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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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Kalbarczyk A, Brownlee N, Katz E. Of Money and Men: A Scoping Review to Map Gender Barriers to Immunization Coverage in Low- and Middle-Income Countries. Vaccines (Basel) 2024; 12:625. [PMID: 38932354 PMCID: PMC11209140 DOI: 10.3390/vaccines12060625] [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: 04/29/2024] [Revised: 05/22/2024] [Accepted: 06/04/2024] [Indexed: 06/28/2024] Open
Abstract
Among the multiple factors impeding equitable childhood immunization coverage in low- and middle-income countries (LMICs), gender barriers stand out as perhaps the most universal. Despite increasing recognition of the importance of gender considerations in immunization programming, there has not yet been a systematic assessment of the evidence on gender barriers to immunization. We conducted a scoping review to fill that gap, identifying 92 articles that described gender barriers to immunization. Studies documented a range of gender influencers across 43 countries in Africa and South Asia. The barrier to immunization coverage most frequently cited in the literature is women's lack of autonomous decision-making. Access to immunization is significantly impacted by women's time poverty; direct costs are also a barrier, particularly when female caregivers rely on family members to cover costs. Challenges with clinic readiness compound female caregiver's time constraints. Some of the most important gender barriers lie outside of the usual purview of immunization programming but other barriers can be addressed with adaptations to vaccination programming. We can only know how important these barriers are with more research that measures the impact of programming on gender barriers to immunization coverage.
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Affiliation(s)
- Anna Kalbarczyk
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA
| | - Natasha Brownlee
- Global Center for Gender Equality, Washington, DC 20036, USA; (N.B.); (E.K.)
| | - Elizabeth Katz
- Global Center for Gender Equality, Washington, DC 20036, USA; (N.B.); (E.K.)
- Department of Economics, University of San Francisco, San Francisco, CA 94117, USA
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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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Farrenkopf BA, Zhou X, Shet A, Olayinka F, Carr K, Patenaude B, Chido-Amajuoyi OG, Wonodi C. Understanding household-level risk factors for zero dose immunization in 82 low- and middle-income countries. PLoS One 2023; 18:e0287459. [PMID: 38060516 PMCID: PMC10703331 DOI: 10.1371/journal.pone.0287459] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Accepted: 06/06/2023] [Indexed: 12/18/2023] Open
Abstract
INTRODUCTION In 2021, an estimated 18 million children did not receive a single dose of routine vaccinations and constitute the population known as zero dose children. There is growing momentum and investment in reaching zero dose children and addressing the gross inequity in the reach of immunization services. To effectively do so, there is an urgent need to characterize more deeply the population of zero dose children and the barriers they face in accessing routine immunization services. METHODS We utilized the most recent DHS and MICS data spanning 2011 to 2020 from low, lower-middle, and upper-middle income countries. Zero dose status was defined as children aged 12-23 months who had not received any doses of BCG, DTP-containing, polio, and measles-containing vaccines. We estimated the prevalence of zero-dose children in the entire study sample, by country income level, and by region, and characterized the zero dose population by household-level factors. Multivariate logistic regressions were used to determine the household-level sociodemographic and health care access factors associated with zero dose immunization status. To pool multicountry data, we adjusted the original survey weights according to the country's population of children 12-23 months of age. To contextualize our findings, we utilized United Nations Population Division birth cohort data to estimate the study population as a proportion of the global and country income group populations. RESULTS We included a total of 82 countries in our univariate analyses and 68 countries in our multivariate model. Overall, 7.5% of the study population were zero dose children. More than half (51.9%) of this population was concentrated in African countries. Zero dose children were predominantly situated in rural areas (75.8%) and in households in the lowest two wealth quintiles (62.7%) and were born to mothers who completed fewer than four antenatal care (ANC) visits (66.5%) and had home births (58.5%). Yet, surprisingly, a considerable proportion of zero dose children's mothers did receive appropriate care during pregnancy (33.5% of zero dose children have mothers who received at least 4 ANC visits). When controlled for other factors, children had three times the odds (OR = 3.00, 95% CI: 2.72, 3.30) of being zero dose if their mother had not received any tetanus injections, 2.46 times the odds (95% CI: 2.21, 2.74) of being zero dose if their mother had not received any ANC visits, and had nearly twice the odds (OR = 1.87, 95% CI: 1.70, 2.05) of being zero dose if their mother had a home delivery, compared to children of mothers who received at least 2 tetanus injections, received at least 4 ANC visits, and had a facility delivery, respectively. DISCUSSION A lack of access to maternal health care was a strong risk factor of zero dose status and highlights important opportunities to improve the quality and integration of maternal and child health programs. Additionally, because a substantial proportion of zero dose children and their mothers do receive appropriate care, approaches to reach zero dose children should incorporate mitigating missed opportunities for vaccination.
