Skip to main content

Advertisement

We're creating a new version of this page. See preview

  • Research note
  • Open Access

Immunization coverage and factors associated with incomplete vaccination in children aged 12 to 59 months in health structures in Lomé

  • 1, 2,
  • 1, 2, 3Email author,
  • 2,
  • 2,
  • 2,
  • 4, 5,
  • 4, 6 and
  • 4, 7
BMC Research Notes201912:84

https://doi.org/10.1186/s13104-019-4115-5

  • Received: 13 December 2018
  • Accepted: 6 February 2019
  • Published:

Abstract

Objective

To estimate the immunization coverage among children admitted for consultation or hospitalization in health structures of Lomé.

Results

A total of 797 respondent–child couples were included and 31.1% of them had their immunization cards. Complete immunization coverage was 69.3%, 95% confidence interval (65.9–72.5) and per antigen, it ranged from 83.1% for measles to 95.7% for BCG. Factors associated with incomplete immunization were the absence of immunization card (p < 0.001), respondents’ sex (p < 0.001), level of education (p < 0.001), marital status (p < 0.001) and the level of the health structure in the organization of the Togolese health system (p < 0.001). Obstacles to immunization were mainly the lack of money to pay for immunization fees (38.4%) and forgetting the immunization appointment (28.1%).

Keywords

  • Immunization coverage
  • Associated factors
  • Obstacles
  • Hospital studies
  • Togo

Introduction

Immunization is one of the most cost effective health interventions which helps prevent 2–3 million deaths per year [1]. To protect children against vaccine preventable diseases and to facilitate their access to vaccines, the World Health Organization (WHO) and United Nations International Children’s Emergency Fund (UNICEF) have implemented in 1977 the Expanded Program on Immunization (EPI) [2]. In Togo, the implementation of EPI is effective since 1980. Nowadays, it has become one of the country’s public health priorities [3].

Monitoring of immunization program is usually carried out through vaccination coverage surveys. The first surveys conducted in Togo used the WHO cluster survey methodology [4] or household surveys such as the demographic and health surveys (DHS) or the Multiple Indicator Cluster Survey (MICS). According to the third DHS conducted in 2013–2014 in Togo, 61% of children aged 12–23 months were fully immunized based on immunization cards or mother’s recall, and the immunization coverage was higher in urban (66%) than in rural area (59%) [5]. In 2010, immunization coverage was estimated at 63.8% among children aged less than 5 years in the fourth MICS [6].

Vaccination coverage surveys are often difficult to carry out because of their high financial cost, information bias when immunization cards are not available and households characteristics (geographic inaccessibility, climatic and security issues) [7]. Consequently, these surveys are not regularly conducted. However, it is important to monitor vaccination coverage indicators on a regular basis. Other sources of information on immunization coverage, such as hospital studies, must be explored to assess these indicators. Therefore, this study aimed to estimate vaccination coverage among children aged 12–59 months seen in medical consultation or hospitalized in health structures in Lomé.

Main text

Methods

Study design and population

A cross-sectional study was carried out from April to August 2017 in five health structures in Lomé. Togo health system has a three-level pyramid structure: tertiary, secondary and primary levels. Therefore, we selected at least one health structure at each level of the health pyramid. The study was conducted in the two teaching hospitals (out of two) from tertiary level (Centres Hospitaliers Universitaires Sylvanus Olympio and Campus), two secondary-level health structures (out of two) (Centre Hospitalier Régional Lomé-Commune and Hôpital de Bè) and one randomly selected (out of 140) primary-level health structure (Centre Medico Social Adidogomé).

All children aged 12–59 months hospitalized or seen in consultation in selected health structures during the survey period were eligible for this study. At this age, children should have received all vaccines according to the EPI schedule in Togo. A systematic sampling method was used to select eligible participants. The health card of recruited children was marked with a sticker to avoid double counting.

With a vaccination coverage estimated at 61%, a precision of 4% and a significance level of 5%, the minimum sample size was estimated at 571 respondent–child couples.

