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Sowe A, Namatovu F, Cham B, Gustafsson PE. Starting then stopping: a nationwide register-based study on the magnitude, predictors, and urban-rural patterns of under-vaccination variation across health centers in The Gambia. Glob Health Action 2024; 17:2348788. [PMID: 38826143 PMCID: PMC11149585 DOI: 10.1080/16549716.2024.2348788] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2023] [Accepted: 04/24/2024] [Indexed: 06/04/2024] Open
Abstract
OBJECTIVES Six million children were under-vaccinated in 2022. Our study aimed to 1) quantify the magnitude of under-vaccination variation between health facilities, 2) assess to which extent individual and health center level factors contributed to the variation, 3) identify individual and health facility factors associated with under-vaccination, and 4), explore rural vs. urban health facility variations. METHODS We used data from 61,839 children from The Gambia national routine vaccination register. We cross tabulated under-vaccination status across study variables and fitted two-level random intercept multilevel logistic regression models to measure variance, contribution to the variance, and factors associated with the variance and under-vaccination. RESULTS We found that 7% of the prevalence of under-vaccination was due to variation between health facilities. Thirty-seven percent of the variation was explained by individual and health center variables. The variables explained 36% of the variance in urban and 19% in rural areas. Children who were not vaccinated at 4 months or with delayed history, due for vaccination in the rainy season, and health facilities with very small or large population to health worker ratios had higher under-vaccination odds. CONCLUSION Our study indicates that one of the pathways to improving vaccination coverage is addressing factors driving under-vaccination inequities between health facilities through urban-rural differentiated strategies.
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Affiliation(s)
- Alieu Sowe
- Department of Epidemiology and Global Health, Umeå University, Umeå, Sweden
- Expanded Program on Immunization, Ministry of Health, Banjul, The Gambia
| | - Fredinah Namatovu
- Department of Epidemiology and Global Health, Umeå University, Umeå, Sweden
| | - Bai Cham
- Medical Research Council Unit The Gambia at the London School of Hygiene and Tropical Medicine, Bakau, The Gambia
- School of Public Health, Georgia State University, Atlanta, GA, USA
| | - Per E. Gustafsson
- Department of Epidemiology and Global Health, Umeå University, Umeå, Sweden
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Muhoza P, Shah MP, Amponsa-Achiano K, Gao H, Quaye P, Opare W, Okae C, Aboyinga PN, Opare JKL, Ehlman DC, Wardle MT, Wallace AS. Timeliness of Childhood Vaccinations Following Strengthening of the Second Year of Life (2YL) Immunization Platform and Introduction of Catch-Up Vaccination Policy in Ghana. Vaccines (Basel) 2024; 12:716. [PMID: 39066354 PMCID: PMC11281534 DOI: 10.3390/vaccines12070716] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2024] [Revised: 06/20/2024] [Accepted: 06/23/2024] [Indexed: 07/28/2024] Open
Abstract
Strengthening routine immunization systems to successfully deliver childhood vaccines during the second year of life (2YL) is critical for vaccine-preventable disease control. In Ghana, the 18-month visit provides opportunities to deliver the second dose of the measles-rubella vaccine (MR2) and for healthcare workers to assess for and provide children with any missed vaccine doses. In 2016, the Ghana Health Service (GHS) revised its national immunization policies to include guidelines for catch-up vaccinations. This study assessed the change in the timely receipt of vaccinations per Ghana's Expanded Program on Immunizations (EPI) schedule, an important indicator of service quality, following the introduction of the catch-up policy and implementation of a multifaceted intervention package. Vaccination coverage was assessed from household surveys conducted in the Greater Accra, Northern, and Volta regions for 392 and 931 children aged 24-35 months with documented immunization history in 2016 and 2020, respectively. Age at receipt of childhood vaccines was compared to the recommended age, as per the EPI schedule. Cumulative days under-vaccinated during the first 24 months of life for each recommended dose were assessed. Multivariable Cox regression was used to assess the associations between child and caregiver characteristics and time to MR2 vaccination. From 2016 to 2020, the proportion of children receiving all recommended doses on schedule generally improved, the duration of under-vaccination was shortened for most doses, and higher coverage rates were achieved at earlier ages for the MR series. More timely infant doses and caregiver awareness of the 2YL visit were positively associated with MR2 vaccination. Fostering a well-supported cadre of vaccinators, building community demand for 2YL vaccination, sustaining service utilization through strengthened defaulter tracking and caregiver-reminder systems, and creating a favorable policy environment that promotes vaccination over the life course are critical to improving the timeliness of childhood vaccinations.
