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Amouzou A, Melesse DY, Wehrmeister FC, Ferreira LZ, Jiwani SS, Kassegne S, Maïga A, Faye CM, Ca T, Boerma T. Erosion of the Capital City Advantage in Child Survival and Reproductive, Maternal, Newborn, and Child Health Intervention Coverage in Sub-Saharan Africa. J Urban Health 2024:10.1007/s11524-023-00820-0. [PMID: 38767766 DOI: 10.1007/s11524-023-00820-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/08/2023] [Indexed: 05/22/2024]
Abstract
The place of residence is a major determinant of RMNCH outcomes, with rural areas often lagging in sub-Saharan Africa. This long-held pattern may be changing given differential progress across areas and increasing urbanization. We assessed inequalities in child mortality and RMNCH coverage across capital cities and other urban and rural areas. We analyzed mortality data from 163 DHS and MICS in 39 countries with the most recent survey conducted between 1990 and 2020 and RMNCH coverage data from 39 countries. We assessed inequality trends in neonatal and under-five mortality and in RMNCH coverage using multilevel linear regression models. Under-five mortality rates and RMNCH service coverage inequalities by place of residence have reduced substantially in sub-Saharan Africa, with rural areas experiencing faster progress than other areas. The absolute gap in child mortality between rural areas and capital cities and that between rural and other urban areas reduced respectively from 41 and 26 deaths per 1000 live births in 2000 to 23 and 15 by 2015. Capital cities are losing their primacy in child survival and RMNCH coverage over other urban areas and rural areas, especially in Eastern Africa where under-five mortality gap between capital cities and rural areas closed almost completely by 2015. While child mortality and RMNCH coverage inequalities are closing rapidly by place of residence, slower trends in capital cities and urban areas suggest gradual erosion of capital city and urban health advantage. Monitoring child mortality and RMNCH coverage trends in urban areas, especially among the urban poor, and addressing factors of within urban inequalities are urgently needed.
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Affiliation(s)
- Agbessi Amouzou
- Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD, 21205, USA.
| | - Dessalegn Y Melesse
- Institute for Global Public Health, Department of Community Health Sciences, University of Manitoba, Winnipeg, MB, Canada
| | - Fernando C Wehrmeister
- International Center for Equity in Health, Federal University of Pelotas, Pelotas, Brazil
| | - Leonardo Z Ferreira
- International Center for Equity in Health, Federal University of Pelotas, Pelotas, Brazil
| | - Safia S Jiwani
- Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD, 21205, USA
| | | | - Abdoulaye Maïga
- Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD, 21205, USA
| | - Cheikh M Faye
- African Population and Health Research Center, Dakar, Senegal
| | - Tome Ca
- West African Health Organization, Bobo-Dioulasso, Burkina Faso
| | - Ties Boerma
- Institute for Global Public Health, Department of Community Health Sciences, University of Manitoba, Winnipeg, MB, Canada
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Nwachukwu BC, Alatishe-Muhammad BW, Ibizugbe S, Alake DI, Bolarinwa OA. Low Immunization Completion among Under-Five Children: Are Underserved Nomadic and Farming Communities in a North Central State of Nigeria doing Better? Niger J Clin Pract 2023; 26:709-719. [PMID: 37470643 DOI: 10.4103/njcp.njcp_652_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/21/2023]
Abstract
Background The recent drop in immunization coverage in Nigeria has left more than 3.25 million children unimmunized and has risen concern over immunization completion among the under-five children. More so among underserved communities of pastoralist nomads and farmers that were isolated from immunization services because of operational and sociocultural factors. Materials and Methods A cross-sectional analytical (comparative analysis) study was carried out among 550 eligible caregivers of under-five children in nomadic and farming communities in Niger State, Nigeria. The mothers and caregivers paired with under-five children were recruited into the study using a multistage sampling technique. Data was collected using a validated interviewer-administered questionnaire. Data was analyzed with the statistical software package (version 23). Results More than half of the under-five children studied were males in both the nomadic (57.5%) and farming (52.0%) communities. The aggregated score of immunization knowledge was significantly (P < 0.001) better (Good 44.4%; Fair 49.8%) among farmers compared to their nomads' counterpart (Good 21.1%; Fair 43.6%). Conversely, almost all the respondents (98.2%) in nomadic community significantly had a good overall perception of childhood immunization compared to 77.1% in the farming community. More farmers' children (99.6%) had received immunization compared to 92.4% of the nomads' children. About 87.3% of farmers compared to 76% of the nomads' (76.0%) children reported immunization completion. About 50.5% of the farmers' and 41.4% of the nomads' children have achieved immunization on card inspection. Conclusion This study revealed that average immunization completion reported among under-five children in both farming and nomadic communities is higher than the national average. It is recommended that more strategies are needed to intensify immunization campaigns targeted at populations in Nigeria.
