Peer-reviewed article
Immunisation status and clinical outcomes in children admitted to a Paediatric emergency unit in Ghana: a prospective cohort study
Serwah Bonsu Asafo‐Agyei, Emmanuel Ameyaw, Samuel Blay Nguah, Vivian Paintsil, Akua Afriyie Ocran ·
Summary
Written by AI, not yet AICS's view · claude-haiku-4-5-20251001A study of 306 children admitted to a hospital emergency unit in Ghana found that 74.5% were fully vaccinated for their age, while 24.5% were under-vaccinated and 1% were unvaccinated. Younger children and those under five years were significantly more likely to have incomplete vaccinations. Mortality was higher in un- and under-vaccinated children (16.7%) compared to fully vaccinated children (7%). The main reasons caregivers gave for not completing vaccinations were hesitancy, vaccine unavailability, and child health concerns.
Key points
- 74.5% of children were fully vaccinated for age, 24.5% under-vaccinated, and 1.0% unvaccinated
- Vaccination default was 7.86 times more common in children under five years than older children
- Mortality was 16.7% among un- and under-vaccinated children versus 7.0% among fully vaccinated children
- Caregiver hesitancy (48.7%), vaccine unavailability (20.5%), and child health issues (19.2%) were leading reasons for incomplete vaccination
- Vaccination default was independently associated with younger age, respiratory distress at presentation, and shorter hospital stay
Limitations
The study was conducted at a single hospital emergency unit over a short period (three months), so findings may not generalise to other settings in Ghana or represent population-level immunisation patterns. The cross-sectional design cannot establish causation between vaccination status and mortality, as mortality may reflect differences in disease severity or other unmeasured factors rather than vaccination alone.
Abstract
BACKGROUND: Incomplete childhood immunisation remains a global concern, especially following disruptions caused by the COVID-19 pandemic. This study assessed the immunisation status and clinical outcomes of children admitted to the Paediatric Emergency Unit (PEU) of Komfo Anokye Teaching Hospital (KATH), Ghana, from November 2024 to January 2025. Differences in vaccination coverage before and after the pandemic were also explored by comparing immunisation status between children under five and those aged five years and above. METHODS: This prospective cohort study collected data on demographic characteristics, clinical diagnoses, outcomes, and immunisation status through caregiver interviews and medical record review using a structured questionnaire. Immunisation status was evaluated against the Ghana Expanded Programme on Immunisation (EPI) schedule. Reasons for incomplete immunisation were also explored. Logistic regression was used to identify factors associated with vaccination default and their outcomes. RESULTS: Out of 401 children admitted, 95 were excluded (13 readmissions, 77 inadequate immunisation records, five refusals), leaving 306 enrolled. Median age was 3.2 years (IQR 1.2, 7.6), and 55.9% were male. Overall, 74.5% were fully vaccinated for age, 24.5% under-vaccinated, and 1.0% unvaccinated. Vaccination default was significantly more common in children under five years (AOR: 7.86, 95% CI: 3.66–19.2). Mortality was higher among un- and under-vaccinated children (16.7%) compared to fully vaccinated (7.0%) children. While univariate analysis demonstrated a significant association between vaccination default and mortality (p = 0.017), this association did not remain significant in multivariate analysis. Instead, vaccination default was independently associated with younger age, the presence of respiratory distress at presentation, and a shorter duration of hospital stay. Caregiver hesitancy (48.7%), vaccine unavailability (20.5%), and child-related health issues (19.2%) were the leading reasons for vaccination default. CONCLUSIONS: Immunisation coverage in children admitted to the PEU was suboptimal, with younger children, especially those vaccinated during or after the COVID-19 pandemic, being disproportionately affected. Strengthening routine immunisation services, addressing caregiver concerns, and institutionalising catch-up vaccination protocols in hospitals are critical.
Findings the Hub has extracted
Each claim below is labelled by its type of design and links back to this report.
- Intervention
- Receipt of age-appropriate vaccinations according to Ghana's Expanded Programme on Immunisation schedule
- Population
- 306 children aged 0-15 years admitted to Paediatric Emergency Unit at Komfo Anokye Teaching Hospital, Ghana; median age 3.2 years, 55.9% male
Key finding
Mortality was 16.7% in un- and under-vaccinated children versus 7.0% in fully vaccinated children
Asafo‐Agyei et al. · OpenAlex · 9 Dec 2025