Peer-reviewed article
Tracking coverage, dropout and multidimensional equity gaps in immunisation systems in West Africa, 2000–2017
Oghenebrume Wariri, Bassey Effiom Edem, Esin Nkereuwem, Oluwatosin Nkereuwem, Gregory Umeh et al. ·
Summary
Written by AI, not yet AICS's view · claude-haiku-4-5-20251001This study tracked immunisation coverage and dropout rates across 15 West African countries from 2000 to 2017, comparing progress against global targets. While the region showed improvement over time, with dropout rates meeting targets by 2008, significant gaps in coverage persist and are heavily determined by wealth, region, and parental education. Only 47% of West African countries achieved the recommended 90% coverage target for the DTP3 vaccine by 2017. Inequalities in immunisation access remain a major challenge, with differences of over 20 percentage points between rich and poor populations.
Key points
- BCG coverage increased from 60.7% in 2000 to a peak of 83.2% in 2009, then declined to 65.7% in 2017
- DTP3 coverage rose from 42.3% in 2000 to a peak of 70.3% in 2009, reaching 61.5% in 2017
- Only 7 of 15 countries (46.7%) met the GVAP target of ≥90% DTP3 coverage by 2017
- Immunisation dropout rates (DTP1-DTP3) decreased from 16.4% in 2000 to 7.4% in 2017, meeting the ≤10% target by 2008
- Equity gaps of more than 20 percentage points exist between wealthy and poor populations, high and low coverage regions, and between children of mothers with secondary education versus no formal education
Limitations
The study does not explain the reasons for the peak and subsequent decline in coverage between 2009 and 2017. The analysis is limited to two vaccines (BCG and DTP3) and does not assess other immunisation indicators or the quality of vaccination programmes.
Abstract
BACKGROUND: Several West African countries are unlikely to achieve the recommended Global Vaccine Action Plan (GVAP) immunisation coverage and dropout targets in a landscape beset with entrenched intra-country equity gaps in immunisation. Our aim was to assess and compare the immunisation coverage, dropout and equity gaps across 15 West African countries between 2000 and 2017. METHODS: We compared Bacille Calmette Guerin (BCG) and the third dose of diphtheria-tetanus-pertussis (DTP3) containing vaccine coverage between 2000 and 2017 using the WHO and Unicef Estimates of National Immunisation Coverage for 15 West African countries. Estimated subregional median and weighted average coverages, and dropout (DTP1-DTP3) were tracked against the GVAP targets of ≥90% coverage (BCG and DTP3), and ≤10% dropouts. Equity gaps in immunisation were assessed using the latest disaggregated national health survey immunisation data. RESULTS: The weighted average subregional BCG coverage was 60.7% in 2000, peaked at 83.2% in 2009 and was 65.7% in 2017. The weighted average DTP3 coverage was 42.3% in 2000, peaked at 70.3% in 2009 and was 61.5% in 2017. As of 2017, 46.7% of countries (7/15) had met the GVAP targets on DTP3 coverage. Average weighted subregional immunisation dropouts consistently reduced from 16.4% in 2000 to 7.4% in 2017, meeting the GVAP target in 2008. In most countries, inequalities in BCG, and DTP3 coverage and dropouts were mainly related to equity gaps of more than 20% points between the wealthiest and the poorest, high coverage regions and low coverage regions, and between children of mothers with at least secondary education and those with no formal education. A child's sex and place of residence (urban or rural) minimally determined equity gaps. CONCLUSIONS: The West African subregion made progress between 2000 and 2017 in ensuring that its children utilised immunisation services, however, wide equity gaps persist.