Atlas of African health statistics 2022: Health situation analysis of the WHO African Region

The population of the World Health Organization's (WHO) African Region was estimated to be 1 120 161 000 in 2020 and about 14.4% of the world's population of 7 758 157 000. It was 8 billion in 20211 . It is the third largest population among the WHO regions after South-East Asia and the Western Pacific. Between 2019 and 2020, the population differential was equivalent to that of a state of more than 28 million inhabitants. The five most populated countries account for more than 45% of the Region's population. Among these, Nigeria and the Democratic Republic of the Congo represent about 50% of the population of the West African and Central African subregions, respectively, and Ethiopia represents about 20% of the population of the East and Southern Africa subregions. The average annual population growth in Africa was 2.5% in 2020. If the heterogeneity of the population growth between the regions of the world and between countries in the same subregion is considered, countries from and East and Southern Africa subregions seem to have lower population growth rates than countries in other large subregions, which show significantly higher increases. The current population density of Africa is low, estimated to be 36 inhabitants per km2 for the whole continent. However, many areas are uninhabitable and some countries have relatively large populations. High population density is a concern that must be addressed through policies, because it could generate surges and high concentrations of populations in mega cities and urban slums, which can be an issue when it comes to accessing various qualitative services. Gross domestic product (GDP) reflects a country's resources and therefore its potential to provide access to services to its people, particularly health services. This dynamic creates a circle, with healthier people going to work and contributing to the production of wealth for the benefit of the country. The most vulnerable people live from agriculture in rural areas, or in conflict-affected states. Difficulties in accessing health services, low education and inequalities between men and women are additional obstacles to poverty reduction. The population of sub-Saharan Africa is expected to almost double over the next three decades, growing from 1.15 billion in 2022 to 2.09 billion in 2050. The world's population is expected to grow from 7.94 billion at present to 8.51 billion in 2030 and 9.68 billion in 2050. The demographic dividend2 for African countries will emanate from the acceleration of economic growth following a de crease in fertility with a change in the structure of the age pyramid where the active population, that is those aged 18­65 years, will be more important, reaching a certain optimum to make positive the ratio between the population able to finance health and education systems and the population that benefits from these systems. This is the human capital for development at a given moment. The demographic dividend appears to be an opportunity and an invitation to action, but it is also a real challenge, that of creating sustainable jobs to generate the development to activate the economic growth lever.

Atlas of African Health Statistics 2022: Health situation analysis of the WHO African Region - Country profiles

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Atlas des statistiques sanitaires africaines 2022: analyse de la situation sanitaire de la Région africaine ­ rapport de synthèse

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Performance of the allometric power model in scaling from adult to paediatric antiretroviral dose in children at a Referral Hospital in Windhoek, Namibia

Background: World Health Organization (WHO) advocates use of weight bands in antiretroviral therapy (ART) guidelines. Allometric scaling could be a more reliable method because it uses a non-linear approach in relating dose to body weight. This study evaluates performance of the allometric ¾ power model in comparison to WHO weight band method in children receiving ART. Methods: Records of children receiving (ABC/3TC) + DTG were reviewed. Paediatric ABC/3TC dose was calculated from the adult dose using the allometric ¾ power model and compared to WHO weight band dose. Results: WHO weight band strategy grouped 50.6% of the children in the 25 kg category and therefore received the adult dose of ABC/3TC (600 mg/300 mg); only 1.1% received this dose with allometric scaling. Mean dose (3.8 tablets) for the WHO weight band dosing method was found to be significantly higher (p<0.0001) than for allometric scaling (1.5 tablets). Conclusions: WHO weight bands may result in the 25 kg weight category receiving a much higher dose leading to ADRs. Using allometric scaling, we recommend a weight band strategy that could improve paediatric ABC/3TC dosing

The Status of Facility Based Emergency Care in Public Hospitals of Ethiopia Using WHO Assessment Tool