Data collection

A 10-min pre-tested questionnaire was administered to children’s respondent during a face-to-face interview. Information collected included data on child’s health and immunization, the respondent’s socio-demographic characteristics and knowledge on immunization, as well as the reasons for incomplete immunization. The availability of the immunization card was also assessed. If the card was not available, the vaccine injection sites were showed to the respondent for recall purpose.

Definition of variables

Complete immunization coverage was defined as the immunization status of a child who received all the doses of vaccines recommended by the Togo’s EPI, including one dose of tuberculosis vaccine (BCG), four doses of oral poliomyelitis vaccine (OPV), three doses of pentavalent (PENTA) vaccine (conjugate vaccine against diphtheria, tetanus, pertussis, hepatitis viral B and infections to Haemophilus influenzae b), three doses of pneumococcus vaccine (PNEUMO), two doses of rotavirus vaccine (ROTA), one dose of measles vaccine, one dose against rubella and one dose against yellow fever [8]. Otherwise, immunization status was defined as incomplete.

A knowledge score on immunization was constructed with five questions based on routine recommendations provided by midwives to parents after childbirth, including the total number of required immunization sessions, number of vaccines to be administered to children, ages at first and last vaccine, and citing at least two EPI vaccines. Each correct answer was worth one point and total score ranged from 0 (no correct answer) to 5 (correct answers to all five items).

Statistical analysis

Descriptive statistics were performed and results were presented with frequency tabulations and percentages. Quantitative variables were presented as medians with their interquartile range (IQR). Prevalence rates were estimated with their 95% confidence interval (95% CI). Logistic regression analyses were performed to identify factors associated with “incomplete immunization coverage”. All analyses were performed using R® software.

Results

A total of 797 were enrolled in the study, resulting in a response rate of 96.1% and 42.9%, 25.5% and 31.6% of study participants were recruited in primary, secondary and tertiary level health structures, respectively.

Respondents were mainly mothers (91.6%), with median age of 30 years, (IQR: 26–34) and 45.5% had a secondary school level education. Children’s median age was 25 months (IQR: 17–36) and 51.7% of recruited children were male (Table 1).
Table 1

Sociodemographic characteristics of respondents and children according to the health structure level

Characteristics

Health structures (N = 797)

Total

Primary level

Secondary level

Tertiary level

n

%

n

%

n

%

N

%

Respondent

 Sex

  Female

321

93.8

197

97.1

238

94.4

756

94.9

  Male

21

6.2

6

2.9

14

5.6

41

5.1

 Relationship between respondent and child

  Mother

313

91.5

187

92.1

230

91.3

730

91.6

  Father

12

3.4

7

3.4

12

4.7

31

3.9

  Grand parents

5

1.5

5

2.5

7

2.8

17

2.1

  Tutor

2

0.6

1

0.5

0

3

0.4

  Brother/sister

3

0.9

0

0

3

0.4

  Other

7

2.1

3

1.5

3

1.2

13

1.6

 Education level of respondent

  No education

43

12.6

32

15.8

28

11.1

103

12.9

  Primary

93

27.2

50

24.6

51

20.2

194

24.3

  Secondary

162

47.3

89

43.8

112

44.4

363

45.5

  Higher

42

12.3

32

15.8

61

24.3

135

17.0

  MD

2

0.6

0

0

2

0.3

 Median age group

  < 30 years

206

60.2

99

48.8

132

52.4

437

54.8

  ≥ 30 years

128

37.5

103

50.7

120

47.6

351

44.1

  MD

8

2.3

1

0.5

0

9

1.1

 Marital status

  Never in union

48

14.0

21

10.4

14

5.6

83

10.4

  Married

262

76.6

182

89.6

230

91.3

674

84.5

  Other

32

9.4

0

8

3.1

40

5.1

 Occupation

  Not working

6

1.7

7

3.4

18

7.1

31

3.9

  Salaried employee

21

6.1

13

6.4

45

17.9

79

9.9

  Housewife

53

15.5

27

13.3

65

25.8

145

18.2

  Retailer (self employed)