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Affiliation(s)
- Brooke Amara Farrenkopf
- International Vaccine Access Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - Xiaobin Zhou
- International Vaccine Access Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - Anita Shet
- International Vaccine Access Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - Folake Olayinka
- United States Department of International Development, Immunization Team, District of Columbia, Washington, DC, United States of America
| | - Kelly Carr
- International Vaccine Access Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - Bryan Patenaude
- International Vaccine Access Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - Onyema Greg Chido-Amajuoyi
- Department of Epidemiology, The University of Texas MD Anderson Cancer Center, Houston, Texas, United States of America
| | - Chizoba Wonodi
- International Vaccine Access Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
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Frozanfar MK, Hamajima N, Fayaz SH, Rahimzad AD, Stanekzai H, Inthaphatha S, Nishino K, Yamamoto E. Factors associated with pentavalent vaccine coverage among 12-23-month-old children in Afghanistan: A cross-sectional study. PLoS One 2023; 18:e0289744. [PMID: 37552707 PMCID: PMC10409276 DOI: 10.1371/journal.pone.0289744] [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: 11/01/2022] [Accepted: 07/25/2023] [Indexed: 08/10/2023] Open
Abstract
INTRODUCTION This study aimed to identify the factors associated with the coverage of the third dose of pentavalent vaccine (Penta3) among children aged 12-23 months in Afghanistan. METHODS The data of 3,040 children aged 12-23 months were taken from the Afghanistan Health Survey 2018, including characteristics of the children and their households, household heads, and mothers/primary care givers. Adjusted odds ratios (AORs) and 95% confidence intervals (CIs) were estimated using a logistic model. Multivariable stepwise logistic regression analysis with forward-selection (Model 1) and backward-selection (Model 2) was performed using variables that showed significant differences by bivariate analysis. RESULTS The coverage of Penta3 among 12-23-month-old children was 82.3%. Factors associated with Penta3 coverage in the two models of multivariable analysis were 18-23 months old compared to 12-17 months old; having no diarrhea in the last two weeks compared to having diarrhea; no bipedal edema compared to having edema; taking vitamin A supplement; 1-2 children under five years in a household compared to three or more; distance from residence to the nearest health facility ≤2 hours on foot; having a radio; having a TV; educated heads of households; non-smoking of heads of households; and literacy of mothers/primary caregivers. CONCLUSIONS Penta3 coverage among 12-23-month-old children improved but was still lower than the target. Primary education should be provided to all children throughout the country. TV and radio are useful tools for providing health information. Mobile outreach programs and the establishment of new health facilities should be promoted to improve access to health service for all people in Afghanistan.
