BACKGROUND
Achieving the goals of Immunisation Agenda 2030 (IA2030) requires a clear understanding of vaccination timeliness and its determinants. We assessed vaccination timeliness and associated factors in two rural districts of northern Ghana.
METHODS
We conducted a community-based analytical cross-sectional study among 3371 caregivers of children aged 0-59 months in Gushegu (n = 1361) and Nanumba South (n = 2010) Districts, Northern Ghana, from 24 April to 4 May 2025. The study examined the timeliness of 19 vaccine doses in Ghana's national immunisation schedule. Vaccination status was classified as early, age-appropriate, delayed, unvaccinated, or up to date based on recommended age windows. Cox proportional hazards models were used to identify factors associated with vaccination timeliness.
RESULTS
Timely vaccination declined progressively across the immunisation schedule in both districts. Bacille Calmette-Guérin had the highest age-appropriate coverage (64.2% in Gushegu and 52.6% in Nanumba South), whereas timeliness decreased across multi-dose vaccine series. Age-appropriate coverage for pneumococcal conjugate vaccine declined from 60.9% to 20.5% in Gushegu and from 51.1% to 21.5% in Nanumba South between the first and third doses. Similarly, timely Pentavalent vaccination declined from 59.6% to 19.8% and from 52.1% to 23.0%, respectively. Rotavirus vaccine age-appropriate coverage dropped to 8.6% in Gushegu and 9.4% in Nanumba South for the third dose. Delays increased with successive doses and were greater in Nanumba South. Possession of a vaccination card was the strongest predictor of timely vaccination (Gushegu: aHR 30.82, 95% CI 12.02-79.03; Nanumba South: aHR 19.09, 95% CI 6.84-53.26). Higher caregiver education improved timeliness, while home or traditional birth attendant delivery reduced timeliness.
CONCLUSION
Timely vaccination remains suboptimal in both districts, with marked declines across the immunisation schedule. Strategies to improve vaccination card retention, caregiver education, access to vaccination services, and facility-based deliveries may enhance vaccination timeliness.
M. Konlan, R. Bhandari, M. Adjei et al.· Vaccine· 0 citations
On March 2nd, 2021, Ghana, the first country to receive vaccines from the COVAX facility, began its COVID-19 vaccination using a complex multi-phased approach, to reach target populations. We evaluated the vaccine deployment to document best practices challenges and lessons for future new vaccine introductions and public health emergency readiness.
We conducted a mixed methods post-introduction evaluation, purposively sampling 36 facilities from 12 districts in six regions. Adapting the World Health Organization’s COVID-19 Post-Introduction Evaluation tool, we conducted a cross-sectional survey using a structured questionnaire, reviewed programme records, observed practices, and interviewed purposively selected health workers, immunization managers and partners who supported vaccine deployment. We performed summary descriptive statistics on quantitative data, thematic analysis on qualitative data, and triangulated the results.
As of March 2023, more than 70% of the target population (15 years and older) had received at least one dose, while more than 50% had completed the primary series. Vaccine deployment was built on the existing immunisation programme and functional coordinating bodies. Cold chain capacity was revamped with ultra-low-temperature freezers, while 33.3% of surveyed districts adjusted waste disposal systems to accommodate COVID-19 vaccine introduction. Door-to-door delivery and demand generation through varied risk communication and community engagement strategies improved vaccine access. Electronic data platforms were established, surge capacity improved, and healthcare and community workers were trained. Initial unpredictable vaccine supplies limited vaccination efforts. Changing vaccine information affected health workers’ ability to engage communities with up-to-date guidance. While vaccine safety monitoring systems were in place, reporting knowledge varied among health workers, and 36% of surveyed facilities had ever documented and reported COVID-19 vaccine-related adverse events following immunisation. Challenges with electronic data systems limited timely access to and use of granular service-delivery data for decision-making.
Ghana leveraged existing immunisation and emergency-response systems to make substantial progress in COVID-19 vaccine deployment. Coordination, cold chain expansion, flexible service delivery, demand generation and workforce mobilisation supported implementation. Irregular vaccine supply, data system challenges, variable adverse event reporting, waste management pressure and misinformation challenged deployment. These findings provide lessons for adult immunisation, life-course vaccination and future public health emergency readiness.
K. Amponsa-Achiano, Angela K. Shen, Eunice Baiden Laryea et al.· BMC Public Health· 0 citations
