Understanding Vaccination Card Retention in Ghana

Childhood vaccination is one of the best ways to keep children healthy. It prevents around four million deaths every year. Vaccination not only protects kids from diseases but also connects families to healthcare services. This contact is important because it allows families to access other health services. Vaccination helps lower the number of diseases that can be prevented, reduces the use of antibiotics, and decreases deaths linked to these diseases.

#Vaccination Tracking in Low-Income Countries

In many low- and middle-income countries, Caregivers use home-based vaccination cards to track if their children have received their Vaccinations. These cards also serve as reminders for when to bring the Child back for future vaccinations, helping parents remember to keep up with the vaccination schedule. Unfortunately, caregivers often do not value these cards enough, and they are not always kept safe or used effectively.

In Ghana, vaccination information is collected during healthcare visits. The health workers keep vaccination registers, which are paper records used to calculate how many children have been vaccinated. Caregivers hold onto their child's vaccination cards, which are useful for keeping track of when the child needs their shots and for surveys measuring vaccination coverage.

#Current Status of Vaccination Card Retention in Ghana

Recent information shows that 78.5% of vaccination cards were kept safe, a drop from 80% in 2014. Knowing what factors affect how well caregivers keep vaccination cards can help create better strategies to improve that retention. However, there are few studies on why caregivers in Ghana do not keep these cards. To address this, a study was conducted to look into why caregivers in Tamale, Ghana, might not be keeping vaccination cards for their children aged 0-59 months.

#Study Overview

The study took place between December 21, 2022, and January 10, 2023. It focused on children aged 0-59 months in the Tamale Metropolis area. The study is part of a larger project that gathered information about children's health before and after the COVID-19 pandemic.

#Location of the Study

Tamale is the capital city of the Northern Region of Ghana and has a population of around 374,744 people. It is divided into four parts: Vittin, Bilpela, Nyohini, and Tamale Central, and has 77 health facilities that provide services, including vaccinations.

#Participants in the Study

The study included children aged 0-59 months and their caregivers. Although Ghana's vaccination schedule is mainly for children under 18 months, the study looked at kids up to five years old to compare those who still need vaccinations with those who have already completed their schedule.

#Sample Size

Using the World Health Organization’s sample size calculator, the researchers aimed to include 1,512 children. They considered factors like the expected coverage of vaccinations, a margin of error, and other statistical elements to ensure accuracy.

#How Participants Were Chosen

A series of steps were taken to choose participants. First, 63 clusters were carefully selected from the four parts of Tamale. Each cluster represented a grouped community where children would be surveyed. Then, communities were randomly chosen from these clusters. Homes were selected for the study, and eligible children were chosen randomly from those homes.

#Who Was Included and Excluded

The study included caregivers of children aged 0-59 months. Caregivers of older children, those who had never received a vaccination card, and those who refused to participate were left out.

#Data Collection Process

Researchers collected data using a questionnaire created by the World Health Organization to check vaccination coverage. The questionnaire asked about the caregiver's background, the child's vaccination status, and whether the vaccination card was available. Data was collected using a software called KoboCollect on tablets. Trained assistants conducted face-to-face interviews and asked caregivers to show the vaccination cards.

#Ensuring Data Quality

To make sure the data was accurate, the research assistants received a day of training on how to conduct interviews and ask the right questions. They also pretested the tools they used to ensure clarity. The researchers checked the gathered information for any mistakes before analyzing it.

#Definitions

A vaccination card is a document given to caregivers that shows the vaccination status of a child. A caregiver is anyone who takes care of a child. The card is considered retained if researchers see it and can verify the child's vaccination status.

#Analyzing the Data

Data was organized and cleaned before being analyzed using a statistical program. Card retention was the main focus, determined by whether caregivers could show their child's vaccination card. Several factors were analyzed for their influence on the retention of these cards, including the child's age, gender, and the caregiver's background.

#Ethical Approval and Consent

The study received permission from the appropriate research boards. Caregivers gave verbal consent before being included in the study.

#Sample Description and Card Retention Rates

The study enrolled 1,577 children, but only 1,566 were included in the final analysis after cleaning the data. Among those studied, 89.5% showed their vaccination cards. Of the 164 children who did not present their cards, the main reason was that the card was lost. Other reasons included not knowing where it was or being too lazy to get it.

#Key Findings on Vaccination Card Retention

The analysis found specific factors that were important in determining whether vaccination cards were kept. Living in certain parts of Tamale or being an older child were linked to lower chances of retaining the card. However, caregivers who paid for the vaccination card were more likely to keep it safe.

#Reasons for Low Retention Rates

Living in the Nyohini or Tamale Central areas was associated with lower card retention, likely due to a lack of understanding of how important these cards are. Similarly, older children showed lower chances of keeping their cards because caregivers might not realize the importance of retaining the card after the child is done with the vaccination schedule.

#Importance of Caregiver Payment

Interestingly, caregivers who had to pay for the vaccination card were far more likely to keep it safe. This might be because they recognize its value and want to avoid the hassle of replacing it. However, selling vaccination cards is not allowed in Ghana.

#Strengths and Limitations

This study used a large sample size, which makes the findings applicable to a broader context. The study also used a method of checking the cards directly, which adds reliability to the results. However, being a cross-sectional study means it cannot definitively prove cause and effect. Additionally, if some caregivers did not present their cards, it does not mean they do not have them.

#Conclusion

The study found a high retention rate for vaccination cards, with certain factors such as location, age of the child, and payment for the card being significant. To improve retention, healthcare providers in specific areas should focus on educating caregivers about the importance of keeping vaccination cards safe. It’s also vital to inform caregivers of older children about the need to hold onto the cards even after the vaccination schedule is complete. Ensuring vaccination cards are provided free of charge could also help improve retention rates.