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Affiliation(s)
- Muhammad Kamel Frozanfar
- Department of Healthcare Administration, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
- Healthcare-Associated Infections and Antimicrobial Resistance Program, Office of Epidemiology, Virginia Department of Health, Richmond, Virginia, United States of America
| | - Nobuyuki Hamajima
- Department of Healthcare Administration, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
| | - Said Hafizullah Fayaz
- Department of Healthcare Administration, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
- National Heart, Lung and Blood Institute, National Institute of Health, Bethesda, Maryland, United States of America
| | - Abdullah Darman Rahimzad
- Department of Ear, Nose and Throat, Balkh University Faculty of Medicine, Mazar-i-Sharif, Balkh, Afghanistan
| | | | - Souphalak Inthaphatha
- Department of Healthcare Administration, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
| | - Kimihiro Nishino
- Department of Healthcare Administration, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
| | - Eiko Yamamoto
- Department of Healthcare Administration, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan
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Kachoria AG, Mubarak MY, Singh AK, Somers R, Shah S, Wagner AL. The association of religion with maternal and child health outcomes in South Asian countries. PLoS One 2022; 17:e0271165. [PMID: 35819940 PMCID: PMC9275688 DOI: 10.1371/journal.pone.0271165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Accepted: 06/24/2022] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE Theological beliefs play an important role in cultural norms and could impact women's prenatal and postpartum decisions in South Asia, which has a high burden of disease in children and pregnant women. The aim of this study is to identify any associations religion may have in affecting a woman's decision-making ability, and how that in turn affects maternal and child health, at a group level in multiple South Asian countries. STUDY DESIGN Cross-sectional study utilizing secondary data analysis. METHODS We used Demographic and Health Surveys (DHS) between 2014 and 2018 in Afghanistan, Bangladesh, India, Maldives, Myanmar, Nepal, and Pakistan. Not every country's survey asked about religion, so we imputed these results based on Census data. We assessed maternal and child health through a composite coverage index (CCI), which accounts for family planning, attendance of a skilled attendant at birth, antenatal care, BCG vaccinations, 3 doses of diphtheria-tetanus-pertussis vaccine, measles vaccine, oral rehydration therapy, and seeking care if the child has pneumonia. The relationship between religion, women's empowerment, and CCI was assessed through linear regression models. RESULTS The sample included 57,972 mothers who had children aged 12-23 months. CCI is observed to be affected by family income, in addition to religion and country. CCI was higher in Hindus (2.8%, 95% CI: 2.4%, 3.1%) and Buddhists (2.0%, 95% CI: 1.2%, 2.9%) than Muslims. Mother's age, education, income, decision-making autonomy, and attitude towards beatings were all related to CCI. In a model stratified by religion, age, education, and income were significant predictors of CCI for both Muslims and non-Muslims, but were more impactful among Muslims. CONCLUSION Though multiple imputation had to be used to fill in gaps in religion data, this study demonstrates that maternal and child health outcomes continue to be a concern in South Asia, especially for Muslim women. Given the importance of religious beliefs, utilizing a simple indicator, such as the CCI could be helpful for monitoring these outcomes and provides a tangible first step for communities to address gaps in care resulting from disparities in maternal empowerment.
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Affiliation(s)
- Aparna G. Kachoria
- Department of Maternal and Child Health, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina, United States of America
| | | | - Awnish K. Singh
- National Technical Advisory Group on Immunization Secretariat, Ministry of Health and Family Welfare, National Institute of Health and Family Welfare, New Delhi, India
| | - Rachael Somers
- Department of Maternal and Child Health, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina, United States of America
| | | | - Abram L. Wagner
- Department of Maternal and Child Health, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina, United States of America
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Sabahelzain MM, Moukhyer M, Bosma H, van den Borne B. Determinants of Measles Vaccine Hesitancy among Sudanese Parents in Khartoum State, Sudan: A Cross-Sectional Study. Vaccines (Basel) 2021; 10:vaccines10010006. [PMID: 35062667 PMCID: PMC8780692 DOI: 10.3390/vaccines10010006] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Revised: 12/07/2021] [Accepted: 12/20/2021] [Indexed: 11/20/2022] Open
Abstract
Determinants of vaccine hesitancy are not yet well understood. This study aims to assess measles vaccine hesitancy and characterize its determinants among Sudanese parents in Omdurman in Khartoum State. A community-based cross-sectional quantitative study was conducted in Khartoum State in February 2019. The Parent Attitudes about Childhood Vaccination (PACV) was used to measure measles vaccine hesitancy. Questions about the sociodemographic characteristics of the family, the perception of the parents about the measles vaccine, and the parental exposure to information were asked. Proportions of vaccine hesitancy and coefficients of linear regression were computed. Five hundred parents were recruited for the study. We found that a significant proportion of participants (about 1 in 5 parents) had hesitations regarding the measles vaccine. Significant predictors of measles vaccine hesitancy were parental exposure to anti-vaccination information or materials (β = −0.478, p-value < 0.001), the parents’ perception of the effectiveness of measles vaccines (β = 0.093, p-value = 0.020), the age of the mother (β = 0.112, p-value = 0.017), the birth rank of the child (β = −0.116, p-value = 0.015), and the total number of the children in the family (β = 0.098, p-value = 0.013). Vaccination access issues were the common justification for parental vaccination hesitancy. Our findings indicate that investment in vaccine communication as well as addressing access issues might be an effective intervention for improving measles vaccine acceptance and, ultimately, measles vaccine coverage.