BACKGROUND: The availability of emergency care contributes to half of the total mortality burden in a low and middle income countries. The significant proportion of emergency departments in LMICs are understaffed and poorly equipped. The purpose of this study is to examine the status of emergency units and to describe the facilitators and barriers to the provision of facility-based emergency care at selected Ethiopian public hospitals. METHODS: A mixed-methods explanatory design was used. Ten hospitals were purposively selected due to their high number of patients and referral service. A WHO facility assessment tool was used to quantitatively assess the facilities, and an in-depth interview with hospital and emergency room leadership was conducted. The quantitative results were descriptively analyzed, and the qualitative data was thematically analyzed. RESULT: This survey included a total of ten hospitals. Three of the facilities were general hospitals, and seven were tertiary level hospitals. They all were equipped with an emergency room. All of the studied hospitals serve a population of over one million people. In terms of infrastructure, only 3/10 (30%) have adequate water supply, and alf (5/10) have telephone access in their ED. The qualitative resultshowedthat the most common barriers to emergency care delivery were prolonged patient stays in the emergency room, inadequate equipment, and a shortage of trained professionals. CONCLUSION: The status of emergency care in Ethiopia is still developing, and hospital care as a whole should improve to alleviate the high burden of care in emergency rooms and reduce morbidity and mortality.

A pandemic of inequality: reflections on AIDS and COVID-19 in the southern African context

In 2020, COVID-19 started spreading from Wuhan in China to the USA, the UK and Europe and then to the rest of the world. In Africa, the first case of COVID-19 was reported in Egypt on 14 February, while South Africa's first case was identified on 5 March. On 11 March, the World Health Organization declared a pandemic. At the time, it was said that COVID-19 would become the great equaliser because the virus made no distinction between first and third world countries, between the rich and the poor, and nor was it influenced by gender, sexual orientation or race. When someone contracted SARS-CoV-2, no guarantee could be given that the patient would survive, regardless of who they were or their status in the community.This stood in contrast to the early experience of AIDS before antiretrovirals existed and when HIV was spreading like wildfire in sub-Saharan Africa and other countries with low or lower-middle-income status. It seemed as if these countries were doubly cursed ­ by poverty and the AIDS pandemic that was causing as many as 6 000 mortalities per day in sub-Saharan Africa. This led to the South African president at the time, Thabo Mbeki, to assert that poverty was an even greater problem than HIV and AIDS.It did not take long to see that COVID-19 was not the anticipated equaliser. As lockdowns were enforced within most countries across the globe and resulting in economic slumps, differences between rich and poorer countries and their respective citizens were thrown into sharp relief once again. This article reports how both AIDS and COVID-19 adversely affected women, the impoverished and those without access to sustainable souces of food and medicine.

Compliance with WHO recommended measures against Covid-19 among a Nigerian population

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Primary healthcare services in the rural Eastern Cape, South Africa: evaluating a service-support project

Background: In 2012, 38% of the South African population resided in the rural areas of the country. The professional healthcare services are concentrated in the urban areas, resulting in an imbalance between urban and rural healthcare services. Aim: The aim of this study was to evaluate the use of a non-governmental organisation (NGO)-supported mobile healthcare service in a remote area. Setting: Eastern Cape Province in South Africa. Methods: The walking distance between the community and the nearest fixed government healthcare service was evaluated and compared with the recommendations of World Health Organization (WHO). Services provided to people visiting the mobile community service were recorded, and descriptive data were analysed and compared with the anonymised patient records of the nearest fixed service clinic. Results: Of the 30 outreach points served by the NGO, 24 points were at a distance more than the WHO-designated walking distance and 11 points were more than twice the WHO-designated distance from the perspective of fixed clinic. The average headcount per annum of the outreach NGO mobile clinics exceeded those of the fixed Department of Health (DoH) clinics by an average of 250 patients per clinic session. The increase in services was also noteworthy, with a mean differential of 1774 services per annum for the same day above that of the DoH clinics. Conclusion: Mobile services could make a difference to the utilisation of essential healthcare facilities. The provision of augmented NGO-led mobile clinical outreach services and joint government­NGO partnerships holds possibilities for improving healthcare for those living in remote rural areas

Novel educational adjuncts for the World Health Organization Basic Emergency Care Course: a prospective cohort study