122

35.7

79

39.0

47

18.6

248

31.1

  Other

140

41.0

77

37.9

77

30.6

294

36.9

Child

 Sex

  Male

157

45.9

115

56.6

140

55.6

412

51.7

  Female

185

54.1

88

43.4

112

44.4

385

48.3

 Age group (months)

  12–24

149

43.6

120

59.1

129

51.2

398

49.9

  24–36

98

28.6

46

22.7

70

27.8

214

26.9

  36–59

95

27.8

37

18.2

53

21.0

185

23.2

 Place of birth

  Public structure

266

77.8

161

79.3

205

81.3

632

79.3

  Private structure

71

20.8

37

18.2

46

18.3

154

19.3

  Home

1

0.3

3

1.5

0

4

0.5

  Other

4

1.1

2

1.0

1

0.4

7

0.9

MD: missing data

Possession of immunization card

Among recruited children, 31.1% came to the health care center with an immunization card. The proportion of children having an immunization card was 22.2%, 39.9% and 35.3% in primary, secondary and at tertiary level health structures, respectively (p < 0.001). The reasons for the absence of the immunization card were: leaving the card at home (91.9%), never having a card for the child (4.6%) and the loss of the card (3.5%).

Immunization coverage

Complete immunization coverage in our study was 69.3% (95% CI 65.9–72.5). It was 70.0% in primary level, 76.1% in the secondary level and 62.8% in tertiary level health structures (p = 0.005).

Among the 541 children who did not have an immunization card, complete immunization coverage was 62.3% and was 84.6% among the 247 children who had immunization cards (p = 0.002).

For all children, this coverage was 95.7%, 94.7% and 87.6% for BCG, the first dose (OPV-0) and the fourth dose of poliovirus vaccine (OPV-3), respectively. For pentavalent vaccine, the coverage ranged from 94.2% for PENTA 1 to 87.8% for PENTA 3 while it was 83.1% for measles and 71.9% for yellow fever (Table 2).
Table 2

Immunization coverage of children by antigen

 

Health structures (N = 797)

Total

Primary level

Secondary level

Tertiary level

N

n

%

N

n

%

N

n

%

N

n

%

All children

342

  

203

  

252

  

797

  

BCG

 

330

96.5

 

190

93.6

 

243

96.4

 

763

95.7

PENTA 1/PNEUMO 1

 

329

96.2

 

190

93.6

 

213

84.5

 

751

94.2

PENTA 2/PNEUMO 2

 

326

95.3

 

188

92.6

 

222

88.1

 

736

92.4

PENTA 3/PNEUMO 3

 

306

89.5

 

178

87.7

 

216

85.7

 

700

87.8

OPV-0

 

328

95.9

 

185

91.1

 

242

96.0

 

755

94.7

OPV-1

 

327

95.6

 

186

91.6

 

231

91.7

 

744

93.4

OPV-2

 

325

95.0

 

184

90.6

 

222

88.1

 

731

91.7

OPV-3

 

307

89.8

 

177

87.2

 

214

84.9

 

698

87.6

ROTA-1

 

289

84.5

 

171

84.2

 

197

78.2

 

657

82.4

ROTA-2

 

291

85.1

 

166

81.8

 

198

78.6

 

655

82.2

Measles/rubella

 

245

71.6

 

156

76.8

 

178

70.6

 

579

83.1

Yellow fever

 

241

70.5

 

159

78.3

 

173

68.6

 

573

71.9

BCG: Bacillus Calmette–Guerin; Penta: pentavalent vaccine (vaccine against diphtheria, Tetanus, pertussis, hepatitis B and Haemophilus influenzae); OPV: oral polio vaccine; Pneumo: Pneumococcus conjugated vaccine; Rota: rotavirus vaccine

Knowledge on immunization

Nearly 62.9% of respondents were unaware of the number of required immunization sessions and 96.0% did not know the number of vaccines children must receive. Almost three-quarters (73.2%) of respondents had cited two Togo EPI vaccines. Ages at first and last vaccine were given by 4.7% and 20.3% of respondents, respectively. Knowledge scores on immunization varied from 0 (7.9%) to 3 (8.9%) and a score of 1 and 2 was reported for 45.0% and 38.2% of respondents respectively. Respondent’s knowledge on immunization was higher in primary level health structures (75.0% with a score of 3/5) compared with that of respondents of tertiary level health structures (25.0% with a score of 3/5) (p = 0.076).