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Affiliation(s)
- Pierre Muhoza
- Global Immunization Division, U.S. Centers for Disease Control and Prevention, Atlanta, GA 30329, USA
- Epidemic Intelligence Service, U.S. Centers for Disease Control and Prevention, Atlanta, GA 30329, USA
| | - Monica P. Shah
- Global Immunization Division, U.S. Centers for Disease Control and Prevention, Atlanta, GA 30329, USA
| | - Kwame Amponsa-Achiano
- Expanded Programme on Immunisation, Disease Control and Prevention Department, Public Health Division, Ghana Health Service, Accra P.O. Box M 44, Ghana
| | - Hongjiang Gao
- Global Immunization Division, U.S. Centers for Disease Control and Prevention, Atlanta, GA 30329, USA
| | - Pamela Quaye
- Expanded Programme on Immunisation, Disease Control and Prevention Department, Public Health Division, Ghana Health Service, Accra P.O. Box M 44, Ghana
| | - William Opare
- Expanded Programme on Immunisation, Disease Control and Prevention Department, Public Health Division, Ghana Health Service, Accra P.O. Box M 44, Ghana
| | - Charlotte Okae
- Expanded Programme on Immunisation, Disease Control and Prevention Department, Public Health Division, Ghana Health Service, Accra P.O. Box M 44, Ghana
| | - Philip-Neri Aboyinga
- Expanded Programme on Immunisation, Disease Control and Prevention Department, Public Health Division, Ghana Health Service, Accra P.O. Box M 44, Ghana
| | - Joseph Kwadwo Larbi Opare
- Neglected Tropical Diseases Control Programme, Disease Control and Prevention Department, Public Health Division, Ghana Health Service, Accra P.O. Box M 44, Ghana
| | - Daniel C. Ehlman
- Global Immunization Division, U.S. Centers for Disease Control and Prevention, Atlanta, GA 30329, USA
| | - Melissa T. Wardle
- Global Immunization Division, U.S. Centers for Disease Control and Prevention, Atlanta, GA 30329, USA
| | - Aaron S. Wallace
- Global Immunization Division, U.S. Centers for Disease Control and Prevention, Atlanta, GA 30329, USA
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Agimas MC, Asmamaw M, Mekonen N, Mamo F, Shewaye DA. Spatial pattern and associated factors of timely vaccination in Ethiopia using EDHS-2016 data: A multilevel and spatial analysis. PLoS One 2024; 19:e0296123. [PMID: 38324535 PMCID: PMC10849225 DOI: 10.1371/journal.pone.0296123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Accepted: 12/06/2023] [Indexed: 02/09/2024] Open
Abstract
BACKGROUND Age-appropriate vaccination or vaccine timeliness is the administering of vaccines on the specified schedule of immunization. One of the qualities of the immunization program is an age-appropriate vaccine, it has become an ignored indicator of program performance. Even though age-appropriate vaccination is critical for child health, there are no national-level studies to generate conclusive and tangible evidence about the determination of timely vaccination in Ethiopia. OBJECTIVE To assess the spatial pattern and associated factors of timely vaccination in Ethiopia using EDHS-2016 data: A multilevel and spatial analysis. METHOD Community based cross-sectional study design was employed from 18 January to 27 June 2016. To select the participants, two-stage cluster sampling was employedin the Ethiopian Demographic Health Survey 2016 data. Permission was obtained via online request by explaining the aim of this particular study from DHS international. A statistical package for social science-21 software was used for data cleaning, recoding, and analysis. Arc GIS 10.3 software was used to show the spatial variation of age-appropriate vaccination practices. A generalized linear mixed-effect model was used. For all models, intra-class correlation, a proportional change in variance, the log-likelihood test, and the Akaike information criterion were calculated. The best model was selected by the lowest value Akaike information criterion. Variables with a p-value less than 0.05 and a 95% confidence level were considered for the statistically significant association. RESULT The spatial distribution of age-appropriate vaccination practice in Ethiopia was non-randomly distributed with the global Moran's I value of 0.22 (p-value <0.001). The prevalence of age-appropriate vaccination practice in Ethiopia was 33.8%. Women who receive ≥ 2 TT vaccines (AOR = 1.48; 1.22, 1.79), women who lived in rural residences (AOR = 0.77; 0.62, 0.96), gave birth at a health facility (AOR = 1.2; 1.12, 1.37), ANC follow up (AOR = 174; 1.45, 2.1), richest (AOR = 1.65; 1.15, 2.37), richer (AOR = 1.72; 1.3, 2.22), middle-level income (AOR = 1.65; 1.16, 2.36), poorer (AOR = 1.47; 1.11, 1.96) were the factors of age-appropriate vaccination practice. CONCLUSION The spatial distribution of age-appropriate vaccination practice in Ethiopia was non-randomly distributed across the regions. Age-appropriate vaccination practice was low in Ethiopia. Wealth index, usual caretaker of the child, ANC utilization, history of TT vaccination, place of delivery, and residence were associated with age-appropriate vaccination practice.
