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Tamir TT, Zegeye AF, Mekonen EG, Tekeba B, Ali MS, Gonete AT, Kassie AT, Workneh BS, Wassie M, Alemu TG. Prevalence, spatial variation and determinants of zero-dose children in Ethiopia: Spatial and multilevel analyses. Public Health 2024; 236:365-372. [PMID: 39303624 DOI: 10.1016/j.puhe.2024.09.011] [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: 03/18/2024] [Revised: 07/16/2024] [Accepted: 09/11/2024] [Indexed: 09/22/2024]
Abstract
OBJECTIVES Vaccination is a crucial public health intervention protecting individuals and communities from vaccine-preventable diseases. However, unvaccinated children in low- and middle-income countries pose a significant challenge. Ethiopia, a Global Alliance for Vaccines and Immunisation (GAVI)-supported country, ranks fifth in zero-dose immunisation burden, indicating concerning vaccine coverage gaps. Despite the severity of this issue, there is a dearth of research investigating the disparities, prevalence and contributing factors associated with zero-dose children in Ethiopia. This study aimed to assess the prevalence, spatial distribution and determinants of zero-dose children in Ethiopia. STUDY DESIGN A community-based cross-sectional study was conducted using data from the 2019 Ethiopian Mini Demographic and Health Survey (EMDHS). Data were collected from 21 March 2019 to 28 June 2019. METHODS The study included a total of 1334 children aged 12-35 months (weighted sample). For spatial and multilevel analyses, ArcGIS 10.8 and Stata 17 software were used, respectively. The measure of association was determined by computing the adjusted odds ratio (AOR) at a 95 % confidence interval (95 % CI), and a p-value <0.05 was considered statistically significant. RESULTS The prevalence of zero-dose children in Ethiopia was 46.5 % (95 % CI: 43.8, 49.2). Southeast Amhara, Afar, Somali, Oromia and SNNPR (Southern Nations, Nationalities and Peoples' Region) regions had high zero-dose proportions. Maternal age 15-19 years (AOR = 1.63; 95 % CI: 1.05, 2.64), lack of antenatal care (AOR = 1.77; 95 % CI: 1.34, 2.35), rural residence (AOR = 1.94; 95 % CI: 1.17, 3.19) and region were significantly associated to zero-dose status in Ethiopia. CONCLUSIONS The prevalence of zero-dose children in Ethiopia was high and the distribution exhibited significant variation across the country's clusters. Individual and community factors were key contributors. It is essential that areas with a high prevalence of zero-dose children have access to recommended childhood vaccines. This proactive approach can help protect children from morbidity and mortality caused by vaccine-preventable diseases.
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Affiliation(s)
- Tadesse Tarik Tamir
- Department of Pediatrics and Child Health Nursing, School of Nursing, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia.
| | - Alebachew Ferede Zegeye
- Department of Medical Nursing, School of Nursing, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Enyew Getaneh Mekonen
- Department of Surgical Nursing, School of Nursing, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Berhan Tekeba
- Department of Pediatrics and Child Health Nursing, School of Nursing, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Mohammed Seid Ali
- Department of Pediatrics and Child Health Nursing, School of Nursing, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Almaz Tefera Gonete
- Department of Pediatrics and Child Health Nursing, School of Nursing, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Alemneh Tadesse Kassie
- Department of clinical Midwifery, School of Midwifery, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Belayneh Shetie Workneh
- Department of emergency and critical care Nursing, School of Nursing, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Mulugeta Wassie
- School of Nursing, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Tewodros Getaneh Alemu
- Department of Pediatrics and Child Health Nursing, School of Nursing, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
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Lyons C, Nambiar D, Johns NE, Allorant A, Bergen N, Hosseinpoor AR. Inequality in Childhood Immunization Coverage: A Scoping Review of Data Sources, Analyses, and Reporting Methods. Vaccines (Basel) 2024; 12:850. [PMID: 39203976 PMCID: PMC11360733 DOI: 10.3390/vaccines12080850] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2024] [Revised: 07/12/2024] [Accepted: 07/20/2024] [Indexed: 09/03/2024] Open
Abstract
Immunization through vaccines among children has contributed to improved childhood survival and health outcomes globally. However, vaccine coverage among children is unevenly distributed across settings and populations. The measurement of inequalities is essential for understanding gaps in vaccine coverage affecting certain sub-populations and monitoring progress towards achieving equity. Our study aimed to characterize the methods of reporting inequalities in childhood vaccine coverage, inclusive of the settings, data source types, analytical methods, and reporting modalities used to quantify and communicate inequality. We conducted a scoping review of publications in academic journals which included analyses of inequalities in vaccination among children. Literature searches were conducted in PubMed and Web of Science and included relevant articles published between 8 December 2013 and 7 December 2023. Overall, 242 publications were identified, including 204 assessing inequalities in a single country and 38 assessing inequalities across more than one country. We observed that analyses on inequalities in childhood vaccine coverage rely heavily on Demographic Health Survey (DHS) or Multiple Indicator Cluster Surveys (MICS) data (39.3%), and papers leveraging these data had increased in the last decade. Additionally, about half of the single-country studies were conducted in low- and middle-income countries. We found that few studies analyzed and reported inequalities using summary measures of health inequality and largely used the odds ratio resulting from logistic regression models for analyses. The most analyzed dimensions of inequality were economic status and maternal education, and the most common vaccine outcome indicator was full vaccination with the recommended vaccine schedule. However, the definition and construction of both dimensions of inequality and vaccine coverage measures varied across studies, and a variety of approaches were used to study inequalities in vaccine coverage across contexts. Overall, harmonizing methods for selecting and categorizing dimensions of inequalities as well as methods for analyzing and reporting inequalities can improve our ability to assess the magnitude and patterns of inequality in vaccine coverage and compare those inequalities across settings and time.
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Affiliation(s)
| | | | | | | | | | - Ahmad Reza Hosseinpoor
- Department of Data and Analytics, World Health Organization, 20 Avenue Appia, 1211 Geneva, Switzerland; (C.L.); (D.N.); (N.E.J.); (A.A.); (N.B.)
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Zegeye AF, Mekonen EG, Tekeba B, Alemu TG, Ali MS, Gonete AT, Kassie AT, Workneh BS, Tamir TT, Wassie M. Spatial distribution and determinants of measles vaccination dropout among under-five children in Ethiopia: A spatial and multilevel analysis of 2019 Ethiopian demographic and health survey. PLoS One 2024; 19:e0305393. [PMID: 38976660 PMCID: PMC11230542 DOI: 10.1371/journal.pone.0305393] [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: 01/14/2024] [Accepted: 05/30/2024] [Indexed: 07/10/2024] Open
Abstract
BACKGROUND Each year, vaccine-preventable diseases cost the lives of 8.8 million under-five children. Although vaccination prevents 1-2 million childhood deaths worldwide, measles vaccination dropouts are not well studied in developing countries, particularly in Ethiopia. Therefore, this study aims to assess the spatial distribution of the measles vaccination dropout and its determinants among under-five children in Ethiopia. METHODS Data from Ethiopian Demographic and Health Survey 2019 was used for data analysis. The study used a total of 5,753 children. Spatial autocorrelations was used to determine the spatial dependency of measles vaccination dropout. Ordinary interpolation was employed to forecast measles vaccination dropout. Factors associated with measles vaccination dropout were declared significant at p-values <0.05. The data were interpreted using the confidence interval and adjusted odds ratio. A model with the lowest deviance and highest logliklihood ratio was selected as the best-fit model. RESULTS In Ethiopia, one in three under-five children had measles vaccination dropouts. Factors such as birth interval (AOR = 1.87, 95% CI: 1.30, 2.70), unmarried marital status women (AOR = 3.98, 95% CI: 1.08, 8.45), ≤1 number of under-five children (AOR = 3.86, 95% CI: 2.56, 5.81), rural place of residence (AOR = 2.43, 95% CI: 2.29, 3.11), low community-level ANC utilization (AOR = 3.20, 95% CI: 2.53, 3.56), and residing in Benishangul Gumuz (AOR = 1.80, 95% CI: 1.061, 3.06) had higher odds of measles vaccination dropout. CONCLUSIONS Measles vaccination dropout rates in Ethiopia among under-five children were high compared to the maximum tolerable vaccination dropout level of 10% by the WHO. Both individual and community-level variables were determinants of measles vaccination dropout. The ministry of health in Ethiopia should give attention to those mothers of under-five children who reported underutilization of ANC services and rural residences while designing policies and strategies in areas of high spatial clustering of vaccine dropout in Ethiopia.