Barriers to immunization

Among respondents of children with incomplete immunization (n = 242), 38.4% did not have money to pay for immunization fees; 28.1% reported that they forgot the immunization appointment and 8.7% did not have time to take their children to a health care center for vaccination.

The long waiting time at the health structure (5.4%), the lack of vaccines (4.1%) and the long distance from home to the health structure (2.1%) were cited as the main contextual factors. Cultural beliefs or prohibitions were mentioned by 11.6% of respondents of children who were partially immunized.

Factors associated with incomplete immunization

After adjustment on the other variables, being a male respondent (aOR: 2.7; 1.3–5.7; p < 0.001), being not married (aOR: 2.6; 1.6–3.9; p < 0.001), having primary education level (aOR: 2.2; 1.6–3.2; p < 0.001), not having an immunization card (aOR: 3.5; 2.4–5.4; p < 0.001) and attending primary level health structure (aOR: 2.0; 1.3–3.2; p < 0.001) were associated with incomplete immunization (Table 3).
Table 3

Factors associated with incomplete immunization coverage 

Characteristics of respondents (N)

Children fully immunized

Children partially or no immunized

Univariate analysis

Multivariate analysis

N

%

N

%

OR

95% CI

p-value

aOR

95% CI

p-value

Sex (n = 785)

      

0.008

  

< 0.001

 Female

527

96.9

223

92.5

1

  

1

  

 Male

17

3.1

18

7.5

2.5

[1.3; 4.9]

 

2.7

[1.3; 5.8]

 

Relationship between respondent and child (n = 784)

      

0.002

   

 Mother

515

94.5

210

87.9

1

     

 Other

30

5.5

29

12.1

2.4

[1.4; 4.1]

    

Education level (n = 787)

      

< 0.001

  

< 0.001

 > Primary

371

67.9

123

51.0

1

  

1

  

 ≤ Primary

175

32.1

118

49.0

2.0

[1.5; 2.8]

 

2.2

[1.6; 3.1]

 

Median age group (n = 780) (years)

      

0.323

   

 ≥ 30

247

45.7

100

41.8

1

     

 < 30

294

54.3

139

58.2

1.2

[0.9; 1.6]

    

Marital status (n = 787)

      

< 0.001

  

< 0.001

 Married

484

88.6

184

76.4

1

  

1

  

 Other

62

11.4

57

23.6

2.4

[1.6; 3.6]

 

2.6

[1.6; 4.0]

 

Religion (n = 786)

      

0.0022

   

 Catholic

232

42.6

75

31.1

1

     

 Protestant

155

28.4

66

27.4

1.3

[0.9; 1.9]

    

 Muslim

72

13.2

52

21.6

2.2

[1.4; 2.5]

    

 Other

86

15.8

48

19.9

1.7

[1.1; 2.7]

    

Occupation (n = 785)

      

0.002

  

0.053

 Not working

23

4.2

7

2.9

1

  

1

  

 Salaried employee

66

12.1

12

5.0

0.6

[0.2; 1.8]

 

0.6

[0.2; 1.9]

 

 Housewife

81

14.9

63

26.3

2.6

[1.1; 6.8]

 

1.8

[0.7; 5.1]

 

 Retailer (self employed)

174

31.9

71

29.6

1.3

[0.6; 3.5]

 

1.1

[0.4; 3.1]

 

 Other

201

36.9

87

36.2

1.4

[0.6; 3.3]

 

1.2

[0.5; 3.2]

 

House type (n = 786)

      

0.3944

   

 Multiple dwelling unit

323

59.3

135

56.0

1

     

 Single family home

222

40.7

106

44.0

1.1

[0.8; 1.6]

    

Health structures (n = 788)

      

0.008

  

<0.001

 Secondary level

153

28.0

48

19.8

1

  

1

  

 Tertiary level

157

28.8

93

38.5

1.4

[0.9; 2.0]

