{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,14]],"date-time":"2026-06-14T18:41:45Z","timestamp":1781462505355,"version":"3.54.1"},"reference-count":36,"publisher":"Wiley","issue":"7","license":[{"start":{"date-parts":[[2014,4,28]],"date-time":"2014-04-28T00:00:00Z","timestamp":1398643200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"funder":[{"DOI":"10.13039\/501100000278","name":"Department for International Development","doi-asserted-by":"publisher","award":["EPHIHD66"],"award-info":[{"award-number":["EPHIHD66"]}],"id":[{"id":"10.13039\/501100000278","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100004423","name":"World Health Organization","doi-asserted-by":"publisher","award":["EPNPVE28"],"award-info":[{"award-number":["EPNPVE28"]}],"id":[{"id":"10.13039\/100004423","id-type":"DOI","asserted-by":"publisher"}]},{"name":"Saving Newborn Lives, Save The Children","award":["EPNPVP18"],"award-info":[{"award-number":["EPNPVP18"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Tropical Med Int Health"],"published-print":{"date-parts":[[2014,7]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Objectives<\/jats:title><jats:p>To assess the extent of socio\u2010economic inequity in coverage and timeliness of key childhood immunisations in <jats:styled-content style=\"fixed-case\">G<\/jats:styled-content>hana.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Secondary analysis of vaccination card data collected from babies born between <jats:styled-content style=\"fixed-case\">J<\/jats:styled-content>anuary 2008 and <jats:styled-content style=\"fixed-case\">J<\/jats:styled-content>anuary 2010 who were registered in the surveillance system supporting the <jats:styled-content style=\"fixed-case\">O<\/jats:styled-content>baapa<jats:styled-content style=\"fixed-case\">V<\/jats:styled-content>ita and <jats:styled-content style=\"fixed-case\">N<\/jats:styled-content>ewhints <jats:styled-content style=\"fixed-case\">T<\/jats:styled-content>rials was carried out. 20\u00a0251 babies had 6\u00a0weeks' follow\u2010up, 16\u00a0652 had 26\u00a0weeks' follow\u2010up, and 5568 had 1\u00a0year's follow\u2010up. We performed a descriptive analysis of coverage and timeliness of vaccinations by indicators for urban\/rural status, wealth and educational attainment. The association of coverage with socio\u2010economic indicators was tested using a chi\u2010square\u2010test and the association with timeliness using <jats:styled-content style=\"fixed-case\">C<\/jats:styled-content>ox regression.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Overall coverage at 1\u00a0year of age was high (&gt;95%) for <jats:styled-content style=\"fixed-case\">B<\/jats:styled-content>acillus <jats:styled-content style=\"fixed-case\">C<\/jats:styled-content>almette\u2013<jats:styled-content style=\"fixed-case\">G<\/jats:styled-content>u\u00e9rin (<jats:styled-content style=\"fixed-case\">BCG<\/jats:styled-content>), all three pentavalent diphtheria\u2010pertussis\u2010tetanus\u2010haemophilus influenzae <jats:styled-content style=\"fixed-case\">B<\/jats:styled-content>\u2010hepatitis <jats:styled-content style=\"fixed-case\">B<\/jats:styled-content> (<jats:styled-content style=\"fixed-case\">DPTHH<\/jats:styled-content>) doses and all polio doses except polio at birth (63%). Coverage against measles and yellow fever was 85%. Median delay for <jats:styled-content style=\"fixed-case\">BCG<\/jats:styled-content> was 1.7\u00a0weeks. For polio at birth, the median delay was 5\u00a0days; all other vaccine doses had median delays of 2\u20134\u00a0weeks. We found substantial health inequity across all socio\u2010economic indicators for all vaccines in terms of timeliness, but not coverage at 1\u00a0year. For example, for the last <jats:styled-content style=\"fixed-case\">DPTHH<\/jats:styled-content> dose, the proportion of children delayed more than 8\u00a0weeks were 27% for urban children and 31% for rural children (<jats:italic>P<\/jats:italic>\u00a0&lt;\u00a00.001), 21% in the wealthiest quintile and 41% in the poorest quintile (<jats:italic>P<\/jats:italic>\u00a0&lt;\u00a00.001), and 9% in the most educated group and 39% in the least educated group (<jats:italic>P<\/jats:italic>\u00a0&lt;\u00a00.001). However, 1\u2010year coverage of the same dose remained above 90% for all levels of all socio\u2010economic indicators.