Introduction: The World Health Organization's (WHO) Basic Emergency Care Course (BEC) is a five day, inperson course covering basic assessment and life-saving interventions. We developed two novel adjuncts for the WHO BEC: a suite of clinical cases (BEC-Cases) to simulate patient care and a mobile phone application (BECApp) for reference. The purpose was to determine whether the use of these educational adjuncts in a flipped classroom approach improves knowledge acquisition and retention among healthcare workers in a low-resource setting. Methods: We conducted a prospective, cohort study from October 2017 through February 2018 at two district hospitals in the Pwani Region of Tanzania. Descriptive statistics, Fisher's exact t-tests, and Wilcoxon ranked-sum tests were used to examine whether the use of these adjuncts resulted in improved learner knowledge. Participants were enrolled based on location into two arms; Arm 1 received the BEC course and Arm 2 received the BEC-Cases and BEC-App in addition to the BEC course. Both Arms were tested before and after the BEC course, as well as a 7-month follow-up exam. All participants were invited to focus groups on the course and adjuncts. Results: A total of 24 participants were included, 12 (50%) of whom were followed to completion. Mean pre-test scores in Arm 1 (50%) were similar to Arm 2 (53%) (p=0.52). Both arms had improved test scores after the BEC Course Arm 1 (74%) and Arm 2 (87%), (p=0.03). At 7-month follow-up, though with significant participant loss to follow up, Arm 1 had a mean follow-up exam score of 66%, and Arm 2, 74%. Discussion: Implementation of flipped classroom educational adjuncts for the WHO BEC course is feasible and may improve healthcare worker learning in low resource settings. Our focus- group feedback suggest that the course and adjuncts are user friendly and culturally appropriate

Triage conducted by lay-staff and emergency training reduces paediatric mortality in the emergency department of a rural hospital in Northern Mozambique

Introduction The majority of emergency paediatric death in African countries occur within the first 24 h of admission. A coloured triage system is widely implemented in high-income countries and the emergency triage and assessment treatment (ETAT) is recommended by the World Health Organization, but not put into practice in Mozambique. A retrospective, before and after, mortality analysis was performed using routine patient files from the district hospital between 2014 and 2017. The triage system was implemented in August 2016. Inclusion criteria were children under 15 years of age that entered the emergency centre. Primary outcome was child mortality rate. Secondary outcomes included the percentage agreement between the clinical and non-clinical staff and the duration from triage to first treatment. We used a negative binomial model in STATA 15 to compare mortality rates, and Kappa statistics to estimate the agreement between clinical and non-clinical staff. Results : 4176 admissions were included. The mortality rate ratio (MMR) was 45% lower after the start of the intervention (2016; MRR = 0.55; 0.38, 0.81; p = 0.002), compared to before. To estimate the agreement between non-clinical and clinical staff, 548 (of the 671) patient files were included. The agreement was estimated at 88.7% (Kappa = 0.644; p < 0.001). The median waiting time decreased with urgency of the triage: 2 h33 for 'green'/least serious (IQR 1 h58-3 h30), 21 min for yellow/serious (IQR 0 h10-0 h58) and nine minutes for 'red'/urgent (IQR 2­40 min). Conclusion : In a rural setting with nurse-led clinical care and non-clinician staff working at the triage reception, implementation of a three-coloured triage system was feasible. Triage and ETAT training was associated with a decrease of 45% of paediatric deaths. The impact on mortality, low cost, and ease of the implementation supports scaling this intervention in similar settings

Clients and service providers' assessment of Public and Non-Governmental Youth-Friendly Health Services in Lagos Nigeria: a mixed method approach

Background: The World Health Organization prescribed that Youth-Friendly health services must be accessible, acceptable, equitable, efficient, effective, comprehensive and appropriate to meet the health needs of young people. Objective: To compare the clients' and service providers' assessment of services offered at the public and Non-Governmental Organization (NGO) Youth Friendly facilities (YFF) in Lagos Nigeria. Methods: A mixed method approach was used. Structured questionnaires were administered on youths (294 from public and 273 from NGO YFF) from ten (5 public and 5 NGO) YFF. Ten key informant interviews with service providers were also conducted between March 1st and December 31st 2014. SPSS version 22 was used to analyze quantitative data while thematic analysis of interviews with service providers was done. Results: Youths who utilized the public YFF had 60% chance (AOR 1.6, 95%CI 1.3 ­ 2.5, p= 0.005) of experiencing longer waiting times, 80% chance (AOR 1.8, 95%CI 1.2 ­ 2.8, p=0.004) of being counseled in a separate room and over two-fold chance (AOR 2.3, 95%CI 1.7 ­ 3.3, p <0.001) of having free services. Sexual and reproductive health was the major complaint area of the youths while funding was the major challenge of service providers at both the public and NGO YFF. Conclusion: To address the needs of the youths, there is a need to provide more funds and provide necessary logistics required by YFF