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Affiliation(s)
- Muluken Chanie Agimas
- College of Medicine and Health Science, Institute of Public Health, Department of Epidemiology and Biostatistics, University of Gondar, Gondar, Ethiopia
| | - Meron Asmamaw
- College of Medicine and Health Science, Institute of Public Health, Department of Epidemiology and Biostatistics, University of Gondar, Gondar, Ethiopia
| | - Nebiyu Mekonen
- College of Medicine and Health Science, Institute of Public Health, Department of Epidemiology and Biostatistics, University of Gondar, Gondar, Ethiopia
| | - Fantu Mamo
- College of Medicine and Health Science, Institute of Public Health, Department of Epidemiology and Biostatistics, University of Gondar, Gondar, Ethiopia
| | - Daniel Alayu Shewaye
- College of Medicine and Health Science, Institute of Public Health, Department of Epidemiology and Biostatistics, University of Gondar, Gondar, Ethiopia
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Kundu S, Kundu S, Seidu AA, Okyere J, Ghosh S, Hossain A, Alshahrani NZ, Banna MHA, Rahman MA, Ahinkorah BO. Factors influencing and changes in childhood vaccination coverage over time in Bangladesh: a multilevel mixed-effects analysis. BMC Public Health 2023; 23:862. [PMID: 37170088 PMCID: PMC10173930 DOI: 10.1186/s12889-023-15711-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Accepted: 04/19/2023] [Indexed: 05/13/2023] Open
Abstract
INTRODUCTION This study aimed to investigate the associated factors and changes in childhood vaccination coverage over time in Bangladesh. METHODS Bangladesh's Demographic and Health Surveys from 2011, 2014, and 2017-18 provided data for this study on vaccination coverage among children aged 12 to 35 months. For three survey periods, multilevel binary logistic regression models were employed. RESULTS The overall prevalence (weighted) of full vaccination among children aged 12-35 months were 86.17% in 2011, 85.13% in 2014, and 89.23% in 2017-18. Children from families with high wealth index, mothers with higher education, and over the age of 24 and who sought at least four ANC visits, as well as children from urban areas were more likely to receive full vaccination. Rangpur division had the highest change rate of vaccination coverage from 2011 to 2014 (2.26%), whereas Sylhet division had the highest change rate from 2014 to 2017-18 (34.34%). CONCLUSION To improve immunization coverage for Bangladeshi children, policymakers must integrate vaccine programs, paying special attention to mothers without at least a high school education and families with low wealth index. Increased antenatal care visits may also aid in increasing the immunization coverage of their children.
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Affiliation(s)
- Satyajit Kundu
- Global Health Institute, North South University, Dhaka, 1229, Bangladesh.