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Affiliation(s)
- B C Nwachukwu
- Assistant Public Health Officer, World Health Organization, Kebbi State Field Office, Ilorin, Nigeria
| | - B W Alatishe-Muhammad
- FMCPH, Directorate of Planning, Research and Statistics Kwara State Ministry of Health, Ilorin, Nigeria
| | - S Ibizugbe
- Data Manger/Analyst, Clinton Health Access Initiative, Abuja, Nigeria
| | - D I Alake
- Strategic Information Optimiser, Center for Clinical Care and Clinical Research, Ilorin, Nigeria
| | - O A Bolarinwa
- FWACP, Ph.D. Department of Epidemiology and Community Health University of Ilorin/UITH, Ilorin, Nigeria
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Young R, Kennedy CE, Dam A, Nakyanjo N, Ddaaki W, Kiyingi AC, Mukwana E, Edwards A, Nalugoda F, Chang LW, Wawer MJ, Oaks M, Paina L. From 'no problem' to 'a lot of difficulties': barriers to health service utilization among migrants in Rakai, Uganda. Health Policy Plan 2023; 38:620-630. [PMID: 37002584 PMCID: PMC11020305 DOI: 10.1093/heapol/czad019] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Revised: 01/31/2023] [Accepted: 03/16/2023] [Indexed: 04/03/2023] Open
Abstract
Migration is increasingly common in Africa, especially for employment. Migrants may face additional barriers to accessing health care, including human immunodeficiency virus (HIV) prevention and treatment, compared with long-term residents. Exploring migrants' experiences with health services can provide insights to inform the design of health programmes. In this study, we used qualitative methods to understand migrants' barriers to health service utilization in south-central Uganda. This secondary data analysis used data from in-depth semi-structured interviews with 35 migrants and 25 key informants between 2017 and 2021. Interviews were analysed thematically through team debriefings and memos. We constructed three representative migrant journeys to illustrate barriers to accessing health services, reflecting experiences of migrant personas with differing HIV status and wealth. Migrants reported experiencing a range of barriers, which largely depended on the resources they could access, their existing health needs and their ability to form connections and relationships at their destination. Migrants were less familiar with local health services, and sometimes needed more time and resources to access care. Migrants living with HIV faced additional barriers to accessing health services due to anticipated discrimination from community members or health workers and difficulties in continuing antiretroviral therapy when switching health facilities. Despite these barriers, social networks and local connections facilitated access. However, for some migrants, such as those who were poorer or living with HIV, these barriers were more pronounced. Our work highlights how local connections with community members and health workers help migrants access health services. In practice, reducing barriers to health services is likely to benefit both migrants and long-term residents.
