Immunisation status and clinical outcomes in children admitted to a Paediatric emergency unit in Ghana: a prospective cohort study

Incomplete childhood immunisation remains a global concern, especially following disruptions caused by the COVID-19 pandemic. This study assessed the immunisation status and clinical outcomes of children admitted to the Paediatric Emergency Unit (PEU) of Komfo Anokye Teaching Hospital (KATH), Ghana, from November 2024 to January 2025. Differences in vaccination coverage before and after the pandemic were also explored by comparing immunisation status between children under five and those aged five years and above. This prospective cohort study collected data on demographic characteristics, clinical diagnoses, outcomes, and immunisation status through caregiver interviews and medical record review using a structured questionnaire. Immunisation status was evaluated against the Ghana Expanded Programme on Immunisation (EPI) schedule. Reasons for incomplete immunisation were also explored. Logistic regression was used to identify factors associated with vaccination default and their outcomes. Out of 401 children admitted, 95 were excluded (13 readmissions, 77 inadequate immunisation records, five refusals), leaving 306 enrolled. Median age was 3.2 years (IQR 1.2, 7.6), and 55.9% were male. Overall, 74.5% were fully vaccinated for age, 24.5% under-vaccinated, and 1.0% unvaccinated. Vaccination default was significantly more common in children under five years (AOR: 7.86, 95% CI: 3.66–19.2). Mortality was higher among un- and under-vaccinated children (16.7%) compared to fully vaccinated (7.0%) children. While univariate analysis demonstrated a significant association between vaccination default and mortality (p = 0.017), this association did not remain significant in multivariate analysis. Instead, vaccination default was independently associated with younger age, the presence of respiratory distress at presentation, and a shorter duration of hospital stay. Caregiver hesitancy (48.7%), vaccine unavailability (20.5%), and child-related health issues (19.2%) were the leading reasons for vaccination default. Immunisation coverage in children admitted to the PEU was suboptimal, with younger children, especially those vaccinated during or after the COVID-19 pandemic, being disproportionately affected. Strengthening routine immunisation services, addressing caregiver concerns, and institutionalising catch-up vaccination protocols in hospitals are critical.