- Faculty of Nutrition and Food Science, Patuakhali Science and Technology University, Patuakhali, 8602, Bangladesh.
| | - Subarna Kundu
- Statistics Discipline, Khulna University, Khulna, 9208, Bangladesh
| | - Abdul-Aziz Seidu
- Faculty of Built and Natural Environment, Department of Estate Management, Takoradi Technical University, Takoradi, Ghana
- Centre for Gender and Advocacy, Takoradi Technical University, Takoradi, Ghana
- College of Public Health, Medical and Veterinary Sciences, James Cook University, Townsville, QLD, Australia
| | - Joshua Okyere
- Department of Population and Health, University of Cape Coast, Cape Coast, Ghana
| | - Susmita Ghosh
- Department of Food Technology and Nutrition Science, Noakhali Science and Technology University, Noakhali, Bangladesh
- Department of Nutrition Science, Purdue University, West Lafayette, IN, 47907, USA
| | - Ahmed Hossain
- College of Health Sciences, University of Sharjah, Sharjah, 27272, United Arab Emirates
- Department of Public Health, North South University, Dhaka, 1229, Bangladesh
| | - Najim Z Alshahrani
- Department of Family and Community Medicine, Faculty of Medicine, University of Jeddah, Jeddah, 21589, Saudi Arabia
| | - Md Hasan Al Banna
- Faculty of Nutrition and Food Science, Patuakhali Science and Technology University, Patuakhali, 8602, Bangladesh
- Nutrition Initiative (NI), Kushtia, Bangladesh
| | - Md Ashfikur Rahman
- Development Studies Discipline, Khulna University, Khulna, 9208, Bangladesh
| | - Bright Opoku Ahinkorah
- School of Public Health, Faculty of Health, University of Technology Sydney, Sydney, Australia
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Hahesy E, Cruz-Espinoza LM, Nyirenda G, Tadesse BT, Kim JH, Marks F, Rakotozandrindrainy R, Wetzker W, Haselbeck A. Madagascar's EPI vaccine programs: A systematic review uncovering the role of a child's sex and other barriers to vaccination. Front Public Health 2022; 10:995788. [PMID: 36187658 PMCID: PMC9523513 DOI: 10.3389/fpubh.2022.995788] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2022] [Accepted: 08/29/2022] [Indexed: 01/26/2023] Open
Abstract
Background Immunizations are one of the most effective tools a community can use to increase overall health and decrease the burden of vaccine-preventable diseases. Nevertheless, socioeconomic status, geographical location, education, and a child's sex have been identified as contributing to inequities in vaccine uptake in low- and middle-income countries (LMICs). Madagascar follows the World Health Organization's Extended Programme on Immunization (EPI) schedule, yet vaccine distribution remains highly inequitable throughout the country. This systematic review sought to understand the differences in EPI vaccine uptake between boys and girls in Madagascar. Methods A systematic literature search was conducted in August 2021 through MEDLINE, the Cochrane Library, Global Index Medicus, and Google Scholar to identify articles reporting sex-disaggregated vaccination rates in Malagasy children. Gray literature was also searched for relevant data. All peer-reviewed articles reporting sex-disaggregated data on childhood immunizations in Madagascar were eligible for inclusion. Risk of bias was assessed using a tool designed for use in systematic reviews. Data extraction was conducted with a pre-defined data extraction tool. Sex-disaggregated data were synthesized to understand the impact of a child's sex on vaccination status. Findings The systematic search identified 585 articles of which a total of three studies were included in the final data synthesis. One additional publication was included from the gray literature search. Data from included articles were heterogeneous and, overall, indicated similar vaccination rates in boys and girls. Three of the four articles reported slightly higher vaccination rates in girls than in boys. A meta-analysis was not conducted due to the heterogeneity of included data. Six additional barriers to immunization were identified: socioeconomic status, mother's education, geographic location, supply chain issues, father's education, number of children in the household, and media access. Interpretation The systematic review revealed the scarcity of available sex-stratified immunization data for Malagasy children. The evidence available was limited and heterogeneous, preventing researchers from conclusively confirming or denying differences in vaccine uptake based on sex. The low vaccination rates and additional barriers identified here indicate a need for increased focus on addressing the specific obstacles to vaccination in Madagascar. A more comprehensive assessment of sex-disaggregated vaccination status of Malagasy children and its relationship with such additional obstacles is recommended. Further investigation of potential differences in vaccination status will allow for the effective implementation of strategies to expand vaccine coverage in Madagascar equitably. Funding and registration AH, BT, FM, GN, and RR are supported by a grant from the Bill and Melinda Gates Foundation (grant number: OPP1205877). The review protocol is registered in the Prospective Register of Systematic Reviews (PROSPERO ID: CRD42021265000).