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Affiliation(s)
- Ruth Young
- Bloomberg School of Public Health, Johns Hopkins University, 615 N Wolfe St, Baltimore, MD 21205, United States
| | - Caitlin E Kennedy
- Bloomberg School of Public Health, Johns Hopkins University, 615 N Wolfe St, Baltimore, MD 21205, United States
| | - Anita Dam
- Bloomberg School of Public Health, Johns Hopkins University, 615 N Wolfe St, Baltimore, MD 21205, United States
| | - Neema Nakyanjo
- Rakai Health Sciences Program, P.O Box 279, Kalisizo, Uganda
| | - William Ddaaki
- Rakai Health Sciences Program, P.O Box 279, Kalisizo, Uganda
| | | | | | - Abagail Edwards
- Bloomberg School of Public Health, Johns Hopkins University, 615 N Wolfe St, Baltimore, MD 21205, United States
| | - Fred Nalugoda
- Rakai Health Sciences Program, P.O Box 279, Kalisizo, Uganda
| | - Larry W Chang
- School of Medicine, Johns Hopkins University, 615 N Wolfe St, Baltimore, MD 21205, United States
| | - Maria J Wawer
- Bloomberg School of Public Health, Johns Hopkins University, 615 N Wolfe St, Baltimore, MD 21205, United States
| | - Maya Oaks
- Bloomberg School of Public Health, Johns Hopkins University, 615 N Wolfe St, Baltimore, MD 21205, United States
| | - Ligia Paina
- Bloomberg School of Public Health, Johns Hopkins University, 615 N Wolfe St, Baltimore, MD 21205, United States
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Individual- and Neighborhood-Level Factors of Measles Vaccination Coverage in Niamey, Niger: A Multilevel Analysis. Vaccines (Basel) 2022; 10:vaccines10091513. [PMID: 36146591 PMCID: PMC9505597 DOI: 10.3390/vaccines10091513] [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] [Received: 07/30/2022] [Revised: 09/02/2022] [Accepted: 09/07/2022] [Indexed: 11/16/2022] Open
Abstract
Vaccination is a proven equitable intervention if people take advantage of the opportunity to get vaccinated. Niger is a low-income country in West Africa, with a 76% measles 1 vaccination coverage rate in 2016. This study was conducted to identify individual- and neighborhood-level factors that could improve measles 1 vaccination coverage in Niamey, the capital. In October 2016, 460 mothers with children aged 12-23 months were surveyed. The outcome was to determine whether the mother's child had been vaccinated against measles 1 or not. For individual-level variables of measles 1 vaccination status, the following were included: mother's age group, mother tongue, maternal education level, husband's job, where the mother gave birth (at home or at a health center) and whether the mother discussed vaccination with friends. Neighborhood-level factors were access time to the health center, household access to electricity, and a grand-mean-centered wealth score. Multilevel logistic regression analysis was performed. At the individual-level, primary and secondary-educated mothers were more likely to vaccinate their children against measles 1 (aOR 1.97, 95% CI 1.11-3.51). At the neighborhood-level, no factors were identified. Therefore, a strengthened focus on equity-based, individual factors is recommended, including individual motivation, prompts and ability to access vaccination services.
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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 KAM. 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: 32] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [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)
- Huda Ahmed Ali
- grid.7445.20000 0001 2113 8111Imperial College London, Praed Street, London, UK
| | - Anna-Maria Hartner
- grid.7445.20000 0001 2113 8111Imperial College London, Praed Street, London, UK
| | | | - Jeremy Roth
- grid.7445.20000 0001 2113 8111Imperial College London, Praed Street, London, UK
| | - Xiang Li
- grid.7445.20000 0001 2113 8111Imperial College London, Praed Street, London, UK
| | - Kaja Abbas
- grid.8991.90000 0004 0425 469XLondon School of Hygiene and Tropical Medicine, Keppel Street, London, UK
| | - Allison Portnoy
- grid.38142.3c000000041936754XCenter for Health Decision Science, Harvard T H Chan School of Public Health, Cambridge, USA
| | - Emilia Vynnycky
- grid.271308.f0000 0004 5909 016XPublic Health England, London, UK
| | - Kim Woodruff
- grid.7445.20000 0001 2113 8111Imperial College London, Praed Street, London, UK
| | - Neil M Ferguson
- grid.7445.20000 0001 2113 8111Imperial College London, Praed Street, London, UK
| | - Jaspreet Toor
- grid.7445.20000 0001 2113 8111Imperial College London, Praed Street, London, UK
| | - Katy AM Gaythorpe