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Ghana has substantial health inequity across urban\/rural, socio\u2010economic and educational divides. While overall coverage was high, most vaccines suffered from poor timeliness. We suggest that countries achieving high coverage should include timeliness indicators in their surveillance systems.<\/jats:p><\/jats:sec>","DOI":"10.1111\/tmi.12324","type":"journal-article","created":{"date-parts":[[2014,4,28]],"date-time":"2014-04-28T05:36:49Z","timestamp":1398663409000},"page":"802-811","source":"Crossref","is-referenced-by-count":76,"title":["Socio\u2010economic determinants and inequities in coverage and timeliness of early childhood immunisation in rural <scp>G<\/scp>hana"],"prefix":"10.1111","volume":"19","author":[{"given":"Lu","family":"Gram","sequence":"first","affiliation":[{"name":"London School of Hygiene and Tropical Medicine London UK"},{"name":"Institute Of Child Health University College London London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Seyi","family":"Soremekun","sequence":"additional","affiliation":[{"name":"London School of Hygiene and Tropical Medicine London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Augustinus","family":"ten Asbroek","sequence":"additional","affiliation":[{"name":"London School of Hygiene and Tropical Medicine London UK"},{"name":"Department of Global Health AMC University of Amsterdam Amsterdam the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alexander","family":"Manu","sequence":"additional","affiliation":[{"name":"London School of Hygiene and Tropical Medicine London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maureen","family":"O'Leary","sequence":"additional","affiliation":[{"name":"London School of Hygiene and Tropical Medicine London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zelee","family":"Hill","sequence":"additional","affiliation":[{"name":"London School of Hygiene and Tropical Medicine London UK"},{"name":"Institute Of Child Health University College London London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Samuel","family":"Danso","sequence":"additional","affiliation":[{"name":"University of Leeds Leeds UK"},{"name":"Kintampo Health Research Centre Ghana Health Service Kintampo Ghana"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Seeba","family":"Amenga\u2010Etego","sequence":"additional","affiliation":[{"name":"London School of Hygiene and Tropical Medicine London UK"},{"name":"Kintampo Health Research Centre Ghana Health Service Kintampo Ghana"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Seth","family":"Owusu\u2010Agyei","sequence":"additional","affiliation":[{"name":"London School of Hygiene and Tropical Medicine London UK"},{"name":"Kintampo Health Research Centre Ghana Health Service Kintampo Ghana"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Betty R.","family":"Kirkwood","sequence":"additional","affiliation":[{"name":"London School of Hygiene and Tropical Medicine London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2014,4,28]]},"reference":[{"key":"e_1_2_5_2_1","doi-asserted-by":"publisher","DOI":"10.1136\/jech.2010.124651"},{"key":"e_1_2_5_3_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0035432."},{"key":"e_1_2_5_4_1","first-page":"139","article-title":"Are reminder stickers effective in reducing immunization dropout rates in Addis Ababa, Ethiopia?","volume":"96","author":"Barhane Y","year":"1993","journal-title":"The Journal of Tropical Medicine and Hygiene"},{"key":"e_1_2_5_5_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(10)60549-1"},{"key":"e_1_2_5_6_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(09)60317-2"},{"key":"e_1_2_5_7_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.inhe.2012.07.004"},{"key":"e_1_2_5_8_1","first-page":"14","article-title":"Measuring the prevalence of immunization","volume":"8","author":"Fisher A","year":"1987","journal-title":"International Health