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Affiliation(s)
- Emma Hahesy
- Bowdoin College, Brunswick, ME, United States
| | | | | | | | | | - Florian Marks
- International Vaccine Institute, Seoul, South Korea
- University of Antananarivo, Antananarivo, Madagascar
- Cambridge Institute of Therapeutic Immunology and Infectious Disease, University of Cambridge School of Clinical Medicine, Cambridge, United Kingdom
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Wariri O, Okomo U, Kwarshak YK, Utazi CE, Murray K, Grundy C, Kampmann B. Timeliness of routine childhood vaccination in 103 low-and middle-income countries, 1978-2021: A scoping review to map measurement and methodological gaps. PLOS GLOBAL PUBLIC HEALTH 2022; 2:e0000325. [PMID: 36962319 PMCID: PMC10021799 DOI: 10.1371/journal.pgph.0000325] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Accepted: 06/14/2022] [Indexed: 11/19/2022]
Abstract
Empiric studies exploring the timeliness of routine vaccination in low-and middle-income countries (LMICs) have gained momentum in the last decade. Nevertheless, there is emerging evidence suggesting that these studies have key measurement and methodological gaps that limit their comparability and utility. Hence, there is a need to identify, and document these gaps which could inform the design, conduct, and reporting of future research on the timeliness of vaccination. We synthesised the literature to determine the methodological and measurement gaps in the assessment of vaccination timeliness in LMICs. We searched five electronic databases for peer-reviewed articles in English and French that evaluated vaccination timeliness in LMICs, and were published between 01 January 1978, and 01 July 2021. Two reviewers independently screened titles and abstracts and reviewed full texts of relevant articles, following the guidance framework for scoping reviews by the Joanna Briggs Institute. From the 4263 titles identified, we included 224 articles from 103 countries. China (40), India (27), and Kenya (23) had the highest number of publications respectively. Of the three domains of timeliness, the most studied domain was 'delayed vaccination' [99.5% (223/224)], followed by 'early vaccination' [21.9% (49/224)], and 'untimely interval vaccination' [9% (20/224)]. Definitions for early (seven different definitions), untimely interval (four different definitions), and delayed vaccination (19 different definitions) varied across the studies. Most studies [72.3% (166/224)] operationalised vaccination timeliness as a categorical variable, compared to only 9.8% (22/224) of studies that operationalised timeliness as continuous variables. A large proportion of studies [47.8% (107/224)] excluded the data of children with no written vaccination records irrespective of caregivers' recall of their vaccination status. Our findings show that studies on vaccination timeliness in LMICs has measurement and methodological gaps. We recommend the development and implement of guidelines for measuring and reporting vaccination timeliness to bridge these gaps.
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Affiliation(s)
- Oghenebrume Wariri
- Vaccines and Immunity Theme, MRC Unit The Gambia at London School of Hygiene and Tropical Medicine, Fajara, The Gambia
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, United Kingdom
- Vaccine Centre, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Uduak Okomo
- Vaccines and Immunity Theme, MRC Unit The Gambia at London School of Hygiene and Tropical Medicine, Fajara, The Gambia
| | | | - Chigozie Edson Utazi
- WorldPop, School of geography and Environmental Science, University of Southampton, Southampton, United Kingdom
- Southampton Statistical Sciences Research Institute, University of Southampton, Southampton, United Kingdom
| | - Kris Murray
- MRC Unit The Gambia at The London School of Hygiene and Tropical Medicine, Fajara, The Gambia
- MRC Centre for Global Infectious Disease Analysis, Imperial College School of Public Health, Imperial College London, London, United Kingdom
| | - Chris Grundy
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Beate Kampmann
- Vaccines and Immunity Theme, MRC Unit The Gambia at London School of Hygiene and Tropical Medicine, Fajara, The Gambia
- Vaccine Centre, London School of Hygiene and Tropical Medicine, London, United Kingdom
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Ozigbu CE, Olatosi B, Li Z, Hardin JW, Hair NL. Correlates of Zero-Dose Vaccination Status among Children Aged 12–59 Months in Sub-Saharan Africa: A Multilevel Analysis of Individual and Contextual Factors. Vaccines (Basel) 2022; 10:vaccines10071052. [PMID: 35891216 PMCID: PMC9322920 DOI: 10.3390/vaccines10071052] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Revised: 06/24/2022] [Accepted: 06/27/2022] [Indexed: 11/16/2022] Open
Abstract
Despite ongoing efforts to improve childhood vaccination coverage, including in hard-to-reach and hard-to-vaccinate communities, many children in sub-Saharan Africa (SSA) remain unvaccinated. Considering recent goals set by the Immunization Agenda 2030 (IA2030), including reducing the number of zero-dose children by half, research that goes beyond coverage to identify populations and groups at greater risk of being unvaccinated is urgently needed. This is a pooled cross-sectional study of individual- and country-level data obtained from Demographic and Health Surveys Program and two open data repositories. The sample includes 43,131 children aged 12–59 months sampled between 2010 and 2020 in 33 SSA countries. Associations of zero-dose status with individual and contextual factors were assessed using multilevel logistic regression. 16.5% of children had not received any vaccines. Individual level factors associated lower odds of zero-dose status included mother’s primary school or high school education, employment, use of antenatal care services and household wealth. Compared to children in countries with lower GDP, children in countries with relatively high GDP had nearly four times greater odds of being unvaccinated. Both individual and contextual factors are correlated with zero-dose status in SSA. Our results can inform efforts to identify and reach children who have not received any vaccines.