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Affiliation(s)
- Alebachew Ferede Zegeye
- Department of Medical Nursing, School of Nursing, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Enyew Getaneh Mekonen
- Department of Surgical Nursing, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Berhan Tekeba
- Department of Pediatrics and Child Health Nursing, School of Nursing, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Tewodros Getaneh Alemu
- Department of Pediatrics and Child Health Nursing, School of Nursing, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Mohammed Seid Ali
- Department of Pediatrics and Child Health Nursing, School of Nursing, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Almaz Tefera Gonete
- Department of Pediatrics and Child Health Nursing, School of Nursing, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Alemneh Tadesse Kassie
- Department of Clinical Midwifery, School of Midwifery, College of Medicine and Health Sciences University of Gondar, Gondar, Ethiopia
| | - Belayneh Shetie Workneh
- Department of Emergency and Critical Care Nursing, School of Nursing, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Tadesse Tarik Tamir
- Department of Pediatrics and Child Health Nursing, School of Nursing, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Mulugeta Wassie
- School of Nursing, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
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Williams SV, Akande T, Abbas K. Systematic review of social determinants of childhood immunisation in low- and middle-income countries and equity impact analysis of childhood vaccination coverage in Nigeria. PLoS One 2024; 19:e0297326. [PMID: 38446836 PMCID: PMC10917251 DOI: 10.1371/journal.pone.0297326] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Accepted: 12/22/2023] [Indexed: 03/08/2024] Open
Abstract
BACKGROUND Nigeria has a high proportion of the world's underimmunised children. We estimated the inequities in childhood immunisation coverage associated with socioeconomic, geographic, maternal, child, and healthcare characteristics among children aged 12-23 months in Nigeria using a social determinants of health perspective. METHODS We conducted a systematic review to identify the social determinants of childhood immunisation associated with inequities in vaccination coverage among low- and middle-income countries. Using the 2018 Nigeria Demographic and Health Survey (DHS), we conducted multiple logistic regression to estimate the association between basic childhood vaccination coverage (1-dose BCG, 3-dose DTP-HepB-Hib (diphtheria, tetanus, pertussis, hepatitis B and Haemophilus influenzae type B), 3-dose polio, and 1-dose measles) and socioeconomic, geographic, maternal, child, and healthcare characteristics in Nigeria. RESULTS From the systematic review, we identified the key determinants of immunisation to be household wealth, religion, and ethnicity for socioeconomic characteristics; region and place of residence for geographic characteristics; maternal age at birth, maternal education, and household head status for maternal characteristics; sex of child and birth order for child characteristics; and antenatal care and birth setting for healthcare characteristics. Based of the 2018 Nigeria DHS analysis of 6,059 children aged 12-23 months, we estimated that basic vaccination coverage was 31% (95% CI: 29-33) among children aged 12-23 months, whilst 19% (95% CI:18-21) of them were zero-dose children who had received none of the basic vaccines. After controlling for background characteristics, there was a significant increase in the odds of basic vaccination by household wealth (AOR: 3.21 (2.06, 5.00), p < 0.001) for the wealthiest quintile compared to the poorest quintile, antenatal care of four or more antenatal care visits compared to no antenatal care (AOR: 2.87 (2.21, 3.72), p < 0.001), delivery in a health facility compared to home births (AOR 1.32 (1.08, 1.61), p = 0.006), relatively older maternal age of 35-49 years compared to 15-19 years (AOR: 2.25 (1.46, 3.49), p < 0.001), and maternal education of secondary or higher education compared to no formal education (AOR: 1.79 (1.39, 2.31), p < 0.001). Children of Fulani ethnicity in comparison to children of Igbo ethnicity had lower odds of receiving basic vaccinations (AOR: 0.51 (0.26, 0.97), p = 0.039). CONCLUSIONS Basic vaccination coverage is below target levels for all groups. Children from the poorest households, of Fulani ethnicity, who were born in home settings, and with young mothers with no formal education nor antenatal care, were associated with lower odds of basic vaccination in Nigeria. We recommend a proportionate universalism approach for addressing the immunisation barriers in the National Programme on Immunization of Nigeria.
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Affiliation(s)
| | - Tanimola Akande
- Department of Epidemiology & Community Health, University of Ilorin, Ilorin, Nigeria
| | - Kaja Abbas
- Department of Infectious Disease Epidemiology and Dynamics, London School of Hygiene & Tropical Medicine, London, United Kingdom
- School of Tropical Medicine and Global Health, Nagasaki University, Nagasaki, Japan
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Ferede Zegeye A, Kassa Mekonnen C, Kindie H, Shetie Workneh B, Bihonegn Asmamaw D, Tarik Tamir T. Individual and community-level determinants of pentavalent vaccination dropouts among under-five children in the sub-Saharan African countries: A multilevel analysis of the recent demographic and health survey. Vaccine X 2024; 17:100465. [PMID: 38435980 PMCID: PMC10906395 DOI: 10.1016/j.jvacx.2024.100465] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Revised: 02/16/2024] [Accepted: 02/19/2024] [Indexed: 03/05/2024] Open
Abstract
Background Globally, each year, about 3 million deaths among children are prevented by pentavalent vaccinations. However, in developing countries, particularly in Sub-Saharan Africa, pentavalent vaccination dropout rates are not well reported. Therefore, this study aimed to assess pentavalent vaccination dropout rates and their determinants among under-five children in Sub-Saharan Africa. Methods Data from the recent Demographic and Health Surveys in 33 Sub-Saharan African countries were used for analysis. The study used a total of 358,529 under-five children. The determinants of pentavalent vaccination dropout were determined using a multilevel mixed-effects logistic regression model. Significant factors associated with pentavalent vaccination dropout were declared significant at p-values < 0.05. A model with the lowest deviance and highest logliklihood ratio was selected as the best-fit model. Results In Sub-Saharan Africa, one in five under-five children had pentavalent vaccination dropout rates. Factors such as Age (AOR = 1.61, 95 % CI: 1.51, 1.72), educational level (AOR = 1.30, 95 % CI: 1.22, 1.40), place of delivery (AOR = 1.65, 95 % CI: 1.57, 1.73), ANC visits (AOR = 1.34, 95 % CI: 1.23, 1.45), postnatal check-up (AOR = 1.19, 95 % CI: 1.14, 1.25), wealth status (AOR = 1.09, 95 % CI: 1.04, 1.15), distance to health facility (AOR = 1.08, 95 % CI: 1.03, 1.13), media exposure (AOR = 1.12, 95 % 1.15), and geographical region (AOR = 1.60, 95 % CI: 1.49, 1.72) had higher odds of pentavalent vaccination dropouts. Conclusions Pentavalent vaccination dropout rates in sub-Saharan Africa among under-five children were high. Both individual and community-level variables were determinants of pentavalent vaccination dropout rates. Government and ministry of health in Sub-Saharan Africa should give attention to those mothers of under-five children who reported distance as a big problem in accessing health facilities and to women who do not utilise antenatal and postnatal check-ups while designing policies and strategies in sub-Saharan Africa.
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Affiliation(s)
- Alebachew Ferede Zegeye
- Department of Medical Nursing, School of Nursing, College of Medicine and Health Sciences University of Gondar, Gondar, Ethiopia
| | - Chilot Kassa Mekonnen
- Department of Medical Nursing, School of Nursing, College of Medicine and Health Sciences University of Gondar, Gondar, Ethiopia
| | - Hailemichael Kindie
- Department of Medical Nursing, School of Nursing, College of Medicine and Health Sciences University of Gondar, Gondar, Ethiopia
| | - Belayneh Shetie Workneh
- Department of Emergency and Critical Care Nursing, School of Nursing, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Desale Bihonegn Asmamaw
- Department of Reproductive Health, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Tadesse Tarik Tamir
- Department of Pediatrics and Child Health Nursing, School of Nursing, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
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Lubanga AF, Bwanali AN, Munthali L, Mphepo M, Chumbi GD, Kangoma M, Khuluza C. Malawi vaccination drive: An integrated immunization campaign against typhoid, measles, rubella, and polio; health benefits and potential challenges. Hum Vaccin Immunother 2023; 19:2233397. [PMID: 37431661 PMCID: PMC10337493 DOI: 10.1080/21645515.2023.2233397] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Accepted: 07/03/2023] [Indexed: 07/12/2023] Open
Abstract
Vaccination stands as one of the most important scientific discoveries and public health achievements in the fight against diseases. For over a century, millions of early childhood deaths have been averted through routine immunizations. However, to prevent the morbidity and mortality associated with vaccine-preventable diseases and their complications and optimize the control of vaccine-preventable diseases in communities, high uptake rates must be achieved. Mass immunization campaigns (MICs) have globally been used to introduce new vaccines for major infectious diseases and improve coverage of routine vaccines through catch-up campaigns. Malawi recently undertook such a campaign to introduce a highly efficacious typhoid conjugate vaccine and provides a catch-up to measles, rubella, and polio. Such campaigns are associated with multiple benefits. However, the MICs are associated with multiple challenges to be successfully administered. In this review, we highlight recent MIC, vaccine coverage, and potential challenges and benefits and offer recommendation for future preventive campaigns.