An assessment of infant medication administration and storage practices in selected communities in the Vhembe District of Limpopo Province, South Africa

Background: Effective infant medication administration and storage is a major public health challenge outlined by the World Health Organization. These challenges may be exacerbated in rural or limited-resource areas. Aim: The aim of this study was to investigate infant medication administration and storage practices. Setting: This study took place in selected communities in the Vhembe District of Limpopo Province, South Africa. Method: Data was collected through 39 semi-structured interviews with infant caretakers and rural health workers. Interviews were recorded when permission was given by participants. Interviews were transcribed and coded using grounded theory and Tesch's model of data analysis. Themes were agreed upon through consensus discussions with the researchers and an independent coder. Results: Six themes that affect current infant medication administration and storage practices in the Vhembe District were identified: access to infant healthcare, the role of health workers, the devices used in the administration of infant medication, reluctance of the infant to take the medication, storage and reuse of infant medication in the rural home and hygiene practices surrounding infant medication administration. Conclusions: Many factors were found to affect infant medication administration and storage practices in in the Vhembe District. Substantial evidence was found to suggest that the relationship between rural health workers and infant caretakers strongly influences these practices: a great amount of reliance and trust is placed in the health worker. Ensuring proper dosage of infant medication in the rural household arose as a main concern of participants. Reuse of medication in the home and home hygiene practices surrounding infant medication administration are areas of potential future research. This future research may further inform recommendations for infant medication administration and storage practices in the Vhembe District

Management of severe acute malnutrition in children under 5 years through the lens of health care workers in two rural South African hospitals

Background: Despite the widespread implementation of the World Health Organization (WHO) guidelines for the management of severe malnutrition in South Africa, poor treatment outcomes for children under 5 years are still observed in some hospitals, particularly in rural areas.Objective: To explore health care workers' perceptions about upstream and proximal factors contributing to poor treatment outcomes for severe acute malnutrition in two district hospitals in South Africa.Methods: An explorative descriptive qualitative study was conducted. Four focus group discussions were held with 33 hospital staff (senior clinical and management staff, and junior clinical staff) using interview guide questions developed based on the findings from an epidemiological study that was conducted in the same hospitals. Qualitative data were analysed using the framework analysis.Findings: Most respondents believed that critical illness, which was related to early and high case fatality rates on admission, was linked to a web of factors including preference for traditional medicine over conventional care, gross negligence of the child at household level, misdiagnosis of severe malnutrition at the first point of care, lack of specialised skills to deal with complex presentations, shortage of patient beds in the hospital and policies to discharge patients before optimal recovery. The majority believed that the WHO guidelines were effective and relatively simple to implement, but that they do not make much difference among severe acute malnutrition cases that are admitted in a critical condition. Poor management of cases was linked to the lack of continuity in training of rotating clinicians, sporadic shortages of therapeutic resources, inadequate staffing levels after normal working hours and some organisational and system-wide challenges beyond the immediate control of clinicians.Conclusion: Findings from this study suggest that effective management of paediatric severe acute malnutrition in the study setting is affected by a multiplicity of factors that manifest at different levels of the health system and the community. A verificatory study is encouraged to collaborate these findings

An investigation of barriers to the use of the World Health Organization Surgical Safety Checklist in theatres

Background. The World Health Organization (WHO) has implemented the Surgical Safety Checklist (SSCL) as part of the Safe Surgery Saves Lives campaign. This is aimed at improving surgical safety worldwide. Despite many perceived benefits of the SSCL, compliance and acceptance in many areas remain poor.Objectives. To investigate perceptions of theatre staff regarding the checklist and to identify reasons and barriers for poor compliance and implementation. Methods. Questionnaires were handed out to theatre teams across all surgical disciplines at two large hospitals in Durban, South Africa, over a 2-week period. Data collected included role in theatre, intention of the SSCL, training received, as well as questions regarding previously identified barriers and staff perceptions.Results. Questionnaires were distributed to 225 practitioners, with a response rate of 81.7% from 51 nurses, 54 anaesthetists and 79 surgeons. Rank of medical staff included 52 seniors (consultants) and 81 juniors (registrars and medical officers). The majority (95%) of respondents perceived the SSCL as intended to improve safety, prevent errors or reduce morbidity and mortality. A total of 146 respondents (79.3%) received no SSCL training. No new barriers were identified, but previously identified barriers were confirmed. Our key factors were time-related issues and lack of buy-in from team members. Surgeons were perceived as being supportive by 45.1% of respondents, in contrast to nurses (62.5%), anaesthetists (70.1%) and management (68.5%). When compared with junior staff, senior staff were 5-fold more likely to feel that staff did not need to be trained and 8-fold more likely to indicate that the checklist did not improve patient safety.Conclusions. The WHO SSCL is an important tool in the operating room environment. The barriers in our setting are similar to those identified in other settings. There needs to be widespread training in the use of the SSCL, including adaptation of the checklist to make it fit for purpose in our setting. Improving use of the checklist will allow theatre staff to work together towards ensuring a safer theatre environment for both patients and staff

