title: Effects of low birth weight on time to BCG vaccination in an urban poor settlement in Nairobi, Kenya: an observational cohort study.
abstract: BACKGROUND
  The World Health Organization recommends Bacillus Calmette-Guérin (BCG) vaccination against tuberculosis be given at birth. However, in many developing countries, pre-term and low birth weight infants get vaccinated only after they gain the desired weight. In Kenya, the ministry of health recommends pre-term and low birth weight infants to be immunized at the time of discharge from hospital irrespective of their weight. This paper seeks to understand the effects of birth weight on timing of BCG vaccine.
  
  
  METHODS
  The study was conducted in two Nairobi urban informal settlements, Korogocho and Viwandani which hosts the Nairobi Urban Health and Demographic Surveillance system. All infants born in the study area since September 2006 were included in the study. Data on immunization history and birth weight of the infant were recorded from child's clinic card. Follow up visits were done every four months to update immunization status of the child. A total of 3,602 infants were included in this analysis. Log normal accelerated failure time parametric model was used to assess the association between low birth weight infants and time to BCG immunization.
  
  
  RESULTS
  In total, 229 (6.4%) infants were low birth weight. About 16.6% of the low birth weight infants weighed less than 2000 grams and 83.4% weighed between 2000 and 2490 grams. Results showed that, 60% of the low birth weight infants received BCG vaccine after more than five weeks of life. Private health facilities were less likely to administer a BCG vaccine on time compared to public health facilities. The effects of low birth weight on females was 0.60 and 0.97-times that of males for infants weighing 2000-2499 grams and for infants weighing <2000 grams respectively. The effect of low birth weight among infants born in public health facilities was 1.52 and 3.94-times that of infants delivered in private health facilities for infants weighing 2000-2499 grams and those weighing < 2000 grams respectively.
  
  
  CONCLUSIONS
  Low birth weight infants received BCG immunization late compared to normal birth weight infants. Low birth weight infants delivered in public health facilities were more likely to be immunized much later compared to private health facilities.
authors.affiliation: African Population and Health Research Center, Manga Close, Nairobi, Kenya. mkavao@aphrc.org.|Jomo Kenyatta University of Agriculture and Technology, Nairobi, Kenya. mkavao@aphrc.org.
authors.forename: Martin Kavao
authors.initials: MK
authors.lastname: Mutua
authors.affiliation: Population Services Kenya, Jumuia Place, Lenana road, Nairobi, Kenya. rochako@gmail.com.
authors.forename: Rhoune
authors.initials: R
authors.lastname: Ochako
authors.affiliation: Faculty of Medicine, University of British Columbia, Vancouver, Canada. rettarh@gmail.com.
authors.forename: Remare
authors.initials: R
authors.lastname: Ettarh
authors.affiliation: Research Center for Vitamins and Vaccines, 5 Artillerivej, Copenhagen, Denmark. hjn@ssi.dk.|Bandim Health Project, Statens Serum Institut, 5 Artillerivej, Copenhagen, Denmark. hjn@ssi.dk.|OPEN, University of Southern Denmark/Odense University Hospital, Odense, Denmark. hjn@ssi.dk.
authors.forename: Henrik
authors.initials: H
authors.lastname: Ravn
authors.affiliation: Center for Public Health Research, Kenya Medical Research Institute, Nairobi, Kenya. eechoka@kemri.org.
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Echoka
authors.affiliation: Jomo Kenyatta University of Agriculture and Technology, Nairobi, Kenya. peter.kabanya@gmail.com.
authors.forename: Peter
authors.initials: P
authors.lastname: Mwaniki
mesh_terms: D001500:BCG Vaccine / Q000008:administration & dosage*; D015331:Cohort Studies; D005260:Female; D016304:Hospitals, Private; D006779:Hospitals, Public; D006801:Humans; D007115:Immunization Schedule; D007230:Infant, Low Birth Weight; D007231:Infant, Newborn; D007630:Kenya; D008297:Male; D012044:Regression Analysis; D012737:Sex Factors; D014505:Urban Population
chemical_list: D001500:BCG Vaccine