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Affiliation(s)
- Adriano Focus Lubanga
- Clinical Research Education and Management Services LTD(CREAMS), Lilongwe, Malawi
- Oli Health Magazine Organization, Research and Education, Kigali, Rwanda
| | - Akim Nelson Bwanali
- Clinical Research Education and Management Services LTD(CREAMS), Lilongwe, Malawi
- Oli Health Magazine Organization, Research and Education, Kigali, Rwanda
| | - Leonard Munthali
- Kamuzu Central Hospital, Ministry of Health (MoH), Lilongwe, Malawi
| | - Mzati Mphepo
- Clinical Research Education and Management Services LTD(CREAMS), Lilongwe, Malawi
| | | | - Melina Kangoma
- Kamuzu Central Hospital, Ministry of Health (MoH), Lilongwe, Malawi
| | - Chana Khuluza
- Kamuzu Central Hospital, Ministry of Health (MoH), Lilongwe, Malawi
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Dhalaria P, Kapur S, Singh AK, Priyadarshini P, Dutta M, Arora H, Taneja G. Exploring the Pattern of Immunization Dropout among Children in India: A District-Level Comparative Analysis. Vaccines (Basel) 2023; 11:vaccines11040836. [PMID: 37112748 PMCID: PMC10143302 DOI: 10.3390/vaccines11040836] [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: 02/28/2023] [Revised: 03/27/2023] [Accepted: 04/03/2023] [Indexed: 04/29/2023] Open
Abstract
The dropout rate is one of the determinants of immunization coverage and program performance, program continuity, and follow-up. The dropout rate refers to the proportion of vaccine recipients who did not finish their vaccination schedules, and it is determined by comparing the number of infants who started the schedule to the number who completed it. It is the rate difference between the first and final dosage or the rate difference between the first vaccination and the last vaccine dropout; thus, it denotes that the first recommended dose of vaccine was received, but that the subsequently recommended dose was missed. In India, immunization coverage has shown significant improvements over the last two decades, but full immunization coverage has remained stagnant at 76.5%, of which 19.9% are partially immunized, and 3.6% are children who have been left out. In India, the Universal Immunization Programme (UIP) is challenged with cases related to dropout in immunization. Although immunization coverage in India is improving, the program is challenged by vaccination dropouts. This study provides an analysis of the determinants of vaccination dropout in India using data from two rounds of the National Family Health Survey. The finding shows that the mother's age, education, family wealth, antenatal care visit, and place of delivery were some of the variables that significantly contributed to reducing the dropout rate of immunization among children. The findings of this paper show that the dropout rate has reduced over a certain period of time. The overall improvement in the rates of dropout and increase in full immunization coverage could be attributed to various policy measures taken in the last decade in India, which brought structural changes with a positive impact on full immunization coverage and its components.
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Affiliation(s)
- Pritu Dhalaria
- Immunization Technical Support Unit, Ministry of Health & Family Welfare, New Delhi 110070, India
| | | | - Ajeet Kumar Singh
- Immunization Technical Support Unit, Ministry of Health & Family Welfare, New Delhi 110070, India
| | - Pretty Priyadarshini
- Immunization Technical Support Unit, Ministry of Health & Family Welfare, New Delhi 110070, India
| | - Mili Dutta
- Immunization Technical Support Unit, Ministry of Health & Family Welfare, New Delhi 110070, India
| | | | - Gunjan Taneja
- Bill & Melinda Gates Foundation, New Delhi 110067, India
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Gosling J, Colbourn T. What is associated with reported acute respiratory infection in children under 5 and PCV vaccination in children aged 1-36 months in Malawi? A secondary data analysis using the Malawi 2014 MICS survey. PLoS One 2023; 18:e0283760. [PMID: 37000716 PMCID: PMC10065275 DOI: 10.1371/journal.pone.0283760] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Accepted: 03/16/2023] [Indexed: 04/01/2023] Open
Abstract
INTRODUCTION Acute respiratory illness (ARI) is a leading cause of mortality in children under 5 (CU5) in Malawi and can be prevented with 3-dose pneumococcal conjugate vaccine (PCV). There has been no national study in Malawi that seeks to associate social economic factors leading to PCV vaccine uptake and reported acute respiratory infections (RARI). The objectives of our study were to do this. METHODS We conducted a cross-sectional analysis of secondary data from the 2014 UNICEF Malawi Multiple Indicator Cluster Survey to construct mutlivariable logistic regression models for independent associations with PCV 1/2/3 immunisation and RARI. RESULTS 56% of CU5 in Malawi RARI in the 2 week recall period of the survey. Independent associations with reduced odds of RARI were central region living (OR 0.82, 95%CI (0.71-0.93)) middle (OR 0.84, (0.73-0.97)) fourth (OR 0.79, (0.68-0.92)) and richest wealth quintiles (OR 0.73, (0.60-0.88)). Using straw/shrubs for fuel was associated with increased RARI (OR 3.13, (1.00-9.79)). Among 1-36 month olds, in 2014, 93.3% received PCV1, 86.8% PCV2 and 77.0% PCV3. Between 2011-2014, the average age in months for a child to receive PCV1/2/3 reduced by 26.6 for PCV1, 26.4 for PCV2, and 26.1 for PCV 3. Independent predicators for increased odds of all 3 PCV doses, relative to 0-5 age group, were age group 6-11 (OR 21.8, (18.2-26.1) 12-23 (OR 27.5, (23.5-32.2) 24-36 months (OR 9.09, (7.89-10.5), mothers having a secondary (OR 1.52, (1.25-1.84)) or higher education (OR 2.68, (1.43-5.04) when compared to no education, and children in the middle (OR 1.24, (1.07-1.43)) fourth (OR 1.27, (1.09-1.48)) richest (OR 1.54, (1.27-1.88)) wealth quintiles relative to the lowest. Children living with 4-6 other children was independently associated with reduced odds of receiving all 3 PCV doses (OR 0.56, (0.33-0.96). CONCLUSION We report nationally representative social economic associations with RARI and PCV vaccine uptake and coverage estimates. We found reductions in the average age a child receives all 3 PCV vaccine doses between 2011-2014.
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Affiliation(s)
- Justine Gosling
- UCL Institute for Global Health, London, United Kingdom
- World Health Organization Regional Office for Europe, Copenhagen, Denmark
| | - Tim Colbourn
- UCL Institute for Global Health, London, United Kingdom
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Balgovind P, Mohammadnezhad M. Factors affecting childhood immunization: Thematic analysis of parents and healthcare workers' perceptions. Hum Vaccin Immunother 2022; 18:2137338. [PMID: 36494999 PMCID: PMC9746479 DOI: 10.1080/21645515.2022.2137338] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Immunization against common childhood diseases is an important strategy as it is critical for reducing the global child morbidity and mortality. This review explores the perceptions of parents and HCWs toward childhood immunization. The PRISMA guideline was used to search and include the studies. Relevant electronic databases were systemically searched for the years ranging from 2000 to 2021 to identify studies reported in English. Themes were then identified using thematic analysis. A total of 44 studies met the review criteria and were summarized and categorized into 4 themes: barriers to immunization, parental knowledge, attitude and behavior (KAB), health system factors and HCWs' KAB. This review found that immunization decision-making is a complex process. Parental KAB leads to immunization decisions. HCWs were also noted to be the trusted sources of immunization information. Further research can be conducted on how to improve parents' perceptions of immunization and immunization practices.
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Affiliation(s)
- Preeti Balgovind
- School of Public Health and Primary Care, Fiji National University, Suva, Fiji Islands
| | - Masoud Mohammadnezhad
- School of Nursing and Healthcare Leadership, University of Bradford, Bradford, UK,CONTACT Masoud Mohammadnezhad School of Nursing and Healthcare Leadership, University of Bradford, Bradford, West YorkshireBD7 1DP, UK
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Balgovind P, Mohammadnezhad M. Perceptions of Healthcare Workers (HCWs) towards childhood immunization and immunization services in Fiji: a qualitative study. BMC Pediatr 2022; 22:610. [PMID: 36271395 PMCID: PMC9585826 DOI: 10.1186/s12887-022-03665-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Revised: 09/09/2022] [Accepted: 10/06/2022] [Indexed: 11/30/2022] Open
Abstract
Introduction Childhood immunization has been globally recognized as the single most effective strategy in preventing childhood diseases and mortality. The perceptions of healthcare workers are important as their behavior and attitudes influence parental decision–making process. This research aimed to explore the factors that influence healthcare workers’ experience and perceptions about delivering childhood immunization in Fiji. Materials and methods A qualitative study was conducted in three randomly selected health centers in Suva, Fiji from March 1st to April 5th, 2021. Five focus group discussions were conducted with healthcare workers who were chosen purposively, had worked in the health center for at least 6 months and included either gender. Those that did not consent or did not meet the inclusion criteria were excluded. The interviews were guided by semi–structured open–ended questionnaire and were recorded into a digital voice recorder. The data were coded, sorted, and then categorized into themes, and transcribed onto Microsoft Word. Thematic analysis was utilized to sort the key phrases from the recorded interviews. Results There were a total of 22 participants for the focus group discussions, with their ages ranging from 25 to 51 years, included 3 medical officers, 1 nurse practitioner and 18 registered nurses. Three major themes emerged, which included: healthcare worker factors, parental factors and health system factors. Subthemes identified from the healthcare worker factors were worker knowledge and attitudes. The subtheme for parental factors that emerged were defaulters, parental attitudes, perceived behavior and religious beliefs. For health system factors the subthemes were service delivery, registration, infrastructure, staff turnover, staff training and changes to the immunization schedule. Conclusion Some of the perceived barriers reported by the healthcare workers were parental religious beliefs, parental knowledge and attitude, social or physical factors (finances, transportation, childcare and work conflicts), access to health services, immunization services and policies, hours of operation, waiting time and missed opportunities. Health workers acknowledged that they have an important role to play in immunization as they are the source of information and motivation for parents. Further studies are needed to be conducted nationally to determine the perceptions of healthcare workers towards immunization and how the services can be improved on a national level. Supplementary Information The online version contains supplementary material available at 10.1186/s12887-022-03665-9.
