Vaccination coverage and timely vaccination with valid doses in Malawi

A cluster vaccination coverage survey was conducted in two districts, Dowa and Ntchisi, in Malawi to measure the vaccination coverage of children 12–23 months old and identify factors impacting the utilization of vaccination service. The survey was conducted as a baseline for a new project with the objectives of measuring the vaccination coverage and identifying factors impacting the utilization of vaccination service following the WHO cluster survey reference manual. The survey was cross-sectional, descriptive, and used a two-stage cluster sampling. The first stage was the sampling of enumeration areas (EAs) and the second stage was the sampling of households for the interviews. A total of 601 mothers with children of 12–23 months old were interviewed in the two districts. From each district, 30 clusters were sampled and from each of the clusters 10 children aged 12–23 months were sampled. The data collectors were trained by Expanded Program on Immunization (EPI) officers from neighboring districts, and the MOH/EPI team and the MCSP officers supervised the data collection. The vaccination card availability was very high in both districts, with 94% of the children having a vaccination card. Vaccination coverage by card plus history of mothers was very high, above 93% for all antigens, and the coverage by card alone was also high, with a range of pentavalent coverage of 91% in Ntchisi and 83% in Dowa. However, the percentage of valid doses administered to fully immunized children was low, with 60% in Dowa and 49% in Ntchisi. About 10% of the pentavalent doses in Dowa and 9% in Ntchisi were administered before six weeks of age, and 7% and 8% of the pentavalent3 doses in Dowa and Ntchisi districts respectively were administered in less than 28 days after pentavalent2. The main reason for no vaccination was vaccine stock outs at health facility level. The majority of village heads were satisfied with the vaccination service in their communities. Health surveillance assistants (HSAs), village heads, and religious leaders all play major roles in mobilization for vaccination service in the two districts. The survey found that many children in Malawi receive invalid doses, including premature administration, short intervals between doses, and late administration of doses beyond 12 months of age. This finding calls for immediate action to educate the service providers on administration of valid doses. The study highlights the importance of timely vaccination with valid doses in achieving optimal vaccine response. The World Health Organization (WHO) classified those vaccination doses as invalid doses. The validity of childhood vaccinations has been evaluated in studies conducted in several countries, including South Africa, Kenya, Nigeria, Uganda, Ethiopia, China, and the USA, and children received many invalid doses. The study suggests that the MOH of Malawi should support the vaccination program to improve vaccination coverage and the USAID-funded Maternal and Child Survival Program (MCSP) should provide support in two low-performing districts, Dowa and Ntchisi, to implement the Reaching Every Community (REC) approach.