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Affiliation(s)
- Majdi M. Sabahelzain
- Department of Public Health, School of Health Sciences, Ahfad University for Women, Omdurman P.O. Box 167, Sudan
- Department of Health Promotion, Care and Public Health Research Institute (CAPHRI), Maastricht University, 6211 LK Maastricht, The Netherlands;
- Correspondence:
| | - Mohamed Moukhyer
- Education Development and Quality Unit, College of Applied Medical Sciences, Jazan University, Jazan 45142, Saudi Arabia;
- Public Health Programmes, School of Medicine, University of Limerick, V94 T9PX Limerick, Ireland
| | - Hans Bosma
- Department of Social Medicine, Care and Public Health Research Institute (CAPHRI), Maastricht University, 6211 LK Maastricht, The Netherlands;
| | - Bart van den Borne
- Department of Health Promotion, Care and Public Health Research Institute (CAPHRI), Maastricht University, 6211 LK Maastricht, The Netherlands;
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Porth JM, Wagner AL, Moyer CA, Mutua MK, Boulton ML. Women's Empowerment and Child Vaccination in Kenya: The Modifying Role of Wealth. Am J Prev Med 2021; 60:S87-S97. [PMID: 33189504 DOI: 10.1016/j.amepre.2020.08.015] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Revised: 08/28/2020] [Accepted: 08/30/2020] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Although vaccination coverage is high in Kenya relative to other African nations, undervaccinated children remain, making it important to identify characteristics of these children and their caregivers. Potentially relevant but understudied factors are women's empowerment and early marriage. Women who marry older and have more autonomous decision-making authority may be better able to ensure their children receive health services, including immunizations. This analysis examines the relationship between early marriage and multiple dimensions of women's empowerment and child vaccination status in Kenya and explores whether these relationships are modified by wealth. METHODS Data were from the 2014 Kenya Demographic and Health Survey. The analysis was completed in 2020 using updated data made available to researchers in 2019. Logistic regressions assessed relationships among early marriage, 3 dimensions of women's empowerment (enabling conditions, intrinsic agency, and instrumental agency), and child vaccination. Analyses were stratified by wealth to explore potential effect modification. RESULTS For women in the middle wealth tertile, the odds of having a fully vaccinated child were 3.45 (95% CI=1.51, 7.91) times higher for those with higher versus lower empowerment. Further, among the wealthiest women, those with middle empowerment were 5.99 (95% CI=2.06, 17.40) times more likely to have a fully vaccinated child than women with lower empowerment. CONCLUSIONS Results suggest a threshold effect of wealth's role in the relationship between empowerment and vaccination. Enabling conditions may not influence immunization among the poorest women but exert a stronger positive influence on childhood vaccination among wealthier women. SUPPLEMENT INFORMATION This article is part of a supplement entitled Global Vaccination Equity, which is sponsored by the Global Institute for Vaccine Equity at the University of Michigan School of Public Health.
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Affiliation(s)
- Julia M Porth
- Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, Michigan; Global Institute for Vaccine Equity, School of Public Health, University of Michigan, Ann Arbor, Michigan.