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Affiliation(s)
- Preeti Balgovind
- Ministry of Health and Medical Services, Suva, Fiji Islands., National University, Suva, Fiji Islands.,School of Nursing and Healthcare Leadership, University of Bradford, Bradford, United Kingdom
| | - Masoud Mohammadnezhad
- Ministry of Health and Medical Services, Suva, Fiji Islands., National University, Suva, Fiji Islands. .,School of Nursing and Healthcare Leadership, University of Bradford, Bradford, United Kingdom.
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11
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Ali HA, Hartner AM, Echeverria-Londono S, Roth J, Li X, Abbas K, Portnoy A, Vynnycky E, Woodruff K, Ferguson NM, Toor J, Gaythorpe KA. Vaccine equity in low and middle income countries: a systematic review and meta-analysis. Int J Equity Health 2022; 21:82. [PMID: 35701823 PMCID: PMC9194352 DOI: 10.1186/s12939-022-01678-5] [Citation(s) in RCA: 46] [Impact Index Per Article: 23.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Accepted: 05/17/2022] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Evidence to date has shown that inequality in health, and vaccination coverage in particular, can have ramifications to wider society. However, whilst individual studies have sought to characterise these heterogeneities in immunisation coverage at national level, few have taken a broad and quantitative view of the contributing factors to heterogeneity in immunisation coverage and impact, i.e. the number of cases, deaths, and disability-adjusted life years averted. This systematic review aims to highlight these geographic, demographic, and sociodemographic characteristics through a qualitative and quantitative approach, vital to prioritise and optimise vaccination policies. METHODS A systematic review of two databases (PubMed and Web of Science) was undertaken using search terms and keywords to identify studies examining factors on immunisation inequality and heterogeneity in vaccination coverage. Inclusion criteria were applied independently by two researchers. Studies including data on key characteristics of interest were further analysed through a meta-analysis to produce a pooled estimate of the risk ratio using a random effects model for that characteristic. RESULTS One hundred and eight studies were included in this review. We found that inequalities in wealth, education, and geographic access can affect vaccine impact and vaccination dropout. We estimated those living in rural areas were not significantly different in terms of full vaccination status compared to urban areas but noted considerable heterogeneity between countries. We found that females were 3% (95%CI[1%, 5%]) less likely to be fully vaccinated than males. Additionally, we estimated that children whose mothers had no formal education were 28% (95%CI[18%,47%]) less likely to be fully vaccinated than those whose mother had primary level, or above, education. Finally, we found that individuals in the poorest wealth quintile were 27% (95%CI [16%,37%]) less likely to be fully vaccinated than those in the richest. CONCLUSIONS We found a nuanced picture of inequality in vaccination coverage and access with wealth disparity dominating, and likely driving, other disparities. This review highlights the complex landscape of inequity and further need to design vaccination strategies targeting missed subgroups to improve and recover vaccination coverage following the COVID-19 pandemic. TRIAL REGISTRATION Prospero, CRD42021261927.
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Affiliation(s)
| | | | | | - Jeremy Roth
- Imperial College London, Praed Street, London, UK
| | - Xiang Li
- Imperial College London, Praed Street, London, UK
| | - Kaja Abbas
- London School of Hygiene and Tropical Medicine, Keppel Street, London, UK
| | - Allison Portnoy
- Center for Health Decision Science, Harvard T H Chan School of Public Health, Cambridge, USA
| | | | - Kim Woodruff
- Imperial College London, Praed Street, London, UK
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12
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Mmanga K, Mwenyenkulu TE, Nkoka O, Ntenda PAM. Tracking immunization coverage, dropout and equity gaps among children ages 12-23 months in Malawi - bottleneck analysis of the Malawi Demographic and Health Survey. Int Health 2022; 14:250-259. [PMID: 34153106 PMCID: PMC9070459 DOI: 10.1093/inthealth/ihab038] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Revised: 05/07/2021] [Accepted: 06/03/2021] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Between 2010 and 2016, the proportion of children 12-23 months of age who received full immunization in Malawi decreased from 81% to 76%. Most studies on immunization have mainly focused on the risk factors of vaccination coverage while data on dropouts and equity gaps is very scanty. Thus the aim of the present study was to describe the trend in immunization coverage, dropout rates and effective immunization coverage (EIC) among children ages 12-23 months in Malawi. METHODS Secondary analyses of the cross-sectional data obtained from the three waves of the Demographic and Health Surveys (2004, 2010 and 2015-16) were conducted. Using bottleneck analysis, outputs were generated based on service coverage, demand/equity (service utilization) and quality (full immunization). The World Health Organization benchmarks were used to assess gaps in the immunization coverage indicators. RESULTS The coverage was >90.0% in most of the antigens while full immunization status was estimated at 65%, 84% and 73% in 2004, 2010 and 2015, respectively. The highest coverage was observed in Bacillus Calmette-Guérin (BCG) and lowest in oral polio vaccine 1 (OPV1). OPV1 coverage was <90% in the 2004 cohort year, while pentavalent 3 (Penta3) and measles-containing vaccine 1 (MCV1) coverages were <90% in 2004. Dropout rates of Penta3 and MCV1 were significantly >10% in 2004. The logistic regression analyses showed that children were significantly less likely to be immunized with Penta3 and MCV1 in all cohort years compared with Penta1. CONCLUSIONS Although immunization coverage was in line with the national and district targets for various antigens, full vaccination coverage (FVC) is still lagging behind. Furthermore, the dropout rates for Penta3 and MCV1 showed upside U-shaped patterns. Thus health education, supervision and orientation of service providers are urgently needed to address disparities that are existing in FVC.
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Affiliation(s)
- Kondwani Mmanga
- African Field Epidemiology Network, Ministry of Health, Expanded Programme on Immunization, P.O. Box 30377, Lilongwe, Malawi
| | - Tisungane E Mwenyenkulu
- Department of Clinical Sciences, Academy of Medical Sciences, Malawi University of Science and Technology, P.O. Box 5196, Limbe, Malawi
| | - Owen Nkoka
- Institute of Health and Wellbeing, University of Glasgow, Glasgow G12 8QQ, UK
| | - Peter A M Ntenda
- Malaria Alert Centre, College of Medicine, Kamuzu University of Health Sciences, Private Bag 360, Chichiri, Blantyre 3, Malawi
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13
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Ntenda PAM, Sixpence A, Mwenyenkulu TE, Mmanga K, Chirambo AC, Bauleni A, Nkoka O. Determinants of pentavalent and measles vaccination dropouts among children aged 12-23 months in The Gambia. BMC Public Health 2022; 22:520. [PMID: 35296298 PMCID: PMC8926885 DOI: 10.1186/s12889-022-12914-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Accepted: 03/02/2022] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Every year, vaccination averts about 3 million deaths from vaccine-preventable diseases (VPDs). However, despite that immunization coverage is increasing globally, many children in developing countries are still dropping out of vaccination. Thus, the present study aimed to identify determinants of vaccination dropouts among children aged 12-23 months in The Gambia. METHODS The study utilized cross-sectional data obtained from the Gambia Demographic and Health Survey 2019-20 (GDHS). The percentage of children aged 12-23 months who dropped out from pentavalent and measles vaccination were calculated by (1) subtracting the third dose of pentavalent vaccine from the first dose of Pentavalent vaccine, and (2) subtracting the first dose of measles vaccine from the first dose Pentavalent vaccine. Generalized Estimating Equation models (GEE) were constructed to examine the risk factors of pentavalent and measles vaccinations dropout. RESULTS Approximately 7.0% and 4.0% of the 1,302 children aged 12-23 months had dropped out of measles and pentavalent vaccination respectively. The multivariate analyses showed that when caregivers attended fewer than four antenatal care sessions, when children had no health card or whose card was lost, and resided in urban areas increased the odds of pentavalent dropout. On the other hand, when women gave birth in home and other places, when children had no health card, and being an urban areas dweller increased the odds of measles dropout. CONCLUSION Tailored public health interventions towards urban residence and health education for all women during ANC are hereby recommended.