Prevalence and awareness of diabetes in Guinea: findings from a WHO STEPS

Aims: The aim of the present study was to determine the prevalence of diabetes, and to assess its awareness and related risk factors among adult Guineans.Methods: A population-based cross-sectional survey was conducted on 1 100 adults (46.6% women) aged 35­64 years from Lower Guinea, during September to December 2009, using the WHO STEPwise approach of surveillance of chronic disease risk factors. Data were collected in three steps: demographic and behavioural risk factors, blood pressure and anthropometric measurements, and fasting blood cholesterol and glucose testing. A multi-stage cluster sample design was applied to generate nationwide representative data.Results: The mean age of all participants was 47.3 years (SD 8.8), similarly in Conakry, rural Lower Guinea and urban Lower Guinea. The prevalence of diabetes was 5.7% (95% CI 4.0­8.1). Among participants with diabetes, only 44.0% were aware of their status. In multivariable logistic regression analysis, determinants of diabetes prevalence were urban residency, male sex, age group 45­64 years, increased waist circumference, hypertension and hypercholesterolemia. Male sex, rural residency, age group 45­54 years, no formal education, waist circumference, hypertension and hypercholesterolemia were independent predictors of screen-detected diabetes.Conclusion: The present study found a high prevalence and low awareness of diabetes, suggesting the need for appropriate actions to strengthen primary healthcare approaches towards non-communicable diseases in Guinea

Applying the international classification of diseases to perinatal mortality data, South Africa

Objective:To examine the feasibility of applying the International Classification of Diseases-perinatal mortality (ICD-PM) coding to an existing data set in the classification of perinatal deaths.Methods One author, a researcher with a non-clinical public health background, applied the ICD-PM coding system to South Africa's national perinatal mortality audit system, the Perinatal Problem Identification Program. The database for this study included all perinatal deaths (n=26 810), defined as either stillbirths (of birth weight >1000 g and after 28 weeks of gestation) or early neonatal deaths (age 0­7 days), that occurred between 1 October 2013 and 31 December 2016. A clinical obstetrician verified the coding. Findings The South African classification system does not include the timing of death; however, under the ICD-PM system, deaths could be classified as antepartum (n=15 619; 58.2%), intrapartum (n=3725; 14.0%) or neonatal (n=7466; 27.8%). Further, the South African classification system linked a maternal condition to only 40.3% (10 802/26 810) of all perinatal deaths; this proportion increased to 68.9% (18 467/26 810) under the ICD-PM system. Conclusion The main benefit of using the clinically relevant and user-friendly ICD-PM system was an enhanced understanding of the data, in terms of both timing of death and maternal conditions. We have also demonstrated that it is feasible to convert an existing perinatal mortality classification system to one which is globally comparable and can inform policy-makers internationally

Independent and interactive effects of HIV infection, clinical stage and other comorbidities on survival of children treated for severely malnourished in rural South Africa: A retrospective multi-cohort study

