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Individual and contextual factors associated with low childhood immunisation coverage in sub-Saharan Africa: a
Charles S Wiysonge1, Olalekan A Uthman, Peter M Ndumbe
1Vaccines for Africa Initiative, Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Cape Town, South Africa. charles.wiysonge@uct.ac.za
Insights
In sub-Saharan Africa, parental education and household wealth significantly impact childhood immunization rates. Public health programs must address individual, community, and societal factors to improve vaccine coverage.
Area of Science:
- Global Health
- Public Health Policy
- Pediatrics
Background:
- Millions of children in sub-Saharan Africa miss essential vaccines like diphtheria-tetanus-pertussis (DTP).
- Understanding factors influencing immunization is crucial for effective public health interventions.
- A multilevel model was developed to analyze childhood immunization determinants.
Purpose of the Study:
- To identify individual, community, and country-level factors associated with incomplete childhood immunization in sub-Saharan Africa.
- To analyze the impact of socioeconomic status, parental education, and media access on vaccination status.
- To inform the development of targeted public health strategies for improving vaccine coverage.
Main Methods:
- Multilevel logistic regression analysis of Demographic and Health Survey data.
- Inclusion of 27,094 children aged 12-23 months across 8,546 communities in 24 sub-Saharan African countries.
- Examination of country-level, community-level, and individual-level predictors of immunization.
Main Results:
- Country and community factors explained 21% and 32% of the variance in immunization, respectively.
- Lower parental education and poorer household wealth were linked to higher rates of unimmunized children.
- Maternal access to media and health-seeking behaviors were associated with increased immunization, while urban residence and high community illiteracy were linked to lower rates.
Conclusions:
- Childhood immunization is influenced by a complex interplay of individual, community, and societal factors.
- Public health interventions should adopt a holistic approach, addressing individual needs within their community and societal contexts.
- Targeted strategies are needed to overcome barriers to immunization in sub-Saharan Africa.
Background:
In 2010, more than six million children in sub-Saharan Africa did not receive the full series of three doses of the diphtheria-tetanus-pertussis vaccine by one year of age. An evidence-based approach to addressing this burden of un-immunised children requires accurate knowledge of the underlying factors. We therefore developed and tested a model of childhood immunisation that includes individual, community and country-level characteristics.
Method And Findings:
We conducted multilevel logistic regression analysis of Demographic and Health Survey data for 27,094 children aged 12-23 months, nested within 8,546 communities from 24 countries in sub-Saharan Africa. According to the intra-country and intra-community correlation coefficient implied by the estimated intercept component variance, 21% and 32% of the variance in unimmunised children were attributable to country- and community-level factors respectively. Children born to mothers (OR 1.35, 95%CI 1.18 to 1.53) and fathers (OR 1.13, 95%CI 1.12 to 1.40) with no formal education were more likely to be unimmunised than those born to parents with secondary or higher education. Children from the poorest households were 36% more likely to be unimmunised than counterparts from the richest households. Maternal access to media significantly reduced the odds of children being unimmunised (OR 0.94, 95%CI 0.94 to 0.99). Mothers with health seeking behaviours were less likely to have unimmunised children (OR 0.56, 95%CI 0.54 to 0.58). However, children from urban areas (OR 1.12, 95% CI 1.01 to 1.23), communities with high illiteracy rates (OR 1.13, 95% CI 1.05 to 1.23), and countries with high fertility rates (OR 4.43, 95% CI 1.04 to 18.92) were more likely to be unimmunised.
Conclusion:
We found that individual and contextual factors were associated with childhood immunisation, suggesting that public health programmes designed to improve coverage of childhood immunisation should address people, and the communities and societies in which they live.
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