Factors associated with vaccine coverage improvements in Senegal between 2005-2019: A quantitative retrospective analysis

ABSTRACT Objective Senegal has demonstrated catalytic improvements in national coverage rates for early childhood vaccination, despite lower development assistance for childhood vaccines in Senegal compared to other low and lower-middle income countries. Understanding factors associated with historical changes in childhood vaccine coverage in Senegal, as well as heterogeneities across its 14 regions, can highlight effective practices that might be adapted to improve vaccine coverage elsewhere. Design Childhood vaccination coverage rates, demographic information, and health system characteristics were identified from Senegal’s Demographic and Health Surveys (DHS) and Senegal national reports for years 2005 to 2019. Multivariate logistic and linear regression analyses were performed to determine statistical associations of demographic and health system characteristics with respect to childhood vaccination coverage rates. Setting The 14 administrative regions of Senegal were chosen for analysis. Participants DHS women’s survey respondents with living children aged 12-23 months for survey years 2005-2019. Outcome Measures Immunization with the third dose of the diphtheria-tetanus-pertussis vaccine (DTP3), widely used as a proxy for estimating immunization coverage levels and the retention of children in the vaccine program. Results Factors associated with childhood vaccination coverage include urban residence (β=0·61, p=0·0157), female literacy (β=1·11, p=0·0007), skilled prenatal care (β=1·80, p<0·0001), and self-reported ease of access to care when sick, considering travel distance to a healthcare facility (β=-0·70, p=0·0009) and concerns over traveling alone (β=-1·08, p<0·0001). Higher coverage with less variability over time was reported in urban areas near the capital and the coast (p=0·076), with increased coverage in recent years in more rural and landlocked areas. Conclusions Childhood vaccination was more likely among children whose mothers had higher literacy, received skilled prenatal care, and had perceived ease of access to care when sick. Overall, vaccination coverage is high in Senegal and disparities in coverage between regions have decreased significantly in recent years.