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Affiliation(s)
- Chamberline E. Ozigbu
- Department of Health Services Policy and Management, Arnold School of Public Health, University of South Carolina, Columbia, SC 29208, USA; (C.E.O.); (B.O.); (J.W.H.)
| | - Bankole Olatosi
- Department of Health Services Policy and Management, Arnold School of Public Health, University of South Carolina, Columbia, SC 29208, USA; (C.E.O.); (B.O.); (J.W.H.)
- South Carolina SmartState Center for Healthcare Quality, Arnold School of Public Health, University of South Carolina, Columbia, SC 29208, USA;
- Big Data Health Science Center (BDHSC), University of South Carolina, Columbia, SC 29208, USA
| | - Zhenlong Li
- South Carolina SmartState Center for Healthcare Quality, Arnold School of Public Health, University of South Carolina, Columbia, SC 29208, USA;
- Big Data Health Science Center (BDHSC), University of South Carolina, Columbia, SC 29208, USA
- Geoinformation and Big Data Research Laboratory, University of South Carolina, Columbia, SC 29208, USA
| | - James W. Hardin
- Department of Health Services Policy and Management, Arnold School of Public Health, University of South Carolina, Columbia, SC 29208, USA; (C.E.O.); (B.O.); (J.W.H.)
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, SC 29208, USA
| | - Nicole L. Hair
- Department of Health Services Policy and Management, Arnold School of Public Health, University of South Carolina, Columbia, SC 29208, USA; (C.E.O.); (B.O.); (J.W.H.)
- Correspondence:
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Aheto JMK, Pannell O, Dotse-Gborgbortsi W, Trimner MK, Tatem AJ, Rhoda DA, Cutts FT, Utazi CE. Multilevel analysis of predictors of multiple indicators of childhood vaccination in Nigeria. PLoS One 2022; 17:e0269066. [PMID: 35613138 PMCID: PMC9132327 DOI: 10.1371/journal.pone.0269066] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Accepted: 05/13/2022] [Indexed: 11/18/2022] Open
Abstract
Background Substantial inequalities exist in childhood vaccination coverage levels. To increase vaccine uptake, factors that predict vaccination coverage in children should be identified and addressed. Methods Using data from the 2018 Nigeria Demographic and Health Survey and geospatial data sets, we fitted Bayesian multilevel binomial and multinomial logistic regression models to analyse independent predictors of three vaccination outcomes: receipt of the first dose of Pentavalent vaccine (containing diphtheria-tetanus-pertussis, Hemophilus influenzae type B and Hepatitis B vaccines) (PENTA1) (n = 6059) and receipt of the third dose having received the first (PENTA3/1) (n = 3937) in children aged 12–23 months, and receipt of measles vaccine (MV) (n = 11839) among children aged 12–35 months. Results Factors associated with vaccination were broadly similar for documented versus recall evidence of vaccination. Based on any evidence of vaccination, we found that health card/document ownership, receipt of vitamin A and maternal educational level were significantly associated with each outcome. Although the coverage of each vaccine dose was higher in urban than rural areas, urban residence was not significant in multivariable analyses that included travel time. Indicators relating to socio-economic status, as well as ethnic group, skilled birth attendance, lower travel time to the nearest health facility and problems seeking health care were significantly associated with both PENTA1 and MV. Maternal religion was related to PENTA1 and PENTA3/1 and maternal age related to MV and PENTA3/1; other significant variables were associated with one outcome each. Substantial residual community level variances in different strata were observed in the fitted models for each outcome. Conclusion Our analysis has highlighted socio-demographic and health care access factors that affect not only beginning but completing the vaccination series in Nigeria. Other factors not measured by the DHS such as health service quality and community attitudes should also be investigated and addressed to tackle inequities in coverage.