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Affiliation(s)
- Peter A M Ntenda
- Malaria Alert Center (MAC), Kamuzu University of Health Sciences (KUHeS), Privative Bag 360, Chichiri, Blantyre, 3, Malawi.
| | - Alick Sixpence
- Malaria Alert Center (MAC), Kamuzu University of Health Sciences (KUHeS), Privative Bag 360, Chichiri, Blantyre, 3, Malawi
| | - Tisungane E Mwenyenkulu
- Academy of Medical Sciences (AMS), Malawi University of Science and Technology (MUST), P.O Box 5196, Limbe, Malawi
| | - Kondwani Mmanga
- African Field Epidemiology Network, Ministry of Health, Expanded Programme on Immunization, P.O. Box 30377, Lilongwe, Malawi
| | - Angeziwa C Chirambo
- Malawi-Liverpool-Wellcome (MLW) Trust Clinical Research Programme, P.O. Box 30096, Mahtma Ghandi Road, Chichiri, Blantyre, Malawi
| | - Andy Bauleni
- Malaria Alert Center (MAC), Kamuzu University of Health Sciences (KUHeS), Privative Bag 360, Chichiri, Blantyre, 3, Malawi
| | - Owen Nkoka
- Institute of Health & Wellbeing (IHW), University of Glasgow, 1st Floor 1055 Great Western Road, Glasgow, G12 0XH, Scotland, UK.
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14
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Sangaré S, Sangho O, Doumbia L, Marker H, Sarro YDS, Dolo H, Telly N, Zakour IB, Ndiaye HM, Sanogo M, Sangho F, Diarra NH, Sangho A, Traoré FB, Diallo B, Coulibaly CA, Ongoiba S, Diakité L, Doumbia S. Concordance of vaccination status and associated factors with incomplete vaccination: a household survey in the health district of Segou, Mali, 2019. Pan Afr Med J 2021; 40:102. [PMID: 34887977 PMCID: PMC8627150 DOI: 10.11604/pamj.2021.40.102.29976] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2021] [Accepted: 09/18/2021] [Indexed: 11/24/2022] Open
Abstract
Introduction the region of Segou recorded 36.8% of children were incompletely vaccinated in 2018. In 2019, the district of Segou was one of the districts with the lowest vaccination coverage in the region, with 85.1% coverage for the three doses of the pentavalent vaccine and 85.4% for the measles vaccine. This study was initiated to better understand this low vaccination coverage, in the absence of specific studies on vaccination coverage in the district of Segou. Methods a prospective cross-sectional study was conducted from May to August 2020 with 30 clusters. We performed Kappa coefficient, bivariate, and multiple logistic regression analysis. Results findings showed that 18.46% (101/547) [15.44-21.93] of children were incompletely vaccinated. Mothers correctly reported the vaccination status of their children in 67.30% of cases (Kappa coefficient). Uneducated (OR[IC95%]=2.13[1.30-3.50]), living in rural area (OR[IC95%]=2.07[1.23-3.47]), lack of knowledge of Expanded Program on Immunization (EPI) target diseases (OR[IC95%]=2.37[1.52-3.68]), lack of knowledge of vaccination schedule (OR[IC95%]=3.33[1.90-5.81]) and lack of knowledge of the importance of vaccination (OR[IC95%]=3.6[2.35-6.32]) were associated with incomplete vaccination. In multivariate analysis, uneducated (ORa[IC95%>]=1.68[1.004-2.810]) and lack of knowledge of the importance of vaccination were associated with incomplete vaccination (ORa[IC95%]=3.40[2.049-5.649]). Conclusion findings showed a good concordance of the vaccination status. Living in a rural area, no education, lack of the knowledge of EPI target diseases, lack of the knowledge of vaccination schedule and lack of knowledge of the importance of vaccination were associated with incomplete vaccination.
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Affiliation(s)
| | - Oumar Sangho
- Department of Education and Research of Biological and Medical Sciences, Faculty of Pharmacy, University of Sciences, Techniques and Technologies of Bamako, Bamako, Mali.,Department of Education and Research in Public Health and Specialties, Faculty of Medicine and Dentistry, University of Sciences, Techniques and Technologies of Bamako, Bamako, Mali
| | - Lancina Doumbia
- Department of Education and Research in Public Health and Specialties, Faculty of Medicine and Dentistry, University of Sciences, Techniques and Technologies of Bamako, Bamako, Mali
| | - Hannah Marker
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Yeya Dit Sadio Sarro
- Department of Education and Research in Public Health and Specialties, Faculty of Medicine and Dentistry, University of Sciences, Techniques and Technologies of Bamako, Bamako, Mali
| | - Housseini Dolo
- Department of Education and Research in Public Health and Specialties, Faculty of Medicine and Dentistry, University of Sciences, Techniques and Technologies of Bamako, Bamako, Mali
| | - Nouhoum Telly
- Department of Education and Research in Public Health and Specialties, Faculty of Medicine and Dentistry, University of Sciences, Techniques and Technologies of Bamako, Bamako, Mali
| | | | | | - Moussa Sanogo
- Regional Directorate of Health and Public Hygiene, Kidal, Mali
| | - Fanta Sangho
- Department of Education and Research of Biological and Medical Sciences, Faculty of Pharmacy, University of Sciences, Techniques and Technologies of Bamako, Bamako, Mali.,Department of Education and Research in Public Health and Specialties, Faculty of Medicine and Dentistry, University of Sciences, Techniques and Technologies of Bamako, Bamako, Mali
| | - Niélé Hawa Diarra
- Department of Education and Research in Public Health and Specialties, Faculty of Medicine and Dentistry, University of Sciences, Techniques and Technologies of Bamako, Bamako, Mali
| | - Aboubacar Sangho
- Department of Education and Research of Pharmaceutical Sciences, Faculty of Pharmacy, University of Sciences, Techniques and Technologies of Bamako, Bamako, Mali
| | | | - Baba Diallo
- University Hospital Center for Odonto-Stomatology (CHU-CNOS), Bamako, Mali
| | - Cheick Abou Coulibaly
- Department of Education and Research in Public Health and Specialties, Faculty of Medicine and Dentistry, University of Sciences, Techniques and Technologies of Bamako, Bamako, Mali
| | | | | | - Seydou Doumbia
- Department of Education and Research in Public Health and Specialties, Faculty of Medicine and Dentistry, University of Sciences, Techniques and Technologies of Bamako, Bamako, Mali
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15
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Kantner AC, van Wees SH, Olsson EMG, Ziaei S. Factors associated with measles vaccination status in children under the age of three years in a post-soviet context: a cross-sectional study using the DHS VII in Armenia. BMC Public Health 2021; 21:552. [PMID: 33743623 PMCID: PMC7981943 DOI: 10.1186/s12889-021-10583-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Accepted: 03/02/2021] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND The resurgence of measles globally and the increasing number of unvaccinated clusters call for studies exploring factors that influence measles vaccination uptake. Armenia is a middle-income post-Soviet country with an officially high vaccination coverage. However, concerns about vaccine safety are common. The purpose of this study was to measure the prevalence of measles vaccination coverage in children under three years of age and to identify factors that are associated with measles vaccination in Armenia by using nationally representative data. METHODS Cross-sectional analysis using self-report data from the most recent Armenian Demographic Health Survey (ADHS VII 2015/16) was conducted. Among 588 eligible women with a last-born child aged 12-35 months, 63 women were excluded due to unknown status of measles vaccination, resulting in 525 women included in the final analyses. We used logistic regression models in order to identify factors associated with vaccination status in the final sample. Complex sample analyses were used to account for the study design. RESULTS In the studied population 79.6% of the children were vaccinated against measles. After adjusting for potential confounders, regression models showed that the increasing age of the child (AOR 1.07, 95% CI: 1.03-1.12), secondary education of the mothers (AOR 3.38, 95% CI: 1.17-9.76) and attendance at postnatal check-up within two months after birth (AOR 2.71, 95% CI: 1.17-6.30) were significantly associated with the vaccination status of the child. CONCLUSIONS The measles vaccination coverage among the children was lower than the recommended percentage. The study confirmed the importance of maternal education and attending postnatal care visits. However, the study also showed that there might be potential risks for future measles outbreaks because of delayed vaccinations and a large group of children with an unknown vaccination status.