 

1.0

[0.7; 1.6]

 

 Primary level

236

43.2

101

41.7

1.9

[1.2; 2.9]

 

2.0

[1.3; 3.2]

 

Sex of the child (n = 786)

      

0.3544

   

 Female

266

48.8

109

45.2

1

     

 Male

279

51.2

132

54.8

1.1

[0.8; 1.6]

    

Age of child (n = 788) (months)

      

0.9514

   

 12–24

286

52.4

124

51.2

1

     

 24–36

136

24.9

61

25.2

1.0

[0.7; 1.5]

    

 36–59

124

22.7

57

23.6

1.1

[0.7; 1.5]

    

Birth order (n = 764)

      

0.031

   

 1

213

40.0

70

30.1

1

     

 2

162

30.5

80

34.5

1.5

[1.0; 2.2]

    

 ≥ 3

157

29.5

82

35.4

1.6

[1.1; 2.3]

    

Availability of immunization card (n = 779)

      

< 0.001

  

< 0.001

 Yes

209

38.7

38

15.9

1

  

1

  

 No

331

61.3

201

84.1

3.3

[2.3; 4.9]

 

3.5

[2.4; 5.4]

 

Knowledge level (n = 89)

      

0.197

   

 ≥ 2

32

46.4

6

30.0

1

     

 ≤ 1

37

53.6

14

70.0

2.0

[0.7; 6.3]

    

aOR: adjusted odds-ratio; CI: confidence interval

Discussion

Overall, complete immunization coverage observed in the present study is similar to that reported in household surveys in 2013 and 2017 in Lomé with 62.2% and 72.3% respectively [6, 9]. Although comparisons of immunization coverages must be done with caution because of difference in studies’ methods (including the availability of immunization cards and the age range of study population), it should be noted that carrying out hospital-based study in Togo could be an opportunity to obtain immunization indicators at no additional cost. Indeed, in Togo, data on maternal and infant deaths are compiled weekly and immunization data can be collected as part of this existing surveillance system.

The immunization card is a paper used to record and track immunization coverage. In Togo, for household surveys conducted in 2012 and in 2013, it was available for 77% and 70% of recruited children, respectively [5, 10]. Difference in the availability of immunization card can be explained by the study setting and the study population. The proportion of children who came to the hospital with their immunization card was greater than that of 24% observed in a multicenter study conducted in Cameroon, Central African Republic and Senegal, among hospitalized children aged 3 months to 6 years between April 2009 and May 2010 [11]. In our study, nine respondents in ten who did not have the immunization card declared that the card was left at home while the children of household surveys were aged 12–23 months, with higher odds of immunization card retention [12].

Not having an immunization card was associated with incomplete immunization. Similar findings about immunization card have been reported in Senegal (aOR: 8.27; 95% CI 4.18–16.50) and in Ghana (aOR: 50.30; 95% CI 14.40–175.92) [13, 14]. Using web based tracking system and/or mobile phone could be innovative ways to monitor the immunization coverage of children and reduce the risk of losing the card. However, studies should be carried out to assess these interventions’ efficacy and sustainability. Currently, in Côte d’Ivoire, children can be registered in a database at the first visit for BCG to allow for catch up of vaccines, but this approach has not been yet evaluated. In their studies, Abdulraheem et al. and Wiysonge et al. [15, 16] reported that the lack of time, the poor education level of mother and the poor economic household were strongly associated with incomplete immunization. A study conducted in six West African countries found that being born at home, mothers lacking access to the media, family poverty and illiteracy of mothers were factors associated with incomplete immunization [17]. Health authorities should organize immunization campaigns to allow for catch-up of missed vaccines. Also, there is a need to strengthen sensitization on immunization since the knowledge score of respondents is low.

Barriers to incomplete immunization in our study were also reported by Ndiaye et al. [13] in Senegal, Makoutodé et al. [18] in Benin. In Cameroon and Togo, studies mentioned financial and geographic inaccessibility as main bottlenecks for complete immunization [11, 19]. Immunization costs have been reported in this study; the respondents declared that they have to pay a certain amount for consumables or immunization card during the EPI sessions which should be free.