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Affiliation(s)
- Justice Moses K. Aheto
- WorldPop, School of Geography and Environmental Science, University of Southampton, Southampton, United Kingdom
- Department of Biostatistics, School of Public Health, College of Health Sciences, University of Ghana, Accra, Ghana
- * E-mail: ,
| | - Oliver Pannell
- WorldPop, School of Geography and Environmental Science, University of Southampton, Southampton, United Kingdom
| | - Winfred Dotse-Gborgbortsi
- WorldPop, School of Geography and Environmental Science, University of Southampton, Southampton, United Kingdom
| | - Mary K. Trimner
- Biostat Global Consulting, Worthington, OH, United States of America
| | - Andrew J. Tatem
- WorldPop, School of Geography and Environmental Science, University of Southampton, Southampton, United Kingdom
| | - Dale A. Rhoda
- Biostat Global Consulting, Worthington, OH, United States of America
| | - Felicity T. Cutts
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - C. Edson Utazi
- WorldPop, School of Geography and Environmental Science, University of Southampton, Southampton, United Kingdom
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Schön M, Heesemann E, Ebert C, Subramanyam M, Vollmer S, Horn S. How to ensure full vaccination? The association of institutional delivery and timely postnatal care with childhood vaccination in a cross-sectional study in rural Bihar, India. PLOS GLOBAL PUBLIC HEALTH 2022; 2:e0000411. [PMID: 36962219 PMCID: PMC10021874 DOI: 10.1371/journal.pgph.0000411] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Accepted: 04/05/2022] [Indexed: 11/19/2022]
Abstract
Incomplete and absent doses in routine childhood vaccinations are of major concern. Health systems in low- and middle-income countries (LMIC), in particular, often struggle to enable full vaccination of children, which affects their immunity against communicable diseases. Data on child vaccination cards from a cross-sectional primary survey with 1,967 households were used to assess the vaccination status. The association of timely postnatal care (PNC) and the place of delivery with any-dose (at least one dose of each vaccine) and full vaccination of children between 10-20 months in Bihar, India, was investigated. Bivariate and multivariable logistic regression models were used. The vaccines included targeted tuberculosis, hepatitis B, polio, diphtheria/pertussis/tetanus (DPT) and measles. Moreover predictors for perinatal health care uptake were analysed by multivariable logistic regression. Of the 1,011 children with card verification, 47.9% were fully vaccinated. Timely PNC was positively associated with full vaccination (adjusted odds ratio (aOR) 1.48, 95% confidence interval (CI) 1.06-2.08) and with the administration of at least one dose (any-dose) of polio vaccine (aOR 3.37 95% CI 1.79-6.36), hepatitis B/pentavalent vaccine (aOR 2.11 95% CI 1.24-3.59), and DPT/pentavalent vaccine (aOR 2.29 95% CI 1.35-3.88). Additionally, delivery in a public health care facility was positively associated with at least one dose of hepatitis B/pentavalent vaccine administration (aOR 4.86 95% CI 2.97-7.95). Predictors for timely PNC were institutional delivery (public and private) (aOR 2.7 95% CI 1.96-3.72, aOR 2.38 95% CI 1.56-3.64), at least one ANC visit (aOR 1.59 95% CI 1.18-2.15), wealth quintile (Middle aOR 1.57 95% CI 1.02-2.41, Richer aOR 1.51 95% CI 1.01-2.25, Richest aOR 2.06 95% CI 1.28-3.31) and household size (aOR 0.95 95% CI 0.92-0.99). The findings indicate a correlation between childhood vaccination and timely postnatal care. Further, delivery in a public facility correlates with the administration of at least one dose of hepatitis B vaccine and thus impedes zero-dose vaccination. Increasing uptake of timely PNC, encouraging institutional delivery, and improving vaccination services before discharge of health facilities may lead to improved vaccination rates among children.