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Affiliation(s)
- Annabell C Kantner
- Department of Women's and Children's Health, Uppsala University, Akademiska sjukhuset, SE-751 85, Uppsala, Sweden
| | - Sibylle Herzig van Wees
- Department of Women's and Children's Health, Uppsala University, Akademiska sjukhuset, SE-751 85, Uppsala, Sweden
- Karolinska Institutet, Department of Global Public Health, K9 Global folkhälsa, K9 GH Stålsby Lundborg Hanson, SE-171 77, Stockholm, Sweden
| | - Erik M G Olsson
- Clinical Psychology in Healthcare, Department of Women's and Children's Health, Uppsala University, Akademiska sjukhuset, SE-751 85, Uppsala, Sweden
| | - Shirin Ziaei
- Department of Women's and Children's Health, Uppsala University, Akademiska sjukhuset, SE-751 85, Uppsala, Sweden.
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16
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Huang Y, Danovaro-Holliday MC. Characterization of immunization secondary analyses using demographic and health surveys (DHS) and multiple indicator cluster surveys (MICS), 2006-2018. BMC Public Health 2021; 21:351. [PMID: 33581740 PMCID: PMC7880859 DOI: 10.1186/s12889-021-10364-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2020] [Accepted: 01/31/2021] [Indexed: 11/02/2022] Open
Abstract
BACKGROUND Infant immunization coverage worldwide has plateaued at about 85%. Using existing survey data to conduct analyses beyond estimating coverage may help immunization programmes better tailor strategies to reach un- and under-immunized children. The Demographic and Health Survey (DHS) and the Multiple Indicators Cluster Survey (MICS), routinely conducted in low and middle-income countries (LMICs), collect immunization data, yet vaccination coverage is often the only indicator reported and used. We conducted a review of published immunization-related analyses to characterize and quantify immunization secondary analyses done using DHS and MICS databases. METHODS We conducted a systematic search of the literature, of immunization-related secondary analyses from DHS or MICS published between 2006 and August 2018. We searched 15 electronic databases without language restrictions. For the articles included, relevant information was extracted and analyzed to summarize the characteristics of immunization-related secondary analyses. Results are presented following the PRISMA guidelines. RESULTS Among 1411 papers identified, 115 met our eligibility criteria; additionally, one article was supplemented by the Pan American Health Organization. The majority were published since 2012 (77.6%), and most (68.9%) had a first or corresponding author affiliated with institutions in high-income countries (as opposed to LMICs where these surveys are conducted). The median delay between survey implementation and publication of the secondary analysis was 5.4 years, with papers with authors affiliated to institutions in LMIC having a longer median publication delay (p < 0.001). Over 80% of the published analyses looked at factors associated with a specific vaccine or with full immunization. Quality proxies, such as reporting percent of immunization data from cards vs recall; occurrence and handling of missing data; whether survey analyses were weighted; and listing of potential biases or limitations of the original survey or analyses, were infrequently mentioned. CONCLUSION Our review suggests that more needs to be done to increase the increase the utilization of existing DHS and MICS datasets and improve the quality of the analyses to inform immunization programmes. This would include increasing the proportion of analyses done in LMICs, reducing the time lag between survey implementation and publication of additional analyses, and including more qualitative information about the survey in the publications to better interpret the results.
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Affiliation(s)
- Yue Huang
- Department of Immunization, Immunization, Analytics and Insights (IAI), Vaccines and Biologicals (IVB), World Health Organization (WHO), 1211, Geneva, Switzerland
- Present affiliation: State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, National Institute of Diagnostics and Vaccine Development in Infectious Diseases, Strait Collaborative Innovation Center of Biomedicine and Pharmaceutics, School of Public Health, Xiamen University, Xiamen, 361102, China
| | - M Carolina Danovaro-Holliday
- Department of Immunization, Immunization, Analytics and Insights (IAI), Vaccines and Biologicals (IVB), World Health Organization (WHO), 1211, Geneva, Switzerland.
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17
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Ntenda PAM, Mussa R, Gowelo S, Sixpence A, Bauleni A, Simbeye A, Matengeni A, Matola E, Banda G, Stanley CC, Banda S, Nkoka O. Determinants of self-reported correct knowledge about tuberculosis transmission among men and women in Malawi: evidence from a nationwide household survey. BMC Infect Dis 2021; 21:132. [PMID: 33516174 PMCID: PMC7847566 DOI: 10.1186/s12879-021-05836-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Accepted: 01/24/2021] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Correct knowledge about transmission of tuberculosis (TB) can influence better health-seeking behaviors, and in turn, it can aid TB prevention in society. Therefore, this study aimed to examine the prevalence and predictors of self-reported correct knowledge about TB transmission among adults in Malawi. METHODS We conducted a secondary analysis of the data obtained from the Malawi Demographic and Health Survey, 2015/16 (MDHS 2015/16). Questions regarding self-reported TB transmission were computed to evaluate the correct knowledge about TB transmission. The factors associated with the correct knowledge about Tb were assessed using univariate and multivariable logistic regression. RESULTS Overall, the prevalence of correct knowledge about TB transmission in the general population of Malawian adults was 61.5%. Specifically, the prevalence of correct knowledge about TB transmission was 63.6 and 60.8% in men and women, respectively. Those aged 35-44 years, having secondary or high education, belonging to the richest household, being exposed to mass media, being in professional/technical/managerial, having knowledge that "TB can be cured", and those living in urban areas were significantly associated with correct knowledge about TB transmission. CONCLUSIONS The findings of this study show that if appropriate strategies for TB communication and education to address the rural masses, young individuals, poor individuals, and individuals in the agriculture sector are put it place, can enhance TB prevention in Malawi.
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Affiliation(s)
- Peter A. M. Ntenda
- Malaria Alert Centre (MAC), College of Medicine (CoM), University of Malawi (UNIMA), Private Bag 360, Chichiri, Blantyre 3, Malawi
| | - Razak Mussa
- Centre for Reproduction Health (CRH), College of Medicine (CoM), University of Malawi (UNIMA), Private Bag 360, Chichiri, Blantyre 3, Malawi
| | - Steve Gowelo
- Malaria Alert Centre (MAC), College of Medicine (CoM), University of Malawi (UNIMA), Private Bag 360, Chichiri, Blantyre 3, Malawi
| | - Alick Sixpence
- Malaria Alert Centre (MAC), College of Medicine (CoM), University of Malawi (UNIMA), Private Bag 360, Chichiri, Blantyre 3, Malawi
| | - Andy Bauleni
- Malaria Alert Centre (MAC), College of Medicine (CoM), University of Malawi (UNIMA), Private Bag 360, Chichiri, Blantyre 3, Malawi
| | - Atusayi Simbeye
- Malaria Alert Centre (MAC), College of Medicine (CoM), University of Malawi (UNIMA), Private Bag 360, Chichiri, Blantyre 3, Malawi
| | - Alfred Matengeni
- Malaria Alert Centre (MAC), College of Medicine (CoM), University of Malawi (UNIMA), Private Bag 360, Chichiri, Blantyre 3, Malawi
| | - Ernest Matola
- Malaria Alert Centre (MAC), College of Medicine (CoM), University of Malawi (UNIMA), Private Bag 360, Chichiri, Blantyre 3, Malawi
| | - Godfrey Banda
- Malaria Alert Centre (MAC), College of Medicine (CoM), University of Malawi (UNIMA), Private Bag 360, Chichiri, Blantyre 3, Malawi
| | - Christopher C. Stanley
- Malaria Alert Centre (MAC), College of Medicine (CoM), University of Malawi (UNIMA), Private Bag 360, Chichiri, Blantyre 3, Malawi
| | - Susan Banda
- School of Public Health and Family Medicine (SPHFM), College of Medicine (CoM), University of Malawi (UNIMA), Private Bag 360, Chichiri, Blantyre 3, Malawi
| | - Owen Nkoka
- School of Public Health (SPH), Taipei Medical University (TMU), No. 250, Wuxing Street, Xinyi District, Taipei City, 110 Taiwan
- Institute for Health Research and Communication (IHRC), P.O Box 1958, Lilongwe, Malawi
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
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18
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Shenton LM, Wagner AL, Ji M, Carlson BF, Boulton ML. Vaccination assessments using the Demographic and Health Survey, 2005-2018: a scoping review. BMJ Open 2020; 10:e039693. [PMID: 33268412 PMCID: PMC7713201 DOI: 10.1136/bmjopen-2020-039693] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Revised: 11/02/2020] [Accepted: 11/17/2020] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVE To characterise studies which have used Demographic and Health Survey (DHS) datasets to evaluate vaccination status. DESIGN Scoping review. DATA SOURCES Electronic databases including PubMed, EBSCOhost and POPLINE, from 2005 to 2018. STUDY SELECTION All English studies with vaccination status as the outcome and the use of DHS data. DATA EXTRACTION Studies were selected using a predetermined list of eligibility criteria and data were extracted independently by two authors. Data related to the study population, the outcome of interest (vaccination) and commonly seen predictors were extracted. RESULTS A total of 125 articles were identified for inclusion in the review. The number of countries covered by individual studies varied widely (1-86), with the most published papers using data from India, Nigeria, Pakistan and Ethiopia. Many different definitions of full vaccination were used although the majority used a traditional schedule recommended in the WHO's Expanded Programme on Immunisation. We found studies analysed a wide variety of predictors, but the most common were maternal education, wealth, urbanicity and child's sex. Most commonly reported predictors had consistent relationships with the vaccination outcome, outside of sibling composition. CONCLUSIONS Researchers make frequent use of the DHS dataset to describe vaccination patterns within one or more countries. A clearer idea of past use of DHS can inform the development of more rigorous studies in the future. Researchers should carefully consider whether a variable needs to be included in the multivariable model, or if there are mediating relationships across predictor variables.
