Coverage, Timeliness and Uptake of Childhood Vaccinations in Armenia
Open AccessBackground: To ensure that a population is properly protected from vaccine-preventable disease (VPDs), vaccinations must be continually monitored. Armenia recommends all children receive a vaccine against tuberculosis (BCG), three doses of a diphtheria, tetanus and pertussis vaccine (DTP), three doses of a polio vaccine (Pol) and a measles-containing vaccine (MCV) in their first year. Recently added recommendations include two doses of a rotavirus vaccine (RV) and three doses of a pneumococcal conjugate vaccine (PCV). Because of limited data on vaccination coverage and timeliness among children in Armenia, we examined trends in coverage of the recommended vaccinations from 2000 to 2016, timing of these vaccinations in 2015-16 and uptake of RV and PCV among children in Armenia.Methods: This analysis was based on the Armenia Demographic and Health Survey (ADHS) and included vaccination data on children aged 0-35 months at the time of the survey. First, trends of coverage of the recommended vaccinations were assessed using logistic regression adjusted for explanatory variables with significant trends. Next, the timing of recommended vaccinations in 2015-16 were examined using the Kaplan-Meier method and Cox proportional hazards models with a shared gamma frailty to determine factors associated with timeliness. Lastly, the uptake of the recommended doses of RV and PCV in 2015-16 were examined and multivariable multilevel logistic regression models were used to assess the associated factors. Results: All recommended vaccinations saw significant changes in coverage over time, with 2005 displaying the lowest coverage among all data collection cycles. Pol1 and Pol2 experienced the largest improvements, and DTP3 had the lowest coverage rates among the children throughout the years. The proportion of children with delayed vaccinations increased with subsequent doses, with 51.9% and 48.5% having a delayed DTP3 and Pol3, respectively. Factors associated with delayed vaccinations included female gender, certain regions of residence, previously delayed vaccinations, poorer wealth index and lower educational level of mother. There were no differences in timing of vaccinations between survey clusters. RV uptake was high with 90.0% and 86.6% having received RV1 and RV2, respectively. PCV uptake was lower, with 83.5% having received PCV1, 79.4% PCV2, and 57.5% PCV3. An interaction was found between wealth index and residence resulting in stratified analyses for RV. Age, siblingship, wealth index, distance to the health clinic and region of residence were found to have varying associations with the doses in the RV and PCV series. Significant variability between clusters was found for both doses of RV, as well as PCV2. Conclusion: Coverage of all recommended vaccinations increased from 2000 to 2016 in Armenia, although there were fluctuations over the years. While coverage was generally high, a large proportion of children under three experienced delays in receiving the recommended vaccinations. Uptake of both doses of RV was substantial; uptake of PCV was much lower. Continued monitoring of coverage, timeliness and uptake of childhood vaccinations is recommended to ensure children in Armenia are properly protected from the associated VPDs. In order to gain additional insights, future studies should examine knowledge and attitudes towards vaccinations.
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