| | - Abram L Wagner
- Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, Michigan; Global Institute for Vaccine Equity, School of Public Health, University of Michigan, Ann Arbor, Michigan
| | - Cheryl A Moyer
- Department of Obstetrics and Gynecology, University of Michigan Medical School, Ann Arbor, Michigan; Department of Learning Health Sciences, University of Michigan Medical School, Ann Arbor, Michigan
| | - Martin K Mutua
- African Population and Health Research Center, Nairobi, Kenya
| | - Matthew L Boulton
- Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, Michigan; Global Institute for Vaccine Equity, School of Public Health, University of Michigan, Ann Arbor, Michigan; Division of Infectious Diseases, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, Michigan
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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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Wagner AL, Masters NB, Domek GJ, Mathew JL, Sun X, Asturias EJ, Ren J, Huang Z, Contreras-Roldan IL, Gebremeskel B, Boulton ML. Comparisons of Vaccine Hesitancy across Five Low- and Middle-Income Countries. Vaccines (Basel) 2019; 7:E155. [PMID: 31635270 PMCID: PMC6963484 DOI: 10.3390/vaccines7040155] [Citation(s) in RCA: 95] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2019] [Revised: 10/03/2019] [Accepted: 10/14/2019] [Indexed: 12/22/2022] Open
Abstract
Vaccine hesitancy is a continuum of behaviors ranging from delay in receipt to vaccination refusal. Prior studies have typically focused on high-income countries, where vaccine hesitancy is particularly prevalent in more affluent groups, but the relationship between socioeconomic status and vaccine hesitancy in Low- and Middle-Income Countries (LMICs) is less clear. The aim of this study was to describe vaccine hesitancy in five LMICs. Mothers of children in Sirajganj, Bangladesh (n = 60), Shanghai, China (n = 788), Addis Ababa, Ethiopia (n = 341), Guatemala City and Quetzaltenango, Guatemala (n = 767), and Chandigarh, India (n = 309), completed a survey between 2016 and 2018 using the WHO's 10-item Vaccine Hesitancy Scale. The scores of different constructs were compared across countries and by the mother's education level using linear regression models with generalized estimating equations. Compared to mothers in China, mothers in Bangladesh perceived less vaccination benefit (β: 0.56, P = 0.0001), however, mothers in Ethiopia (β: -0.54, P < 0.0001) and Guatemala (β: -0.74, P = 0.0004) perceived greater benefit. Education level was not significantly linked with vaccine hesitancy. Local circumstances are important to consider when developing programs to promote vaccines. We did not find consistent associations between education and vaccine hesitancy. More research is needed to understand socio-cultural influences on vaccine decision-making.
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Affiliation(s)
- Abram L Wagner
- Department of Epidemiology, School of Public Health, University of Michigan, 1415 Washington Heights, Ann Arbor, MI 48109, USA.
| | - Nina B Masters
- Department of Epidemiology, School of Public Health, University of Michigan, 1415 Washington Heights, Ann Arbor, MI 48109, USA.
| | - Gretchen J Domek
- Department of Pediatrics, University of Colorado Anschutz Medical Campus, B065, 13123 E 16th Ave, Aurora, CO 80045, USA.
- Center for Global Health, Colorado School of Public Health, A090, 13199 E Montview Blvd, Suite 310, Aurora, CO 80045, USA.
| | - Joseph L Mathew
- Advanced Pediatrics Centre, Post Graduate Institute of Medical Education and Research, Chandigarh 160012, India.
| | - Xiaodong Sun
- Department of Immunization Program, Shanghai Municipal Centers for Disease Control & Prevention, NO. 1380, West Zhongshan Road, Shanghai 200336, China.
| | - Edwin J Asturias
- Department of Pediatrics, University of Colorado Anschutz Medical Campus, B065, 13123 E 16th Ave, Aurora, CO 80045, USA.
- Center for Global Health, Colorado School of Public Health, A090, 13199 E Montview Blvd, Suite 310, Aurora, CO 80045, USA.
- Department of Epidemiology, Colorado School of Public Health, B119, 13001 E 17th Place, Aurora, CO 80045, USA.
| | - Jia Ren
- Department of Immunization Program, Shanghai Municipal Centers for Disease Control & Prevention, NO. 1380, West Zhongshan Road, Shanghai 200336, China.
| | - Zhuoying Huang
- Department of Immunization Program, Shanghai Municipal Centers for Disease Control & Prevention, NO. 1380, West Zhongshan Road, Shanghai 200336, China.
| | - Ingrid L Contreras-Roldan
- Center for Health Studies, Universidad del Valle de Guatemala, 18 Av. 11-95, Zona 15, Vista Hermosa III, Guatemala City 01015, Guatemala.
| | - Berhanu Gebremeskel
- Department of Epidemiology, School of Public Health, University of Michigan, 1415 Washington Heights, Ann Arbor, MI 48109, USA.
| | - Matthew L Boulton
- Department of Epidemiology, School of Public Health, University of Michigan, 1415 Washington Heights, Ann Arbor, MI 48109, USA.
- Department of Internal Medicine, Division of Infectious Disease, University of Michigan Medical School, 1500 East Medical Center Drive, Ann Arbor, MI 48109, USA.
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