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Affiliation(s)
- Luke M Shenton
- Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, Michigan, USA
| | - Abram L Wagner
- Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, Michigan, USA
| | - Mengdi Ji
- Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, Michigan, USA
| | - Bradley F Carlson
- Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, Michigan, USA
| | - Matthew L Boulton
- Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, Michigan, USA
- Department of Internal Medicine, Division of Infectious Disease, University of Michigan Medical School, Ann Arbor, Michigan, USA
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19
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Ntenda PAM. Factors associated with non- and under-vaccination among children aged 12-23 months in Malawi. A multinomial analysis of the population-based sample. Pediatr Neonatol 2019; 60:623-633. [PMID: 31040068 DOI: 10.1016/j.pedneo.2019.03.005] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2018] [Revised: 11/15/2018] [Accepted: 03/14/2019] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND Non- and under-vaccination among children in Malawi have received little attention. Between 2010 and 2016, the proportion of children who received full immunization before their first birthday dropped from 81% to 76% in Malawi. This signifies that a certain fraction of children are either non-vaccinated or under-vaccinated. Thus, the present study attempted to examine the predictors of non- and under-vaccination among children aged 12-23 months in Malawi. METHODS Cross-sectional data obtained from the Malawi Demographic and Health Survey 2015-16 were utilized. The percentage of children aged 12-23 months who were non-vaccinated, under-vaccinated, or fully vaccinated with 1 dose of Bacillus Calmette-Guérin, 3 doses of oral polio vaccine, 3 doses of pentavalent, 2 doses of rotavirus vaccine, 3 doses of pneumococcal vaccine and 1 dose of measles-containing vaccine were calculated. The odds of being non-vaccinated and under-vaccinated compared to full vaccination relative to various sociodemographic factors were assessed using a multivariable multinomial logistic regression with logit link function which accounted for survey design. RESULTS Of 3111 children aged 12-23 months, 72% were fully vaccinated, 26% were under-vaccinated, and about 2% were non-vaccinated. The multinomial logistic regression showed that children from the poorest households, and children who did not have postnatal care within two months had increased odds of being under-vaccinated. On the other hand, children who had no health card or whose card was lost had increased odds of being both non- and under-vaccinated. Additionally, children from the northern region and who resided in households with either none or one under-five child had reduced odds of being non-vaccinated and under-vaccinated, respectively. CONCLUSIONS Women from the poorest households and those who are not attending PNC should be targeted when designing interventions that aim at improving childhood vaccination in order to reduce the barriers they face in accessing vaccination services.
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Affiliation(s)
- Peter Austin Morton Ntenda
- School of Public Health, Taipei Medical University, College of Public Health, No. 250, Wu-Hsing St, Taipei City 11031, Taiwan.
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20
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Ntenda PAM, Nkoka O, Nana AW, Majoni P, Mhone TG, Tizifa T, Mwenyenkulu ET, Kazambwe JF, Putthanachote N, Motsa MPS. Factors associated with completion of childhood immunization in Malawi: a multilevel analysis of the 2015-16 Malawi demographic and health survey. Trans R Soc Trop Med Hyg 2019; 113:534-544. [PMID: 31034078 DOI: 10.1093/trstmh/trz029] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2018] [Revised: 03/15/2019] [Accepted: 04/02/2019] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Between 2010 and 2015, the percentage of children 12-23 months of age who received full immunization in Malawi decreased from 81% to 76%, prompting us to investigate the factors associated with completion of childhood immunization in Malawi. METHODS Using data from the 2015-16 Malawi Demographic and Health Survey, generalized linear mixed models were applied on 3145 children 12-23 months of age nested within 850 communities. Complete immunization was defined as the child having received a Bacillus Calmette-Guerin, three doses of pentavalent vaccine, four doses of oral polio vaccine, three doses of pneumococcal vaccine, two doses of rotavirus vaccine and one dose of measles vaccine before their first birthday. RESULTS Adjusted multilevel regression showed that children born to mothers with either none or one antenatal care visit (adjusted odds ratio [aOR] 0.56 [95% confidence interval {CI} 0.32 to 0.93]) and whose mothers had no card or no longer had a vaccination card (aOR 0.06 [95% CI 0.04 to 0.07]) were less likely to receive complete immunization. In addition, children from the poorest households (aOR 0.60 [95% CI 0.40 to 0.92]) and who resided in communities with a medium (aOR 0.73 [95% CI 0.53 to 0.98]) or high percentage (aOR 0.73 [95% CI 0.53 to 0.99]) of households that perceived the distance to the nearest health facility as a big problem had reduced odds of achieving complete immunization. Furthermore, the findings showed evidence of clustering effects of childhood complete immunization at the community level. CONCLUSIONS Our findings show that a series of sociodemographic, health and contextual factors are associated with the completion of childhood vaccination. Therefore interventions that aim at increasing the completion of childhood immunization in Malawi should not only address individual needs, but should also consider contextual factors and the communities addressed in this study.
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Affiliation(s)
- Peter Austin Morton Ntenda
- School of Public Health, College of Public Health, Taipei Medical University, No. 250, Wuhsing St, Taipei City 110, Taiwan
| | - Owen Nkoka
- School of Public Health, College of Public Health, Taipei Medical University, No. 250, Wuhsing St, Taipei City 110, Taiwan
| | | | - Precious Majoni
- Department of Computer Science, Chancellor College, University of Malawi, Zomba, Malawi
| | - Thomas Gabriel Mhone
- Medical Laboratory Science and Biotechnology, College of Health Sciences, Kaohsiung Medical University, No. 100, Shiquan 1st Road, Sanmin District, Kaohsiung City, Taiwan
| | - Tinashe Tizifa
- Training and Research Unit of Excellence (TRUE), School of Public Health and Family Medicine, College of Medicine, University of Malawi, Private Bag 360, Chichiri, Blantyre 3, Malawi
| | - Edward Tisungane Mwenyenkulu
- School of International Education, Southern Medical University, No. 1023, South Shatai Road, Guangzhou, Guangdong, People's Republic of China
| | - Jane Flora Kazambwe
- NBS, House Corner Chipembere Highway & Johnstone Roads Ginnery Corner Blantyre, Chichiri, Blantyre, Malawi
| | - Nuntiput Putthanachote
- Roi Et Hospital, 111 Ronnachaicharnyut Soi 13, Tambon Nai Mueang, Amphoe Mueang Roi Et, Roi Et Province, Thailand
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21
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Women's status within the household as a determinant of institutional delivery in Malawi. Midwifery 2019; 74:44-56. [DOI: 10.1016/j.midw.2019.03.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2018] [Revised: 03/02/2019] [Accepted: 03/17/2019] [Indexed: 11/20/2022]
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22
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Nkoka O, Chuang TW, Chen YH. Multilevel Analysis of Factors Associated with Treatment-Seeking Behaviors among Caregivers with Febrile Children in Malawi. Am J Trop Med Hyg 2019; 100:1454-1465. [PMID: 30994089 PMCID: PMC6553897 DOI: 10.4269/ajtmh.18-0900] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2018] [Accepted: 03/04/2019] [Indexed: 12/19/2022] Open
Abstract
Early diagnosis and treatment of childhood fever, an important sign of potentially serious infections such as malaria, is essential for controlling disease progression, and ultimately, preventing deaths. This study examined individual- and community-level factors associated with treatment-seeking behaviors and promptness in these behaviors among caregivers of febrile under-five children in Malawi. The 2015-2016 Malawi Demographic Health Survey was used to analyze a nationally representative sample of 4,133 under-five children who had fever within 2 weeks before the survey. A multilevel logistic regression model was used to examine the association between individual- and community-level factors and treatment-seeking behaviors. Approximately 67.3% of the caregivers reported seeking treatment for their febrile child, whereas only 46.3% reported promptly seeking treatment. Children from communities with moderate and high percentages of educated caregivers were more likely to be taken for treatment (adjusted odds ratio [aOR] = 1.26, 95% CI = 1.01-1.58 and aOR = 1.31, 95% CI = 1.02-1.70, respectively) than those from communities with a low percentage of educated caregivers. Children from communities with moderate and high percentages of caregivers complaining about the distance to a health facility were less likely to be taken for treatment (aOR = 0.74, 95% CI = 0.58-0.96 and aOR = 0.67, 95% CI = 0.51-0.88, respectively). At the individual level, having a cough in the last 2 weeks, region, religion, and having better health behaviors in other health dimensions were associated with fever treatment-seeking behaviors among Malawian caregivers. Programs aimed at improving treatment-seeking behaviors should consider these factors and the regional variations observed in this study.
