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Research Evaluation of Access and Utilization of EPI Services Amongst Children 12-23 Months in Kwahu Afram Plains, Eastern Region, Ghana

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Research Evaluation of Access and Utilization of EPI Services Amongst Children 12-23 Months in Kwahu Afram Plains, Eastern Region, Ghana Open Access Research Evaluation of access and utilization of EPI services amongst children 12-23 months in Kwahu Afram Plains, Eastern region, Ghana Emmanuel Tettey Sally1,2, Ernest Kenu1,& 1Department of Epidemiology and Disease Control, School of Public Health, University of Ghana, Accra, Ghana, 2Eastern Regional Health Directorate, Ghana Health Service, Koforidua, Ghana &Corresponding author: Ernest Kenu, Department of Epidemiology and Disease Control, School of Public Health, University of Ghana, Accra, Ghana Key words: Immunization Programs, Utilization, Program Accessibility, coverage, vaccination, EPI Received: 31/12/2016 - Accepted: 14/11/2017 - Published: 15/11/2017 Abstract Introduction: High vaccination coverage is required to successfully control, eliminate and eradicate vaccine preventable diseases (VPDs). In Ghana, access complete vaccination coverage is 77%. However, sustaining high coverages in island communities such as Kwahu Afram Plains North (KAPN) is still a challenge. Methods: Study site and settings, an Island district. It targeted children aged 12–23 months. We used a modified WHO EPI 30 by 7 cluster sampling approach. Semi-structured questionnaires were employed for data collection. Wincosas and EpiInfo were used for data entry, management and analysis. The vaccination coverage, antigen-specific coverage calculated. The probability was set at 0.05 and the value was calculated to determine statistical significance of association. Results: Of the 480 records of children analysed, fully vaccinated accounted 81.3%, partially 16.7% and not vaccinated at all 2.1%. Access was 97.3% and utilization 91.2% with Pentavalent 1-3 dropout rate of 8.8%. Coverage for specific antigens were: BCG (97.1%), OPV 1/Pentavalent 1/PCV 1/Rotarix 1 (97.3%), OPV2/ Pentavalent 2/PCV 2/Rotarix 2 (94.0%), OPV3/ Pentavalent3/PCV 3 (88.8%), MR (87.7%) and YF (87.7%). Vaccination card availability, higher educational level of mothers and lower parity levels were significantly associated (p < 0.05) positively with childhood vaccination status. Invalid doses were 21.6% of childhood total vaccinations. Key reasons accounting for non-vaccination were: distant place of immunization 34.4 % (31/90), mother being busy 14.4% (13/90), vaccine unavailability 10.0% (9/90) and fears of side reactions 8.9% (8/90). Conclusion: EPI childhood vaccination coverage for January, 2016 in KAPN District was high. There is the need to focus on counteracting the reasons identified to account for vaccination failure. This would improve and sustain vaccination coverage. Pan African Medical Journal. 2017;28:238. doi:10.11604/pamj.2017.28.238.11538 This article is available online at: http://www.panafrican-med-journal.com/content/article/28/238/full/ © Emmanuel Tettey Sally et al. The Pan African Medical Journal - ISSN 1937-8688. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Pan African Medical Journal – ISSN: 1937- 8688 (www.panafrican-med-journal.com) Published in partnership with the African Field Epidemiology Network (AFENET). (www.afenet.net) Page number not for citation purposes 1 Introduction and measles-rubella vaccine at 9 and 18 months of age [9]. Immunizations are recorded on child health records cards obtained from the clinics. In KAPN, DPT3 administrative coverage for 2014 Immunization remains one of the most important public health was 89.9%. However, a complete vaccination coverage survey has interventions and a cost effective strategy to reduce both the not been conducted in KAPN within the past eight years. morbidity and mortality associated with infectious diseases. The Administrative coverages, though with unreliable targets still records World Health Organization, in 1974, initiated the Expanded dropout of more than 10%. Reasons for this drop-out rate are still Programme of Immunization (EPI) as a recommendation from the not known. Administrative data validation is a requirement by WHO. World Health Assembly (WHA). This was to help member states This study therefore sought to find out the coverage rate of children develop an immunization and surveillance programme against aged 12 - 23 months in KAPN as well as to identify the factors that Measles, Poliomyelitis, Tuberculosis, Diphtheria, Pertussis and influence it so as to propose recommendations for interventions and Tetanus. EPI has led to high vaccination coverages of about 80% increase the immunization coverage. for the six major vaccine preventable diseases: pertussis, childhood