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Timeliness of Childhood Vaccination Coverage: the Growing Up in Singapore Towards Healthy Outcomes Study

Prevention Science volume 21, pages 283–292 (2020)Cite this article

Abstract

Studies investigating timeliness for childhood vaccination are limited especially in Asia. We examined the timeliness of vaccine administration and associated factors among infant and young children in Singapore. A total of 782 children born between November 2009 and July 2011 from a prospective cohort in Singapore were studied. Vaccination records from birth to 24 months of age were obtained from the National Immunization Registry of Singapore. Multivariable logistic regression models were performed. By 2 years of age, 92.8% of children in our cohort experienced a delay in receiving 1 or more vaccine doses according to the recommended national immunization schedule. When vaccinations were reviewed by series for each vaccine, 15.6% received all vaccine series outside the recommended age ranges. Factors associated with receiving vaccination series outside the recommended ages included maternal aged ≤ 35 years (OR 2.00; 95% CI 1.09, 3.66), Malay (1.71; 1.01, 2.89) or Indian ethnicity (2.06; 1.19, 3.59), low monthly household income (1.91; 1.14, 3.18), having at least four children (3.46; 1.62, 7.38) and private (3.42; 1.80, 6.48) and multiple vaccination providers (3.91; 1.23, 12.48). These findings show an unacceptably high proportion of children experienced a delay in the receipt of their vaccinations. The identification of several demographic, socioeconomic, health-seeking behavioural and vaccine provider factors provides opportunities for targeted interventions to enhance the timeliness of childhood vaccination in Singapore.

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Acknowledgements

We would like to thank the participants and the GUSTO study group, which includes Allan Sheppard, Amutha Chinnadurai, Anne Eng Neo Goh, Anne Rifkin-Graboi, Anqi Qiu, Arijit Biswas, Bee Wah Lee, Birit F.P. Broekman, Boon Long Quah, Borys Shuter, Chai Kiat Chng, Cheryl Ngo, Choon Looi Bong, Christiani Jeyakumar Henry, Cornelia Yin Ing Chee, Yam Thiam Daniel Goh, Doris Fok, George Seow Heong Yeo, Helen Chen, Hugo P S van Bever, Iliana Magiati, Inez Bik Yun Wong, Ivy Yee-Man Lau, Jeevesh Kapur, Jenny L. Richmond, Joanna D. Holbrook, Joshua J. Gooley, Kenneth Kwek, Krishnamoorthy Niduvaje, Leher Singh, Lin Lin Su, Lourdes Mary Daniel, Marielle V. Fortier, Mark Hanson, Mary Foong-Fong Chong, Mary Rauff, Mei Chien Chua, Michael Meaney, Mya Thway Tint, Neerja Karnani, P. C. Wong, Peter D. Gluckman, Pratibha Agarwal, Rob M. van Dam, Salome A. Rebello, Seang-Mei Saw, Shang Chee Chong, Shirong Cai, Sok Bee Lim, Chin-Ying Stephen Hsu, Victor Samuel Rajadurai, Walter Stunkel, Wee Meng Han, Wei Wei Pang, Yiong Huak Chan and Yung Seng Lee.

Funding

This work is supported by the Singapore National Research Foundation under its Translational and Clinical Research Flagship Programme and administered by the Singapore Ministry of Health’s National Medical Research Council (NMRC), Singapore [NMRC/TCR/004-NUS/2008; NMRC/TCR/012-NUHS/2014]. Additional funding is provided by the Singapore Institute for Clinical Sciences, Agency for Science Technology and Research (A*STAR), Singapore. YB Cheung is supported by the National Research Foundation, Singapore (NMRC/CSA/0039/2012). JKY Chan is supported by the Ministry of Health’s NMRC, Singapore (NMRC/CSA (SI)/008/2016). KM Godfrey is supported by the National Institute for Health Research (no. 289346). N Lek is supported by the Ministry of Health’s NMRC, Singapore (NMRC/TA/0037/2015).

Author information

Affiliations

  1. Department of Reproductive Medicine, KK Women’s and Children’s Hospital, Singapore, 229899, Singapore

    See Ling Loy & Jerry Kok Yen Chan

  2. Duke-NUS Medical School, Singapore, 169857, Singapore

    See Ling Loy, Jerry Kok Yen Chan, Kok Hian Tan, Ngee Lek, Fabian Yap & Koh Cheng Thoon

  3. Center for Quantitative Medicine, Duke-NUS Medical School, Singapore, 169857, Singapore

    Yin Bun Cheung

  4. Tampere Center for Child Health Research, University of Tampere and Tampere University Hospital, 33014, Tampere, Finland

    Yin Bun Cheung

  5. Singapore Institute for Clinical Sciences, Agency for Science, Technology and Research (A*STAR), Singapore, 117609, Singapore

    Shu E Soh, Lynette Pei-Chi Shek & Yap-Seng Chong

  6. Department of Paediatrics, Yong Loo Lin School of Medicine, National University of Singapore, National University Health System, Singapore, 119228, Singapore

    Shu E Soh & Lynette Pei-Chi Shek

  7. Medical Research Council Lifecourse Epidemiology Unit, University of Southampton, Southampton, SO16 6YD, UK

    Keith M. Godfrey

  8. National Institute for Health Research Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton National Health Service Foundation Trust, Southampton, SO16 6YD, UK

    Keith M. Godfrey

  9. Department of Maternal Fetal Medicine, KK Women’s and Children’s Hospital, Singapore, 229899, Singapore

    Kok Hian Tan

  10. Khoo Teck Puat-National University Children’s Medical Institute, National University Hospital, National University Health System, Singapore, 119074, Singapore

    Lynette Pei-Chi Shek

  11. Department of Obstetrics & Gynaecology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, 119228, Singapore

    Yap-Seng Chong

  12. Department of Paediatrics, KK Women’s and Children’s Hospital, Singapore, 229899, Singapore

    Ngee Lek, Fabian Yap, Oon Hoe Teoh, Chee Fu Yung & Koh Cheng Thoon

  13. Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, 636921, Singapore

    Fabian Yap

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  1. See Ling Loy
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  2. Yin Bun Cheung
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  3. Jerry Kok Yen Chan
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  4. Shu E Soh
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  7. Lynette Pei-Chi Shek
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  9. Ngee Lek
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Corresponding author

Correspondence to Koh Cheng Thoon.

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Conflict of Interest

KMG, YSC and FY have received reimbursement for speaking at conferences sponsored by companies selling nutritional products. KMG and YSC are part of an academic consortium that has received research funding from Abbott Nutrition, Nestle and Danone. Other authors declared that they have no conflict of interest.

Ethical Approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed Consent

Informed written consent was obtained from all mothers of infants included in the study.

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Loy, S.L., Cheung, Y.B., Chan, J.K.Y. et al. Timeliness of Childhood Vaccination Coverage: the Growing Up in Singapore Towards Healthy Outcomes Study. Prev Sci 21, 283–292 (2020). https://doi.org/10.1007/s11121-019-01078-2

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  • DOI: https://doi.org/10.1007/s11121-019-01078-2

Keywords

  • Age-appropriate
  • Childhood immunization
  • Coverage
  • Timeliness
  • Vaccination