This hospital survey was easier to carry out in terms of time and costs than household surveys. It must lead to change in routine practices of health providers such as the systematic verification of immunization cards at each consultation or hospitalization and the application of catch-up strategies for missed vaccines.

Limitations

Our study has some limits: PENTA and PNEUMO vaccines are administered during the same immunization session but in some immunization cards, only the date of immunization was reported; vaccines names and tags were not recorded. Therefore, we could not determine with precision which vaccine was administered, leading to an underestimation of antigen specific immunization coverage among children who had their immunization card. Moreover, the study was restricted to Lomé and the results cannot be extrapolated nationwide. In this survey, for the children who have not an immunization card, the immunization status was determined based on declarative data of respondents; this could be a source of memory and classification bias with an underestimation or overestimation of children’s immunization status.

Abbreviations

95% CI: 

95% confidence interval

aOR: 

adjusted odds ratio

BCG: 

tuberculosis vaccine

EPI: 

Expanded Program on Immunization

IQI: 

interquartile interval

MD: 

missing data

MICS4: 

Fourth Multiple Indicator Cluster Survey

OPV: 

oral polio vaccine

PENTA: 

pentavalent vaccine

PNEUMO: 

pneumococcal vaccine

ROTA: 

vaccine against rotavirus gastroenteritis

UNICEF: 

United Nations International Children’s Emergency Fund

WHO: 

World Health Organization

Declarations

Authors’ contributions

DKE, WICZC and FAGK conceived the study and participated in its design and coordination. ADG, DAA, YA and TB participated in the study design and data collection. WICZC and EKS performed statistical analyses. DKE, WICZC and FAGK wrote the first draft of the manuscript and ADG, DAA, YA, EKS and TB subsequently revised the manuscript. All authors read and approved the final manuscript.

Acknowledgements

We are thankful to the children’s parents who accepted to participate in this study and to the staff of the health structures where the study was conducted for their technical and logistical support.

Competing interests

The authors declare that they have no competing interests.

Availability of data and materials

All data used for the present study are available and could be requested from the authors.

Consent for publication

Not applicable.

Ethics approval and consent to participate

This study was approved by the National Ethics Committee of the Ministry of Health in Togo (n° 06/2017/CBRS) and authorizations were obtained from the directors of each participating health structure. All respondents gave a written informed consent before enrollment in the study.

Funding

This research receives no specific grant from any funding agency in the public, commercial or not-for-profit sectors.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

Authors’ Affiliations

(1)
Département de Santé Publique, Faculté des Sciences de la Santé, Université de Lomé, Lomé, Togo
(2)
Centre Africain de Recherche en Epidémiologie et en Santé Publique (CARESP), Lomé, Togo
(3)
ISPED, Université de Bordeaux & Centre INSERM U1219-Bordeaux Population Health, Bordeaux, France
(4)
Département de Pédiatrie, Faculté des Sciences de la Santé, Université de Lomé, Lomé, Togo
(5)
Hôpital de Bè, Lomé, Togo
(6)
Centre Hospitalier Régional de Lomé-Commune, Lomé, Togo
(7)
Centre Hospitalier Universitaire Sylvanus Olympio, Lomé, Togo

