Abstract:
Background: The World Health Organization recommends Bacillus Calmette-Guérin (BCG) vaccination against
tuberculosis be given at birth. However, in many developing countries, pre-term and low birth weight infants get
vaccinated only after they gain the desired weight. In Kenya, the ministry of health recommends pre-term and low
birth weight infants to be immunized at the time of discharge from hospital irrespective of their weight. This paper
seeks to understand the effects of birth weight on timing of BCG vaccine.
Methods: The study was conducted in two Nairobi urban informal settlements, Korogocho and Viwandani which
hosts the Nairobi Urban Health and Demographic Surveillance system. All infants born in the study area since
September 2006 were included in the study. Data on immunization history and birth weight of the infant were
recorded from child’s clinic card. Follow up visits were done every four months to update immunization status of
the child. A total of 3,602 infants were included in this analysis. Log normal accelerated failure time parametric
model was used to assess the association between low birth weight infants and time to BCG immunization.
Results: In total, 229 (6.4%) infants were low birth weight. About 16.6% of the low birth weight infants weighed
less than 2000 grams and 83.4% weighed between 2000 and 2490 grams. Results showed that, 60% of the low
birth weight infants received BCG vaccine after more than five weeks of life. Private health facilities were less likely
to administer a BCG vaccine on time compared to public health facilities. The effects of low birth weight on females
was 0.60 and 0.97-times that of males for infants weighing 2000–2499 grams and for infants weighing <2000 grams
respectively. The effect of low birth weight among infants born in public health facilities was 1.52 and 3.94-times that
of infants delivered in private health facilities for infants weighing 2000–2499 grams and those weighing < 2000
grams respectively.
Conclusion: Low birth weight infants received BCG immunization late compared to normal birth weight infants. Low
birth weight infants delivered in public health facilities were more likely to be immunized much later compared to
private health facilities.
Keywords: Bacillus Calmette-Guérin, Low birth weight, Immunization
