V ACCINATION C OVERAGE

The 2014 GDHS collected information on immunisation coverage for all children born in the five years before the survey. The government of Ghana has adopted the World Health Organisation (WHO) and UNICEF guidelines for vaccinating children. According to these guidelines, to be considered fully vacci-nated, a child should receive the following vaccinations: one dose each of BCG and measles, three doses of polio vaccine, and three doses of DPT. In addition, in Ghana, a vaccine against yellow fever is recommended for children. BCG, which protects against tuberculosis, should be given at birth or at first clinical contact.

DPT protects against diphtheria, pertussis (whooping cough), and tetanus. A dose of polio vaccine is given at birth (Polio 0) or within 13 days of birth. DPT and polio vaccine guidelines require three vaccinations at approximately 6, 10, and 14 weeks of age. The measles and yellow fever vaccines are given at nine months.

Currently, the pentavalent vaccine, (DPT-HepB-Hib) introduced in 2002, has replaced the DPT vaccine.

This vaccine contains, in addition to DPT, the hepatitis B vaccine and a vaccine against Haemophilus

influenza type B. It is recommended that children receive the complete schedule of vaccinations before 12 months.

In 2012, the Ministry of Health introduced two new vaccines, the pneumococcal and rotavirus vaccines. These protect children from pneumococcal diseases (particularly pneumonia and other invasive pneumococcal diseases) and diarrhea, respectively. The country had earlier in the year introduced a measles second-dose vaccine at 18 months. In 2013, the Ministry of Health replaced the measles-only vaccine at nine months with a rubella-containing measles vaccine [Measles-Rubella (MR) vaccine] also given at nine months. Ghana follows a schedule for the administration of all basic childhood vaccines. BCG is given shortly after birth. Oral polio vaccine is given at birth and at approximately age 6, 10, and 14 weeks.

Pentavalent vaccine is also given at approximately age 6, 10, and 14 weeks. Measles-rubella and yellow fever vaccines are given at or soon after the child reaches 9 calendar months (39 weeks). The rotavirus vaccine is given at age 6 and 10 weeks. The pneumococcal vaccine is administered as an injection to infants in three doses at age 6, 10, and 14 weeks. The measles-only dose offered to children at 18 months is primarily a booster dose. It is recommended that all vaccinations be recorded on a card that is given to the parents or guardians.

In the 2014 GDHS, information on vaccination coverage was obtained in two ways—from health cards and from mother’s verbal reports. All mothers were asked to show the interviewer the health card on which the child’s immunisations are recorded. If the card was available, the interviewer copied the dates of each vaccination received. If a vaccination was not recorded on the card, the mother was asked to recall whether that particular vaccination had been given. If the mother was not able to present a card for a child, she was asked to recall whether the child had received BCG, polio, pentavalent, pneumococcal, rotavirus, measles, and yellow fever vaccines. If she recalled that the child had received the polio, pentavalent, measles, pneumococcal or rotavirus vaccines, she was asked about the number of doses that the child received.

The data presented in Table 10.2.1 are for children age 12-23 months, the youngest cohort of children who have reached the age by which they should have had the basic vaccines, and are restricted to children who were alive at the time of the survey. The table shows the percentage of children age 12-23 months who received specific vaccines at any time before the survey by source of information. Overall, 77 percent of children age 12-23 months are fully immunised (have received all basic vaccinations). This percentage is slightly lower than that reported in the 2008 GDHS (79 percent). Only 2 percent of children in Ghana have not received any vaccinations; in the 2008 GDHS, by comparison, 1 percent of children was reported to have not received any vaccinations. Seventy-one percent of children age 12-23 months were fully immunised by age 12 months, which is slightly higher than that reported in the 2008 GDHS (70 percent).

With respect to specific vaccines, 97 percent of children have received BCG, 97 percent have received the first dose of pentavalent vaccine, 97 percent have received polio 1, 93 percent have received the first dose of pneumococcal vaccine, and 91 percent have received one dose of rotavirus vaccine.

Coverage for the pentavalent, polio, pneumococcal, and rotavirus vaccinations declines with subsequent doses; 89 percent of children received the recommended three doses of pentavalent (DPT-HepB-Hib), 84 percent received three doses of polio, 89 percent received two doses of rotavirus, and 84 percent received three doses of pneumococcal vaccine. Coverage of the first dose of measles vaccine is 89 percent and that of yellow fever is 88 percent, similar to that reported in the 2008 GDHS (90 percent and 89 percent, respectively, for measles and yellow fever).

Child Health and Early Development • 129

Table 10.2.1 Vaccinations by source of information: Children age 12-23 months

Percentage of children age 12-23 months who received specific vaccines at any time before the survey, by source of information (vaccination card or mother’s report), and percentage vaccinated by 12 months of age, Ghana 2014

Source of

1 Polio 0 is the polio vaccination given at birth.

2 BCG, three doses of pentavalent (DPT-HepB-Hib) vaccine, four doses of polio vaccine, one dose of measles, three doses of pneumococcal vaccine, two doses of rotavirus vaccine, and one dose of yellow fever

3 BCG, measles, and three doses each of pentavalent (DPT-HepB-Hib) and polio vaccine (excluding polio vaccine given at birth)

4 For children whose information is based on the mother’s report, the proportion of vaccinations given during the first year of life is assumed to be the same as for children with a written record of vaccination.

