Immunisation in sub-Saharan Africa: Coverage, geographical variations and the hotspots

Background: Expanded Programme on Immunisation is one of the most cost-effective public health intervention for reaching the newly set Sustainable Development Goals. It helps ascertain the level of the reduction of child... [ view full abstract ]

Background: Expanded Programme on Immunisation is one of the most cost-effective public health intervention for reaching the newly set Sustainable Development Goals. It helps ascertain the level of the reduction of child morbidity and mortality in countries with poor performing health statistics such as seen in sub-Saharan Africa. This study seeks to evaluate level of coverage for basic childhood vaccinations, geographical variation and to identify the “hotspot of low performance” among sub-Saharan Africa countries.

Methods: The study used data from the cross-sectional, population-based Demographic and Health Survey (DHS) from different countries in sub-Saharan Africa. The study involved 28 countries with DHS that are within the time frame of 2010-2015. Descriptive and spatial data analysis methods were used to determine the coverage level and geographic variation in children aged 12-23 months who received all basic vaccinations at any time before the survey. Kruskal-Wallis test was also used in the analysis.

Results: The basic vaccination coverage ranged from 24.3% in Ethiopia to 90.1% in Rwanda. On average, the countries of West African, Central/East African and Southern African sub-regions recorded 57.2%, 56.2% and 69.2% respectively. There was no significant differences among the three sub-regions, p= 0.335. Congo (Brazzaville), Congo Democratic Republic, Cote d'Ivoire, Ethiopia, Gabon, Guinea and Nigeria had regional hotspots of poor performance. Affar and North West regions of Ethiopia and Nigeria had the lowest performance at less than 10%. However, 11 of the countries had at least a region with a high level coverage.

Conclusions: The combined use of statistical and geographic system analysis contributes to better understanding of the geographical disparity and identification of poor performing areas for vaccination coverage among children in sub-Saharan Africa. This is useful for customising intervention strategies for local regions, countries and more efficient allocation of limited resources.