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Affiliation(s)
- Owen Nkoka
- School of Public Health, College of Public Health, Taipei Medical University, Taipei, Taiwan
| | - Ting-Wu Chuang
- Department of Molecular Parasitology and Tropical Diseases, School of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Yi-Hua Chen
- School of Public Health, College of Public Health, Taipei Medical University, Taipei, Taiwan
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23
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Tesfaye TD, Temesgen WA, Kasa AS. Vaccination coverage and associated factors among children aged 12 - 23 months in Northwest Ethiopia. Hum Vaccin Immunother 2018; 14:2348-2354. [PMID: 30118398 DOI: 10.1080/21645515.2018.1502528] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
Abstract
BACKGROUND Full vaccination coverage has been identified as the foundation for the prevention of morbidity and mortality from the childhood illnesses. However, a significant number of children do not get recommended vaccinations. The problem is much worse in low-income countries with varied figures and evidence gap. Therefore, this study was conducted to assess vaccination coverage and its predicting factors in one of the low-income country Ethiopia, particularly in northwest Ethiopia. METHODS A community-based cross-sectional study was conducted in Northwest Ethiopia in 2016 on 846 children aged 12 to 23 completed months. Cluster sampling method was used. Mothers or caretakers were interviewed. SPSS version 20 was used for analysis. RESULTS In Northwest Ethiopia, full-vaccination coverage for the children aged 12-23 months was 58.4%, while 17% and 24.6% were partially vaccinated and not vaccinated at all respectively. Child full vaccination status has a positive association with urban residence, having antenatal care visit, institutional delivery for the study child, vaccination site at health institutions, mothers who knows vaccination schedule of a catchment area, and mothers taking a child for vaccination even if the child is sick. However, mothers who ever-married and their travel time to the nearest vaccination site ≤ 30 minutes were negatively associated with child full-vaccination status. CONCLUSION Vaccination coverage in Northwest Ethiopia, East Gojam, is better than the national coverage. Yet, it is far below the plan. Encouraging antenatal care utilization, delivery at health institutions, and providing adequate information on child vaccination (including when to start, return and finish) for mothers would increase full-vaccination coverage.
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Affiliation(s)
- Tadesse Dagget Tesfaye
- a College of Medicine and Health Sciences, Department of Adult Health Nursing , Bahir Dar University , Bahir Dar , Ethiopia
| | - Worku Animaw Temesgen
- a College of Medicine and Health Sciences, Department of Adult Health Nursing , Bahir Dar University , Bahir Dar , Ethiopia
| | - Ayele Semachew Kasa
- a College of Medicine and Health Sciences, Department of Adult Health Nursing , Bahir Dar University , Bahir Dar , Ethiopia
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Ekouevi DK, Gbeasor-Komlanvi FA, Yaya I, Zida-Compaore WI, Boko A, Sewu E, Lacle A, Ndibu N, Toke Y, Landoh DE. Incomplete immunization among children aged 12-23 months in Togo: a multilevel analysis of individual and contextual factors. BMC Public Health 2018; 18:952. [PMID: 30071824 PMCID: PMC6090752 DOI: 10.1186/s12889-018-5881-z] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2018] [Accepted: 07/24/2018] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND Inadequate immunization coverage remains a public health problem in Africa. In Togo, only 62% of children under one year of age were fully immunized in 2013. This study aimed to estimate the immunization coverage among children aged 12-23 months, and to identify factors associated with incomplete immunization status in Togo. METHODS A cross-sectional survey was conducted in the six health regions of Togo. Children aged 12 to 23 months who were living with one of their parents or guardians from selected households were recruited for the study. Data was collected using a pre-tested questionnaire through face-to-face interviews. Multilevel logistic regression analyses were performed to assess factors associated with incomplete immunization coverage. RESULTS A total of 1261 households were included. Respondents were predominantly women (91.9%) and 22.8% had secondary or higher education level. Immunization cards were available for 85.3% of children. Complete immunization coverage was 72.3%, 95% confidence interval (CI): [69.7-74.8]). After controlling for both individual and contextual level variables, children whose mothers attended secondary school or above were 33% (adjusted Odds Ratio (aOR) = 0.67, CI [0.47-0.94]) less likely to have an incomplete immunization coverage compared to those with no education. The likelihood of incomplete immunization in children decreased with the increase in household's income (aOR = 0.73, 95% CI [0.58-0.93]), children who did not have an immunization card (aOR = 13.41, 95% CI [9.19-19.57]) and those whose parents did not know that children immunization was free of charge (aOR = 1.82, 95% CI [1.00-3.30]) were more likely to have an incomplete immunization. Finally, children whose parents had to walk half an hour to one hour to reach a healthcare center were 57% (aOR = 1.57, 95% CI [1.15-2.13]) more likely to have an incomplete immunization coverage than those whose parents had to walk less than half an hour. CONCLUSION The goal of 90% coverage at the national level has not been achieved in 2017. Innovative strategies such as using electronic cards and strengthening sensitization activities must be initiated in order to attain a complete immunization coverage in Togo.
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Affiliation(s)
- Didier K. Ekouevi
- Département de Santé Publique, Université de Lomé, Faculté des Sciences de la Santé, Lomé, Togo
- Centre Africain de Recherche en Epidémiologie et en Santé Publique (CARESP), Lomé, Togo
- ISPED, Université de Bordeaux & Centre INSERM U1219 - Bordeaux Population Health, Bordeaux, France
| | - Fifonsi A. Gbeasor-Komlanvi
- Département de Santé Publique, Université de Lomé, Faculté des Sciences de la Santé, Lomé, Togo
- Centre Africain de Recherche en Epidémiologie et en Santé Publique (CARESP), Lomé, Togo
| | - Issifou Yaya
- Sciences Economiques & Sociales de la Santé & Traitement de l’Information Médicale (SESSTIM), Aix Marseille Université, Marseille, France
| | | | - Amevegbé Boko
- Programme Elargi de Vaccination, Ministère de la Santé et de la Protection Sociale, Lomé, Togo
| | - Essèboe Sewu
- Centre Africain de Recherche en Epidémiologie et en Santé Publique (CARESP), Lomé, Togo
| | - Anani Lacle
- Programme Elargi de Vaccination, Ministère de la Santé et de la Protection Sociale, Lomé, Togo
| | | | - Yaovi Toke
- UNICEF, country office of Togo, Lomé, Togo
| | - Dadja E. Landoh
- World Health Organization, country office of Togo, Lomé, Togo
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25
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Ntenda PAM, Chuang KY, Tiruneh FN, Chuang YC. Multilevel Analysis of the Effects of Individual- and Community-Level Factors on Childhood Anemia, Severe Anemia, and Hemoglobin Concentration in Malawi. J Trop Pediatr 2018; 64:267-278. [PMID: 28977637 DOI: 10.1093/tropej/fmx059] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND The purpose of this article was to examine individual- and community-level factors associated with childhood anemia, severe anemia, and hemoglobin (Hb) concentration in Malawi. METHODS Using data from the 2010 Malawi demographic and health survey (MDHS), the multilevel regression models were constructed to analyze 2597 children aged 6-59 months living in 849 communities. RESULTS The results showed that both childhood anemia and severe anemia were negatively associated with child's age, no fever in the previous 2 weeks and height-for-age, and positively associated with residing in poor household. Childhood anemia was negatively associated with community female education. Child's age, no fever in the previous 2 weeks and maternal Hb levels were positively associated with child Hb concentration, while residing in poorest households was negatively associated with children's Hb concentration. CONCLUSION Comprehensive public health strategies aimed at reducing childhood anemia need to focus more on the significant characteristics addressed in this study.
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Affiliation(s)
| | - Kun-Yang Chuang
- School of Public Health, Taipei Medical University, No. 250, Wu-Hsing St, Taipei City, Taiwan 110
| | - Fentanesh Nibret Tiruneh
- School of Public Health, Taipei Medical University, No. 250, Wu-Hsing St, Taipei City, Taiwan 110
| | - Ying-Chih Chuang
- School of Public Health, Taipei Medical University, No. 250, Wu-Hsing St, Taipei City, Taiwan 110
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