title: Neonatal vaccination of low birthweight infants in Ghana.
abstract: OBJECTIVE
  Global vaccination policy advocates for identifying and targeting groups who are underserved by vaccination to increase equity and uptake. We investigated whether birth weight and other factors are determinants of neonatal BCG vaccination in order to identify infants underserved by vaccination.
  
  
  METHODS
  We used logistic regression to calculate adjusted ORs (AORs) for the association between birth weight (categorised as non-low birth weight (NLBW) (≥2.50 kg) and low birth weight (LBW) (2-2.49 kg, 1.50-1.99 kg and <1.50 kg)) and non-vaccination with BCG at the end of the neonatal period (0-27 days). We assessed whether this association varied by place of delivery and infant illness. We calculated how BCG timing and uptake would improve by ensuring the vaccination of all facility-born infants prior to discharge.
  
  
  RESULTS
  There was a strong dose-response relationship between LBW and not receiving BCG in the neonatal period (p-trend<0.0001). Infants weighing 1.50-1.99 kg had odds of non-vaccination 1.6 times (AOR 1.64; 95% CI 1.30 to 2.08), and those weighing <1.50 kg 2.4 times (AOR 2.42; 95% CI 1.50 to 3.88) those of NLBW infants. Other determinants included place of delivery, distance to the health facility and socioeconomic status. Neither place of delivery nor infant illness modified the association between birth weight and vaccination (p-interaction all >0.19). Facility-born infants were vaccinated at a mean of 6 days, suggesting that they were not vaccinated in the facility at birth but were referred for vaccination.
  
  
  CONCLUSIONS
  LBW is a risk factor for neonatal under-vaccination, even for facility-born infants. Ensuring vaccination at facility births would substantively improve timing and equitable BCG vaccination.
authors.affiliation: Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK.
authors.forename: Maureen
authors.identifier: http://orcid.org/0000-0001-8078-9045
authors.initials: M
authors.lastname: O'Leary
authors.affiliation: School of Paediatrics and Child Health, University of Western Australia, Crawley, Western Australia, Australia.
authors.forename: Karen
authors.initials: K
authors.lastname: Edmond
authors.affiliation: Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK.
authors.forename: Sian
authors.initials: S
authors.lastname: Floyd
authors.affiliation: Institute of Primary Care and Public Health, School of Medicine, Cardiff University, Cardiff, UK.
authors.forename: Lisa
authors.initials: L
authors.lastname: Hurt
authors.affiliation: Engender Health, New York, New York, USA.
authors.forename: Caitlin
authors.initials: C
authors.lastname: Shannon
authors.affiliation: Kintampo Health Research Centre, Kintampo, Ghana.
authors.forename: Gyan
authors.initials: G
authors.lastname: Thomas
authors.affiliation: Department of Community Health, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana.
authors.forename: Sam
authors.initials: S
authors.lastname: Newton
authors.affiliation: Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK.
authors.forename: Betty
authors.initials: B
authors.lastname: Kirkwood
authors.affiliation: Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK.
authors.forename: Sara
authors.initials: S
authors.lastname: Thomas
mesh_terms: D000293:Adolescent; D000328:Adult; D001500:BCG Vaccine / Q000600:supply & distribution*; D005260:Female; D005869:Ghana; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D007223:Infant; D007230:Infant, Low Birth Weight; D008423:Maternal Age; D008507:Medically Underserved Area; D008875:Middle Aged; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data; D018743:Perinatal Care / Q000706:statistics & numerical data; D011446:Prospective Studies; D012307:Risk Factors; D014611:Vaccination / Q000379:methods / Q000706:statistics & numerical data; D055815:Young Adult
chemical_list: D001500:BCG Vaccine
keywords: Epidemiology; Immunisation; Tropical Paediatrics