References

  1. World Health Organization. Immunization. Geneva: WHO. http://www.who.int/topics/immunization/en/. Accessed 26 Nov 2018.
  2. Santoni F. Le programme élargi de vaccination: 25 ans demain. Méd Trop. 2001;61(2):177–86.Google Scholar
  3. Fitzgibbon B, Ackermann L, Murphy K, Deming M, Gindler J. Programme élargi de vaccination (PEV) dans 12 pays Africans 1982–1993. Atlanta: Stanley O FOSTER; 1994.Google Scholar
  4. Santo EGDE, Floury B. Le programme élargi de vaccination dans les pays francophones d’Afrique de l’Ouest : tendances et perspectives. Cah Détudes Rech Francoph Santé. 1991;1(2):109–16.Google Scholar
  5. République du Togo - Enquête Démographique et de Santé 2013–2014. http://microdata.worldbank.org/index.php/catalog/2241. Accessed 4 Mar 2017.
  6. Landoh DE, Ouro-kavalah F, Yaya I, Kahn A-L, Wasswa P, Lacle A, et al. Predictors of incomplete immunization coverage among one to five years old children in Togo. BMC Public Health. 2016;13(16):968.View ArticleGoogle Scholar
  7. Cutts FT, Claquin P, Danovaro-Holliday MC, Rhoda DA. Monitoring vaccination coverage: defining the role of surveys. Vaccine. 2016;34(35):4103–9.View ArticleGoogle Scholar
  8. Saliou P. Le programme élargi de vaccination (PEV) : origine et évolution. Développement et Santé. https://devsante.org/articles/le-programme-elargi-de-vaccination-pev-origine-et-evolution. Accessed 21 Feb 2018.
  9. Ekouevi DK, Gbeasor-Komlanvi FA, Yaya I, Zida-Compaore WI, Boko A, Sewu E, et al. Incomplete immunization among children aged 12–23 months in Togo: a multilevel analysis of individual and contextual factors. BMC Public Health. 2018;18(1):952.View ArticleGoogle Scholar
  10. Guedehoussou T, Djinadou MG, Atakouma NK, Tatagan-Agbi K, Assimadi JK. Causes de non vaccination et d’abandon vaccinal en zone urbaine à Lomé (Togo). J Rech Sci Univ Lomé. 2012;14(2):187–9.Google Scholar
  11. Bekondi C, Zanchi R, Seck A, Garin B, Giles-Vernick T, Gody JC, et al. HBV immunization and vaccine coverage among hospitalized children in Cameroon, Central African Republic and Senegal: a cross-sectional study. BMC Infect Dis. 2015;15(1):267.View ArticleGoogle Scholar
  12. Sheikh SS, Ali SA. Predictors of vaccination card retention in children 12–59 months old in Karachi, Pakistan. Oman Med J. 2014;29(3):190–3.View ArticleGoogle Scholar
  13. Ndiaye NM, Ndiaye P, Diedhiou A, Gueye AS, Tal-Dia A. Facteurs d’abandon de la vaccination des enfants âgés de 10 à 23 mois à Ndoulo (Sénégal). Cah Détudes Rech Francoph Santé. 2009;19(1):9–13.Google Scholar
  14. Baguune B, Ndago JA, Adokiya MN. Immunization dropout rate and data quality among children 12–23 months of age in Ghana. Arch Public Health. 2017;75:18.View ArticleGoogle Scholar
  15. Abdulraheem IS, Onajole AT, Jimoh AAG, Oladipo AR. Reasons for incomplete vaccination and factors for missed opportunities among rural Nigerian children. J Public Health Epidemiol. 2011;3(4):194–203.Google Scholar
  16. Wiysonge CS, Uthman OA, Ndumbe PM, Hussey GD. Individual and contextual factors associated with low childhood immunisation coverage in sub-Saharan Africa: a multilevel analysis. PLoS ONE. 2012;7(5):e37905.View ArticleGoogle Scholar
  17. Douba A, Aka LBN, Yao GHA, Zengbe-Acray P, Akani BC, Konan NG. Sociodemographic factors associated with incomplete immunization or children aged 12 to 59 months in six West African countries. Sante Publique Vandoeuvre-Nancy Fr. 2015;27(5):723–32.View ArticleGoogle Scholar
  18. Makoutode M, Mohzmed S, Paraıso NM, Akpaka Nago MR, Bessaoud K. Influence de certaines caractéristiques parentales sur la couverture vaccinale des nourrissons au Bénin. Méd Trop. 2009;69(3):267–71.Google Scholar
  19. Ba Pouth SFB, Kazambu D, Delissaint D, Kobela M. Immunization coverage and factors associated with drop-out in children 12 to 23 months in Djoungolo-Cameroon Health District in 2012. Pan Afr Med J. 2014;17:91.PubMedPubMed CentralGoogle Scholar

Copyright

© The Author(s) 2019

Advertisement