tuberculosis, tetanus, polio, measles and diphtheria [1]. WHO reports that an estimated number of 1.5 million deaths among children under-five years occurred in 2008 from diseases that could Methods have been prevented through routine vaccinations. These diseases were measles, diphtheria, tuberculosis, tetanus, whooping Study site and settings cough/pertussis, poliomyelitis, yellow fever, hepatitis B and haemophilus influenza type B infection [2]. Immunization coverage KAPN district was created in 1988 out of the Kwahu District Council levels and trends are used to monitor the performance of as part of Local Government reform policy. The district is located in immunization services locally, nationally and internationally; to guide the northern- part of the Eastern Region, covering a total land mass strategies for the eradication, elimination and control of vaccine- of 3,210km2. The district capital is Donkorkrom with 238 preventable diseases [2-4]. communities. It may be described as more of an island than peninsular as it can only be reached by ferries in the South-west In developed countries, where accurate recording of immunization and North-east. The districts estimated population is 113,806. It is a and reporting of diseases is in place, most vaccine-preventable rural district; majority are farmers with low socio-economic status diseases are at or near record lows [5]. About three quarters of the and health service access far below standard. world’s child population is reached with the required vaccines, however in sub-Saharan Africa only half of the children get access Community-based Health Planning and Services (CHPS) centres to basic immunization. The worse happens in poor remote and hard form majority of the health facilities in the district. Routine to reach areas of developing countries, where one in twenty vaccinations activities are organized using two main approaches, children have access to vaccination [6]. Globally, vaccination thus static and outreach. All CHPS centres render static vaccinations coverage is steady with 86% of children receiving DPT 3 in 2014 services every day. However, each facility has a specific day in a [7]. However, an estimated 18.7 million infants worldwide were not week where Child Welfare Clinic (CWC) are organized; usually linked reached with basic vaccines in 2014. In Ghana, DPT3 administrative to their market days. There are also planned days for outreach coverages were 93.2% and 89.9% respectively for 2014. The services at the community level where they are supported by complete immunization coverage in Ghana in 1993 was 54.8% and community health volunteers. These services availability is solely this rose gradually in 2008 to 79.0% and declined to 77.3% in 2014 dependent on resources (staff, funds, fuel, EPI logistics and boats, [8]. These unvaccinated children can build up as enough susceptible motor-bikes). The session of vaccinations begins with a health talk population over time and contribute to disease outbreaks. Ghana’s on a subject by a nurse. All vaccinations are provided free of Expanded Programme on Immunization policy recommends that charge. children receive Bacillus Calmette-Guerin (BCG) and Oral Polio Vaccine (OPV) at birth; three doses of Pentavalent vaccine, PCV and OPV at 6, 10 and 14 weeks of age, Rotarix at 6, 10 weeks of age Page number not for citation purposes 2 Study design Data management and analysis A community-based cross-sectional study was conducted in which The data from the field was cleaned, coded and double entered into 480 mothers/guardians with children aged 12 - 23 months were WinCosas and EpiInfo statistical package. The data were analyzed interviewed. The participants had to meet the inclusion criteria of and descriptive statistics was run for continues variables. The being residents in the study area for a period of not less than 1 vaccination coverage, antigen-specific coverage calculated and year. A two-stage cluster sampling was used. Stage one, cluster confidence interval of 95% determined. Vaccination coverages were identification was done through the use of Ghana statistical service calculated as crude, valid before 52 weeks. Quality of the department Electoral Areas (EA) as clusters. Each EA was vaccination was accessed by the presence of vaccination cards and considered as clusters, which represented the primary sampling unit invalid doses given. Bivariate analysis using Pearson’s Chi -Square (PSU). In all thirty (30) clusters were selected randomly. No village test was used to evaluate the association between the vaccination was excluded from the sampling frame. Maps of the selected status and socio-demographic factors like sex of child, vaccination clusters were obtained from the KAPN health directorate which card availability, mother’s age, parity, educational status, marital aided in
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