Table 10.2.2 shows the percentage of children age 24-35 months who received specific vaccines at any time before the survey by source of information and proportion vaccinated by the appropriate age.

Overall, 36 percent of children age 24-35 months have received all age-appropriate vaccinations. Sixty-four percent of children age 24-35 months received all age appropriate vaccinations by the recommended age.

With respect to specific vaccines by the appropriate age, 97 percent of children received BCG, 96 percent received the first dose of pentavalent vaccine, 96 percent received polio 1, 75 percent received the first dose of pneumococcal vaccine, and 71 percent received the first dose of rotavirus vaccine. As expected, vaccination coverage by the recommended age for the pentavalent, polio, pneumococcal, and rotavirus vaccinations declines with subsequent doses; 86 percent of children received the recommended three doses of pentavalent (DPT-HepB-Hib), 80 percent received three doses of polio, 61 percent received three doses of pneumococcal vaccine, and 66 percent received two doses of rotavirus vaccine. Coverage of the first dose vaccines by the recommended age is 90 percent for measles vaccine, 87 percent for yellow fever, and 60 percent for the second dose of measles. The results of the 2014 GDHS relate to fieldwork that took place from September to December, 2014. Therefore, the relatively lower coverage for the newer vaccines (rotavirus and pneumococcal) in children age 24-35 months is probably the result of missed opportunities for children who were, at the time of the introduction, relatively older, and had taken more than their first doses of the traditional vaccines given at 6, 10, and 14 weeks. Consequently, the results should be interpreted with caution.

Table 10.2.2 Vaccinations by source of information: Children 24-35 months

Percentage of children age 24-35 months who received specific vaccines at any time before the survey, by source of information (vaccination card or mother’s report), and percentage vaccinated by appropriate age, Ghana 2014

Source of

1 Polio 0 is the polio vaccination given at birth.

2 BCG, three doses of pentavalent (DPT-HepB-Hib) vaccine, four doses of polio vaccine, two doses of measles, three doses of pneumococcal vaccine, two doses of rotavirus vaccine, and one dose of yellow fever

3 For children whose information is based on the mother’s report, the proportion of vaccinations given during the first year of life is assumed to be the same as for children with a written record of vaccination.

4 By 12 months of age for all vaccines, except measles 2 vaccine, which should be received by 24 months of age

Table 10.3.1 shows the percentage of children age 12-23 months who received specific vaccines at any time before the survey (according to a vaccination card or the mother’s report), and the percentage with a vaccination card by background characteristics. Vaccination coverage does not differ substantially by background characteristics, but there are some notable trends. Children in urban areas are most likely to have all basic vaccinations, but children in rural areas are most likely to have all age appropriate vaccinations.

Children who are their mother’s sixth or higher birth have lower rates of age-appropriate vaccination and, in fact, are more likely to have never been vaccinated. Children whose mothers have a secondary or higher education have noticeably higher rates of both basic and age-appropriate vaccinations. The proportion of children with all basic vaccinations does not vary with the mother’s wealth quintile, but age appropriate vaccinations increase with increasing wealth of the mother.

Table 10.3.1 Vaccinations by background characteristics: Children 12-23 months

Percentage of children age 12-23 months who received specific vaccines at any time before the survey (according to a vaccination card or the mother’s report), the percentage ever with a vaccination card, and the percentage with a vaccination card seen, by background characteristics, Ghana 2014

Background

1 Polio 0 is the polio vaccination given at birth.

2 BCG, three doses of pentavalent (DPT-HepB-Hib) vaccine, four doses of polio vaccine, one dose of measles vaccine, three doses of pneumococcal vaccine, two doses of rotavirus vaccine, and one dose of yellow fever vaccine

3 BCG, measles, and three doses each of pentavalent (DPT-HepB-Hib) and polio vaccine (excluding polio vaccine given at birth)

Child Health and Early Development • 131 Table 10.3.2 shows the percentage of children age 24-35 months who received specific vaccines at any time before the survey (according to a vaccination card or the mother’s report), and the percentage with a vaccination card by background characteristics. Large differences in coverage of age-appropriate vaccinations are observed at the level of regions; the lowest percentage of children with age-appropriate vaccination coverage is in the Central region (18 percent) and the highest is in the Greater Accra region (48 percent). Age-appropriate vaccination coverage generally increases somewhat with increasing education.

The proportion of children with age-appropriate vaccination does not vary markedly with sex, birth order, residence, or mother’s wealth quintile.

Overall, 80 percent of mothers of children 24-35 months had the children’s vaccination card seen by interviewers, lower than for children age 12-23 months (88 percent), probably due to the misplacement or wear and tear of older children’s cards.

Table 10.3.2 Vaccinations by background characteristics: Children 24-35 months

Percentage of children age 24-35 months who received specific vaccines at any time before the survey (according to a vaccination card or the mother’s report), the percentage ever with a vaccination card, and the percentage with a vaccination card seen, by background characteristics, Ghana 2014

Background

1 Polio 0 is the polio vaccination given at birth.

2 BCG, three doses of pentavalent (DPT-HepB-Hib) vaccine, four doses of polio vaccine, two doses of measles vaccine, three doses of pneumococcal vaccine, two doses of rotavirus vaccine, and one dose of yellow fever vaccine