Child survival in children born to HIV-2 infected women in Guinea-Bissau, West Africa

Guinea, also sometimes referred as Guinea-Conakry, is found in West Africa. It is bordered by Guinea-Bissau, Senegal, and Mali in the north and Sierra Leone, Liberia, and Ivory Coast in the south. In 2016, Guinea had a population of 12.6 million over a territory of 245 860 square kilometres (km). Its capital and largest city is Conakry. The official language of Guinea is French, and the currency used is the Guinean franc (GNF).

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Out-of-sequence DTP and measles vaccinations and child mortality in Guinea-Bissau: a reanalysis

BMJ Open ◽

10.1136/bmjopen-2018-024893 ◽

2019 ◽

Vol 9 (9) ◽

pp. e024893 ◽

Cited By ~ 1

Author(s):

Sanne M Thysen ◽

Amabelia Rodrigues ◽

Peter Aaby ◽

Ane B Fisker

Keyword(s):

Mortality Rate ◽

Child Mortality ◽

Proportional Hazards ◽

Child Survival ◽

Secondary Analysis ◽

Oral Polio Vaccine ◽

Vaccination Schedule ◽

Cox Proportional Hazards ◽

Vaccination Status ◽

Guinea Bissau

ObjectivesTo assess whether the sequence of diphtheria-tetanus-pertussis vaccine (DTP) and measles vaccine (MV) was associated with child survival in a dataset previously used to assess non-specific effects of vaccines with no consideration of vaccination sequence.DesignProspective cohort study analysed using the landmark approach.SettingBandim Health Project’s Health and Demographic Surveillance System covering 100 village clusters in rural Guinea-Bissau. The recommended vaccination schedule was BCG and oral polio vaccine (OPV) at birth, DTP and OPV at 6, 10 and 14 weeks, MV at 9 months and booster DTP and OPV at 18 months of age.ParticipantsChildren aged 9–17 months (main analysis) and 18–35 months (secondary analysis: age of booster DTP) with vaccination status assessed between April 1991 and April 1996.MethodsSurvival during the 6 months after assessing vaccination status was compared by vaccination sequence in Cox-proportional hazards models with age as underlying time. Analyses were stratified by sex and village cluster.Main outcome measureMortality rate ratio (MRR) for out-of-sequence vaccinations compared with in-sequence vaccinations.ResultsAmong children aged 9–17 months, 60% of observations (3574/5937) were from children who had received both MV and DTP. Among these, 1590 observations were classified as in-sequence vaccinations (last DTP before MV), and 1984 observations were out-of-sequence vaccinations (1491: MV with DTP and 493: MV before DTP). Out-of-sequence vaccinations were associated with higher mortality than in-sequence vaccinations (MRR 2.10, 95% CI 1.07 to 4.11); the MRR was 2.30 (95% CI 1.15 to 4.58) for MV with DTP and 1.45 (95% CI 0.50 to 4.22) for DTP after MV. Associations were similar for boys and girls (p=0.77). Between 18 and 35 months the mortality rate increased among children vaccinated in-sequence and the differential effect of out-of-sequence vaccinations disappeared.ConclusionOut-of-sequence vaccinations may increase child mortality. Hence, sequence of vaccinations should be considered when planning vaccination programmes or introducing new vaccines into the current vaccination schedule.

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