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Neonatal vaccination of low birthweight infants in Ghana
  1. Maureen O'Leary1,
  2. Karen Edmond2,
  3. Sian Floyd1,
  4. Lisa Hurt3,
  5. Caitlin Shannon4,
  6. Gyan Thomas5,
  7. Sam Newton6,
  8. Betty Kirkwood1,
  9. Sara Thomas1
  1. 1Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
  2. 2School of Paediatrics and Child Health, University of Western Australia, Crawley, Western Australia, Australia
  3. 3Institute of Primary Care and Public Health, School of Medicine, Cardiff University, Cardiff, UK
  4. 4Engender Health, New York, New York, USA
  5. 5Kintampo Health Research Centre, Kintampo, Ghana
  6. 6Department of Community Health, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
  1. Correspondence to Maureen O'Leary, Department of Infectious Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, Keppel St, London WC1E 7HT, UK; maureenoleary01{at}


Objectives Global vaccination policy advocates for identifying and targeting groups who are underserved by vaccination to increase equity and uptake. We investigated whether birth weight and other factors are determinants of neonatal BCG vaccination in order to identify infants underserved by vaccination.

Methods We used logistic regression to calculate adjusted ORs (AORs) for the association between birth weight (categorised as non-low birth weight (NLBW) (≥2.50 kg) and low birth weight (LBW) (2–2.49 kg, 1.50–1.99 kg and <1.50 kg)) and non-vaccination with BCG at the end of the neonatal period (0–27 days). We assessed whether this association varied by place of delivery and infant illness. We calculated how BCG timing and uptake would improve by ensuring the vaccination of all facility-born infants prior to discharge.

Results There was a strong dose–response relationship between LBW and not receiving BCG in the neonatal period (p-trend<0.0001). Infants weighing 1.50–1.99 kg had odds of non-vaccination 1.6 times (AOR 1.64; 95% CI 1.30 to 2.08), and those weighing <1.50 kg 2.4 times (AOR 2.42; 95% CI 1.50 to 3.88) those of NLBW infants. Other determinants included place of delivery, distance to the health facility and socioeconomic status. Neither place of delivery nor infant illness modified the association between birth weight and vaccination (p-interaction all >0.19). Facility-born infants were vaccinated at a mean of 6 days, suggesting that they were not vaccinated in the facility at birth but were referred for vaccination.

Conclusions LBW is a risk factor for neonatal under-vaccination, even for facility-born infants. Ensuring vaccination at facility births would substantively improve timing and equitable BCG vaccination.

  • Immunisation
  • Epidemiology
  • Tropical Paediatrics

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  • Contributors MOL drafted the report, and it was reviewed by all authors. MOL, ST, SF and KE designed the study and analyses. KE, BK and SN designed the trial. CS, MOL, GT, SN, LH and KE were responsible for trial conduct. GT coordinated the fieldwork. MOL and CS managed the database. MOL undertook the statistical analyses with input from ST and SF.

  • Funding The Bill and Melinda Gates Foundation funded the Neovita trial.

  • Competing interests None declared.

  • Ethics approval The ethics committees of the WHO, the London School of Hygiene & Tropical Medicine (LSHTM) and the KHRC granted approval for the Neovita trial.

  • Provenance and peer review Not commissioned; externally peer reviewed.