPubMedCentral
15.
Le Polain de Waroux O, Schellenberg JR, Manzi F, Mrisho M, Shirima K, Mshinda H, et al. Timeliness and completeness of vaccination and risk factors for low and late vaccine uptake in young children living in rural southern Tanzania. Int Health. 2013;5(2):139–47.CrossRefPubMed
16.
Scott S, Odutola A, Mackenzie G, Fulford T, Afolabi MO, Lowe Jallow Y, et al. Coverage and timing of children’s vaccination: an evaluation of the expanded programme on immunisation in the Gambia. PLoS One. 2014;9(9):e107280.CrossRefPubMedPubMedCentral
17.
Fadnes LT, Jackson D, Engebretsen IM, Zembe W, Sanders D, Sommerfelt H, et al. Vaccination coverage and timeliness in three south African areas: a prospective study. BMC Public Health. 2011;11:404.CrossRefPubMedPubMedCentral
18.
19.
Schoeps A, Ouedraogo N, Kagone M, Sie A, Muller O, Becher H. Socio-demographic determinants of timely adherence to BCG, Penta3, measles, and complete vaccination schedule in Burkina Faso. Vaccine. 2013;32(1):96–102.CrossRefPubMed
20.
Gram L, Soremekun S, ten Asbroek A, Manu A, O'Leary M, Hill Z, et al. Socio-economic determinants and inequities in coverage and timeliness of early childhood immunisation in rural Ghana. Tropical Med Int Health. 2014;19(7):802–11.CrossRef
21.
Gidado S, Nguku P, Biya O, Waziri NE, Mohammed A, Nsubuga P, et al. Determinants of routine immunization coverage in Bungudu, Zamfara state, northern Nigeria, may 2010. Pan Afr Med J. 2014;18(Suppl 1):9.PubMedPubMedCentral
22.
Thysen SM, Byberg S, Pedersen M, Rodrigues A, Ravn H, Martins C, et al. BCG coverage and barriers to BCG vaccination in Guinea-Bissau: an observational study. BMC Public Health. 2014;14:1037.CrossRefPubMedPubMedCentral
23.
Odusanya OO, Alufohai EF, Meurice FP, Ahonkhai VI. Determinants of vaccination coverage in rural Nigeria. BMC Public Health. 2008;8:381.
24.
Thorpe S, VanderEnde K, Peters C, Bardin L, Yount KM. The influence of Women’s empowerment on child immunization coverage in low, lower-middle, and upper-middle income countries: a systematic review of the literature. Matern Child Health J. 2016;20(1):172–86.CrossRefPubMed
25.
Garcia-Basteiro AL, Lopez-Varela E, Respeito D, Gonzalez R, Naniche D, Manhica I, et al. High tuberculosis burden among people living with HIV in southern Mozambique. Eur Respir J. 2015;45(2):547–9.CrossRefPubMed
26.
Garcia-Basteiro AL, Respeito D, Augusto OJ, Lopez-Varela E, Sacoor C, Sequera VG, et al. Poor tuberculosis treatment outcomes in southern Mozambique (2011-2012). BMC Infect Dis. 2016;16:214.CrossRefPubMedPubMedCentral
27.
28.
29.
Lanaspa M, Balcells R, Sacoor C, Nhama A, Aponte JJ, Bassat Q. The performance of the expanded programme on immunization in a rural area of Mozambique. Acta Trop. 2015;149:262–6.CrossRefPubMed
30.
Marais BJ, Seddon JA, Detjen AK, van der Werf MJ, Grzemska M, Hesseling AC, et al. Interrupted BCG vaccination is a major threat to global child health. Lancet Respir Med. 2016;4(4):251–3.CrossRefPubMed
31.
Sacoor C, Nhacolo A, Nhalungo D, Aponte JJ, Bassat Q, Augusto O, et al. Profile: Manhica health research centre (Manhica HDSS). Int J Epidemiol. 2013;42(5):1309–18.CrossRefPubMed
32.
Gonzalez R, Munguambe K, Aponte J, Bavo C, Nhalungo D, Macete E, et al. High HIV prevalence in a southern semi-rural area of Mozambique: a community-based survey. HIV medicine. 2012;13(10):581–8.CrossRefPubMed
33.
García-Basteiro AL, Miranda Ribeiro R, Brew J, Sacoor C, Valencia S, Bulo H, Cobelens F, Macete E. Tuberculosis on the rise in southern Mozambique (1997-2012). Eur Respir J. 2017;49(3).
34.
35.
Lopez-Varela E, Augusto OJ, Guerra L, Respeito D, Sacoor C, Sacarlal J, et al. Low paediatric tuberculosis case detection rate in southern Mozambique. Eur Respir J. 2016;47(3):1003–5.CrossRefPubMed
36.
Lopez-Varela E, Augusto OJ, Gondo K, Garcia-Basteiro AL, Fraile O, Ira T, et al. Incidence of tuberculosis among young children in rural Mozambique. Pediatr Infect Dis J. 2015;34(7):686–92.CrossRefPubMed
37.
Vyas S, Kumaranayake L. Constructing socio-economic status indices: how to use principal components analysis. Health Policy Plan. 2006;21(6):459–68.CrossRefPubMed
38.
A Prospective Study of Bacillus Calmette-Guérin Scar Formation and Tuberculin Skin Test Reactivity in Infants in Lima, Peru. Pediatrics. 2003;112(4):e298.
39.
Santiago EM, Lawson E, Gillenwater K, Kalangi S, Lescano AG, Du Quella G, et al. A prospective study of bacillus Calmette-Guerin scar formation and tuberculin skin test reactivity in infants in lima. Peru Pediatrics. 2003;112(4):e298.CrossRefPubMed
40.
Timmermann CA, Biering-Sorensen S, Aaby P, Fisker AB, Monteiro I, Rodrigues A, et al. Tuberculin reaction and BCG scar: association with infant mortality. Tropical Med Int Health. 2015;20(12):1733–44.CrossRef
Metadata
Title
BCG vaccination in southern rural Mozambique: an overview of coverage and its determinants based on data from the demographic and health surveillance system in the district of Manhiça
Authors
Elena Marbán-Castro
Charfudin Sacoor
Ariel Nhacolo
Orvalho Augusto
Edgar Jamisse
Elisa López-Varela
Aina Casellas
John J. Aponte
Quique Bassat
Betuel Sigauque
Eusebio Macete
Alberto L. Garcia-Basteiro
Publication date
01-12-2018
Publisher
BioMed Central
Published in
BMC Pediatrics / Issue 1/2018
Electronic ISSN: 1471-2431
DOI
https://doi.org/10.1186/s12887-018-1003-4

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