Increasing Service Availability Critical for Improving Routine Vaccination Coverage In Haiti: Results From a National Coverage Survey

Background: Since 1977, vaccinations to protect against tuberculosis, diphtheria, tetanus, pertussis, polio, and measles have been recommended for infants in Haiti through the national immunization program.  Rubella-containing vaccine was introduced in 2009.

Objectives: A national vaccination coverage survey was conducted in 2009 to evaluate a 2007 – 2008 national measles-rubella campaign and assess the routine vaccination program in reaching children in Haiti.

Methods: A multi-stage cluster survey was conducted from April to July 2009 using a modified WHO-EPI methodology for household sampling. Vaccination histories were obtained for children aged 12 – 23 months with vaccination cards, and a standardized questionnaire was administered to collect demographic information and reasons for under-vaccination. A child who received all recommended vaccinations was considered fully vaccinated. Drop-out was calculated as the proportion of children who received the first dose of diphtheria-tetanus-pertussis (DTP) vaccine, but did not receive the third dose.

Results: Among 1,361 who were enrolled, 39.3% (95% CI: 34.9 – 43.7) were fully vaccinated, including 47.5% of children residing in the Port-au-Prince urban area and 36.3% in rural departments. Drop-out between the first and third DTP doses was 15.5% and 19.0% in urban and rural areas, respectively. Reasons reported by caregivers for under-vaccination included insufficient time to reach the service location (28%), illness in the child at the time of vaccination (10%), the caregiver’s not knowing when to go, or forgetting to go (13%), and vaccine non-availability (9%); < 7% indicated that vaccination was unimportant.

Conclusions: Although few caregivers in Haiti felt that routine immunization was not important, more than 60% of children surveyed were not fully vaccinated. Efforts should focus on ensuring wide availability of services, especially in rural areas, improving the vaccine supply, and disseminating information on the location and timing of services.