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Affiliation(s)
- Mareike Schön
- Department of Paediatrics, University Medical Center Göttingen, Göttingen, Germany
| | | | - Cara Ebert
- RWI-Leibniz Institute for Economic Research, Essen, Germany
| | - Malavika Subramanyam
- Social Epidemiology, Indian Institute of Technology Gandhinagar, Palaj, Gandhinagar, Gujarat, India
| | - Sebastian Vollmer
- Chair of Development Economics, Center for Modern Indian Studies, University of Göttingen, Göttingen, Germany
| | - Sebastian Horn
- Department of Paediatrics, University Medical Center Göttingen, Göttingen, Germany
- Department of Paediatrics, SRH Central Hospital Suhl, Suhl, Germany
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Dejene H, Girma D, Geleta LA, Legesse E. Vaccination timeliness and associated factors among children aged 12-23 months in Debre Libanos district of North Shewa Zone, Oromia Regional State, Ethiopia. Front Pediatr 2022; 10:867846. [PMID: 35967570 PMCID: PMC9363667 DOI: 10.3389/fped.2022.867846] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Accepted: 07/04/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Globally, vaccination is one of the most cost-effective interventions in promoting child survival, preventing 2-3 million child deaths annually from vaccine-preventable diseases (VPDs). In Ethiopia, timely vaccination is stated as key to the prevention of unnecessary childhood mortality from measles, pneumonia, diarrheal diseases, and other VPDs. However, Ethiopia ranked fifth among the ten countries with the most unprotected children. Furthermore, previous vaccine timeliness studies produced widely disparate results. As a result, it was suggested that more research be conducted to investigate the potential factors behind the high proportion of untimely vaccination. Therefore, this study was intended to explore the association between different factors and the proportion of vaccination timeliness administered under the Expanded Program on Immunization in Debre Libanos district, Ethiopia. METHODS A community-based cross-sectional study design was employed from 1 May to 30 May 2021 among children aged 12 to 23 months with their mother/caregiver, who had started vaccination and had vaccination cards in the Debre Libanos. Simple random sampling techniques and pretested semi-structured questionnaires were used for data collection. At last, a multivariable logistic regression was used to identify factors associated with the vaccination timeliness. RESULT In this study, 413 children aged 12 to 23 months were interviewed with their mother/caregiver. Overall, 33.7% [95% CI (29.1-38.3)] of children received their vaccines timely. Having a female child [AOR: 2.9, 95% CI: 1.58-5.35], mother/caregiver attending primary [AOR: 6.33, 95% CI: 2.66-15.06] and secondary/above education [AOR: 5.61, 95% CI: 2.41-13.04], sufficient vaccination knowledge [AOR: 3.46, 95% CI: 1.87-6.38], mother/caregiver with least hesitant [AOR: 3.35, 95% CI: 1.51-7.41] and middle hesitant [AOR: 1.89, 95% CI: 1.05-3.58], utilization of ANC [AOR: 2.89, 95% CI: 1.32-6.33], and giving birth at health facility [AOR: 4.32, 95% CI: 1.95-9.59] were the factors independently associated with vaccination timeliness. CONCLUSION In comparison to Ethiopia's existing vaccination coverage, the proportion of children immunized at the recommended time interval is low in the study district. Policymakers should prioritize vaccine timeliness and integrate it into childhood vaccination strategies.
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Affiliation(s)
- Hiwot Dejene
- Department of Public Health, Salale University, Fiche, Ethiopia
| | - Derara Girma
- Department of Public Health, Salale University, Fiche, Ethiopia
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Boulton ML, Wagner AL. Advancing Global Vaccination Equity. Am J Prev Med 2021; 60:S1-S3. [PMID: 33189501 DOI: 10.1016/j.amepre.2020.10.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Accepted: 10/16/2020] [Indexed: 11/18/2022]
Affiliation(s)
- Matthew L Boulton
- Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, Michigan; Global Institute for Vaccine Equity, University of Michigan, Ann Arbor, Michigan; Infectious Disease Division, Department of Internal Medicine, Michigan Medicine, Ann Arbor, Michigan.
| | - Abram L Wagner
- Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, Michigan; Global Institute for Vaccine Equity, University of Michigan, Ann Arbor, Michigan
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