Background. There is still limited to no evidence on the independent and interactive effects of HIV infection, disease stage, baseline disease severity and other important comorbidities on mortality risk among young children treated for severe acute malnutrition (SAM) in South Africa (SA, using the World Health Organization (WHO) recommended treatment modality. Objectives. To determine baseline clinical characteristics among children with SAM and assess whether HIV infection, disease stage, critical illness at baseline and other comorbidities independently and interactively contributed to excess mortality in this sample. Methods. We followed up children aged 6 - 60 months, who were admitted with and treated for SAM at two rural hospitals in SA, and retrospectively reviewed their treatment records to abstract data on their baseline clinical characteristics and treatment outcomes. In total, 454 children were included in the study. Descriptive statistical tests were used to summarise patients' clinical characteristics. Kaplan-Meier failure curves were created for key characteristics and compared statistically using log-rank tests. Univariate and multivariate Cox regression was used to estimate independent and interactive effects. Results. The combined case fatality rate was 24.4%. HIV infection, clinical disease stage, the presence of lower respiratory tract infection, marasmus and disease severity at baseline were all independently associated with excess mortality. The critical stage for higher risk of death was when cases were admitted at WHO stage III. The interactions of two or three of these characteristics were associated with increased risk of death when compared with having none, with HIV infection and critical illness showing the greatest risk (hazard ratio 22, p<0.001). Conclusion. The high HIV prevalence rate in the study setting and the resultant treatment outcomes support the notion that the WHO treatment guidelines should be revised to ensure that mechanisms for effective treatment of HIV comorbidity in SAM are in place. However, a much more rigorous study is warranted to verify this conclusion

The impact of a modified World Health Organization surgical safety checklist on maternal outcomes in a South African setting: A stratified cluster-randomised controlled trial

Background. In South Africa (SA), the Saving Mothers Reports have shown an alarming increase in deaths during or after caesarean delivery.Objective. To improve maternal surgical safety in KwaZulu-Natal Province, SA, by implementing the modified World Health Organization surgical safety checklist for maternity care (MSSCL) in maternity operating theatres.Methods. The study was a stratified cluster-randomised controlled trial conducted from March to November 2013. Study sites were 18 hospitals offering maternal surgical services in the public health sector. Patients requiring maternal surgical intervention at the study sites were included. Pre-intervention surgical outcomes were assessed. Training of healthcare personnel took place over 1 month, after which the MSSCL was implemented. Post-intervention surgical outcomes were assessed and compared with the pre-intervention findings and the control arm. The main outcome measure was the mean incidence rate ratios (IRRs) of adverse incidents associated with surgery.Results. Significant improvements in the adverse incident rate per 1 000 procedures occurred with combined outcomes (IRR 0.805, 95% confidence interval (CI) 0.706 - 0.917), postoperative sepsis (IRR 0.619, 95% CI 0.451 - 0.849), referral to higher levels of care (IRR 1.409, 95% CI 1.066 - 1.862) and unscheduled return to the operating theatre (IRR 0.719, 95% CI 0.574 - 0.899) in the intervention arm. Subgroup analysis based on the quality of implementation demonstrated greater reductions in maternal mortality in hospitals that were good implementers of the MSSCL.Conclusions. Incorporation of the MSSCL into routine surgical practice has now been recommended for all public sector hospitals in SA, and emphasis should be placed on improving the quality of implementation

State of equity: childhood immunization in the World Health Organization African region

Introduction: in 2010, the Global Vaccine Action Plan called on all countries to reach and sustain 90% national coverage and 80% coverage in all districts for the third dose of diphtheria-tetanus-pertussis vaccine (DTP3) by 2015 and for all vaccines in national immunization schedules by 2020. The aims of this study are to analyze recent trends in national vaccination coverage in the World Health Organization African Region and to assess how these trends differ by country income category.Methods: we compared national vaccination coverage estimates for DTP3 and the first dose of measles-containing vaccine (MCV) obtained from the World Health Organization (WHO)/United Nations Children's Fund (UNICEF) joint estimates of national immunization coverage for all African Region countries. Using United Nations (UN) population estimates of surviving infants and country income category for the corresponding year, we calculated population-weighted average vaccination coverage by country income category (i.e., low, lower middle, and upper middle-income) for the years 2000, 2005, 2010 and 2015.Results: DTP3 coverage in the African Region increased from 52% in 2000 to 76% in 2015,and MCV1 coverage increased from 53% to 74% during the same period, but with considerable differences among countries. Thirty-six African Region countries were low income in 2000 with an average DTP3 coverage of 50% while 26 were low income in 2015 with an average coverage of 80%. Five countries were lower middle-income in 2000 with an average DTP3 coverage of 84% while 12 were lower middle-income in 2015 with an average coverage of 69%. Five countries were upper middle-income in 2000 with an average DTP3 coverage of 73% and eight were upper middle-income in 2015 with an average coverage of 76%.Conclusion: disparities in vaccination coverage by country persist in the African Region, with countries that were lower middle-income having the lowest coverage on average in 2015. Monitoring and addressing these disparities is essential for meeting global immunization targets