PREVENTABLE DISEASES

Immunisation is recognised as one of the most cost-effective interventions to prevent morbidity and mortality caused by infectious diseases (WHO, UNICEF). Vaccines prevent more than 2.5million child deaths each year and it has been shown that children who receive all appropriate vaccinations by 9 months of age are less likely to die than those who do not.

Immunisation is therefore, a vital component in the drive to decrease global childhood mortality, yet challenges remain in ensuring wide coverage of immunisation and full immunisation in low and middle income countries.

In contrast to other developing countries The Gambia has consistently reported high national coverage rates for routine immunisation. The Gambia health system achieves high vaccine coverage in the first year of life. Vaccination is offered for free and there are mobile services for remote populations.

The initial vaccines were BCG, Diptheria, Tetanus, measles, oral polio and yellow fever. Hepatitis B was phased in between 1986-1990. The Gambia, unlike most other Sub-Saharan African countries, also provides a booster dose of DPT at 18 months of age.

As a result of mobile services, vaccination coverage is over 95% for BCG, more than 93% for one dose of DPT and approximately 90% for second dose of DPT. However, coverage was found to be significantly associated with residence and ethnicity, with children in urban areas and of Mandinka ethnicity being least likely to be fully immunised.

Studies have highlighted that despite high coverage for some immunisations, serious gaps exist even in The Gambia, and reaching the United Nation’s target of 90% of children being fully immunised by one year of age remains a challenge. Only 52% of children achieved full immunisation by one year of age during the study period. Despite the fact that The Gambia has reported consistently high national immunisation coverage for many years, there is still room for improvement.

The proportion of children receiving no vaccines at all is very low (3%) and the cover of BCG is high, indicating that the system of delivering immunisation at or close to birth works well. However, coverage of later immunisation, such as measles, is much lower, indicating that challenges still exist in following children throughout the immunisation schedule.

Our charity would like to link into existing strategies to use health education and practical help to promote a better up-take for later childhood vaccines.

Capacity issues and and insufficient health workers are recognised issues in The Gambia. This can lead to long queues at immunisation clinics, especially in the urban areas. This has previously been reported by some women as a deterrent from attending immunisation clinics. Also mothers in urban areas are more likely to be in formal work than their rural counterparts which might affect their ability to attend immunisation clinics, where they are often required to wait for most of the day.

Inability to access the services can also be due to associated costs eg transport. Even in a system where immunisation is free, the indirect costs such as transport may be a deterrent for some mothers. Given the role that measles still plays in under-five mortality in The Gambia, the immunisation coverage rate of 73% indicates that there is further scope for decreasing mortality by improved immunisation.