News"},{"key":"e_1_2_5_9_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.vaccine.2006.08.027"},{"key":"e_1_2_5_10_1","doi-asserted-by":"publisher","DOI":"10.3399\/bjgp10X483535"},{"key":"e_1_2_5_11_1","doi-asserted-by":"publisher","DOI":"10.2471\/BLT.11.087536"},{"key":"e_1_2_5_12_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.vaccine.2006.02.049"},{"key":"e_1_2_5_13_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(10)60311-X"},{"key":"e_1_2_5_14_1","doi-asserted-by":"publisher","DOI":"10.1186\/1745-6215-11-58"},{"key":"e_1_2_5_15_1","first-page":"5","article-title":"General recommendations on immunization \u2014 recommendations of the Advisory Committee on Immunization Practices (ACIP)","volume":"60","author":"Kroger AT","year":"2011","journal-title":"Morbidity and Mortality Weekly Report"},{"key":"e_1_2_5_16_1","doi-asserted-by":"publisher","DOI":"10.1001\/jama.298.16.1900"},{"key":"e_1_2_5_17_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(08)61869-3"},{"key":"e_1_2_5_18_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(12)60560-1"},{"key":"e_1_2_5_19_1","doi-asserted-by":"publisher","DOI":"10.1001\/jama.293.10.1204"},{"key":"e_1_2_5_20_1","unstructured":"Measure DHS Online Tools(2010)STATcompiler[Online] [Cited: 22 August 2010] http:\/\/www.statcompiler.com\/index.cfm."},{"key":"e_1_2_5_21_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.vaccine.2012.10.089"},{"key":"e_1_2_5_22_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.vaccine.2010.06.011"},{"key":"e_1_2_5_23_1","doi-asserted-by":"publisher","DOI":"10.1016\/B978-1-4160-3611-1.50033-7"},{"key":"e_1_2_5_24_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.vaccine.2011.08.096"},{"key":"e_1_2_5_25_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ypmed.2011.11.015"},{"key":"e_1_2_5_26_1","volume-title":"Building a Future for Women and Children: The 2012 Report","author":"Requejo J","year":"2012"},{"key":"e_1_2_5_27_1","doi-asserted-by":"publisher","DOI":"10.1001\/archpedi.1995.02170160047007"},{"key":"e_1_2_5_28_1","unstructured":"RusteinS&JohnsonK(2004)The DHS Wealth Index. DHS Comparative Reports No. 6."},{"key":"e_1_2_5_29_1","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2012.502"},{"key":"e_1_2_5_30_1","volume-title":"Level & Trends in Child Mortality. The Inter\u2010Agency Group for Child Mortality, Estimation","author":"UNICEF","year":"2012"},{"key":"e_1_2_5_31_1","volume-title":"Immunization Summary: A Statistical Reference Containing Data Through 2011","author":"UNICEF, WHO","year":"2012"},{"key":"e_1_2_5_32_1","doi-asserted-by":"publisher","DOI":"10.1027\/1614-2241\/a000005"},{"key":"e_1_2_5_33_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(12)61427-5"},{"key":"e_1_2_5_34_1","volume-title":"Why Invest in Communication for Immunization: Evidence and Lessons Learned","author":"Waisbord S","year":"2005"},{"key":"e_1_2_5_35_1","unstructured":"WHO(2010).Expanded Program of Immunisation \u2010 EPI. African Region: Ghana [Online] [Cited: 8 August 2010.]http:\/\/www.afro.who.int\/en\/ghana\/country-programmes\/3215-expanded-program-of-immunisation-epi.html."},{"key":"e_1_2_5_36_1","first-page":"213","article-title":"Polio vaccines and polio immunization in the pre\u2010eradication era: WHO position paper","volume":"85","author":"WHO","year":"2010","journal-title":"WHO Weekly Epidemiological Record"},{"key":"e_1_2_5_37_1","unstructured":"WHO(2013)Estimates of disease burden and cost\u2010effectiveness. [Online] [Cited: 23 September 2013]http:\/\/www.who.int\/immunization_monitoring\/burden\/estimates_burden\/en\/index.html."}],"container-title":["Tropical Medicine &amp; International Health"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/api.wiley.com\/onlinelibrary\/tdm\/v1\/articles\/10.1111%2Ftmi.12324","content-type":"unspecified","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/tmi.12324","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,9,29]],"date-time":"2023-09-29T11:32:17Z","timestamp":1695987137000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/tmi.12324"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2014,4,28]]},"references-count":36,"journal-issue":{"issue":"7","published-print":{"date-parts":[[2014,7]]}},"alternative-id":["10.1111\/tmi.12324"],"URL":"https:\/\/doi.org\/10.1111\/tmi.12324","archive":["Portico"],"relation":{},"ISSN":["1360-2276","1365-3156"],"issn-type":[{"value":"1360-2276","type":"print"},{"value":"1365-3156","type":"electronic"}],"subject":[],"published":{"date-parts":[[2014,4,28]]}}}