- grid.7445.20000 0001 2113 8111Imperial College London, Praed Street, London, UK
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Shankar Mishra P, Jamadar M, Tripathy A, Anand A. Understanding the Socio-Economic Vulnerability in Child Malnutrition Between Migrants and Non-Migrants Children (12-59 Months) in India: Evidence from a Cross-Sectional Study. CHILD INDICATORS RESEARCH 2022; 15:1871-1888. [PMID: 35601140 PMCID: PMC9108133 DOI: 10.1007/s12187-022-09943-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 04/19/2022] [Indexed: 06/15/2023]
Abstract
India has witnessed increasing trends in internal migration over the last three decades. In India, migrant children are not a homogeneous group and their reasons for movement and vulnerabilities vary across socio-economic stratum. For some children, migration may open possibilities and is associated with expanding social and economic spheres, but for many others, it may bring serious risks. Therefore, the study has been carried out to understand socio-economic vulnerability in child nutrition with migration status and other contributing factors in India. This study used data from the National Family Health Survey, the fourth in the NFHS series which was conducted in 2015-2016 (NFHS-4). We were interested in looking at the children age 12-59 months for their nutritional indicators such as stunting and underweight across migrants and non-migrants children. This resulted in a sample of 199,448 children in selected age group and among them 33.1% children belongs to the migrant family as compared to 67% of non-migrant children. Overall, 44.2% of children were stunted and 39.5% were underweight among non-migrant children as compared to 37.4% & 32.8% of migrant children were stunted and underweight respectively. Further, the results showed that among the social groups, scheduled caste children were found a high variation in underweight (34% vs. 41.6%) and stunting (36% vs. 46%) between migrants and non-migrants children. Similar trend of malnourishment is found in the poor wealth quintile, for rural residents and low educated women with non-migrant status. Those children who were poor but non-migrant were more likely to be malnourished as underweight [aOR; 1.15, CI: 1.11-1.18] and stunted [aOR; 1.17, CI:1.13-1.20] as compared to migrant status children in the same category of the household. Similarly in reference to scheduled caste migrant group, the scheduled caste non-migrant were more likely to be underweight [aOR; 1.15, CI: 1.09-1.20] and stunted [aOR; 1.18, CI: 1.12-1.23] than the children with migrant status. There were huge differences between migrant and non-migrant children in nutritional statuses. Education, caste and wealth index are found to be an important variables to explain the differential between migrants and non-migrants in child's nutritional aspects. Children associated with poor socio-economic vulnerability and non-migrant category need to be taken care of more and a community targeted approach is required to understand the gaps. The programs such as ICDS, and Poshan Abhiyan need to be revamped adding the migration aspect of the families and children in terms of their health and nutritional aspects.
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Affiliation(s)
- Prem Shankar Mishra
- Population Research Centre, Institute for Social and Economic Change, Bengaluru, 560072 Karnataka India
| | - Mudassar Jamadar
- Centre for Research in Urban Affairs, Institute for Social and Economic Change, Bangalore, 560072 Karnataka India
| | - Abhipsa Tripathy
- Department of Statistics, Utkal University, Bhubaneswar, Odisha 751004 India
| | - Ankit Anand
- Population Research Centre, Institute for Social and Economic Change, Bengaluru, 560072 Karnataka India
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Muluye M, Oljira L, Eyeberu A, Getachew T, Debella A, Deressa A, Dheresa M. Partial vaccination and associated factors among children aged 12-23 months in eastern Ethiopia. BMC Pediatr 2022; 22:268. [PMID: 35550040 PMCID: PMC9097114 DOI: 10.1186/s12887-022-03320-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Accepted: 04/28/2022] [Indexed: 11/23/2022] Open
Abstract
Background Vaccine prevents about 2–3 million deaths from vaccine-preventable diseases each year. However, immunization coverage in Ethiopia is lower than the herd immunity level required to prevent the spread of all vaccine-preventable diseases. Thus, this study aimed to assess the partial immunization and associated factors among 12–23-month-old children in Eastern Ethiopia. Method A community-based cross-sectional study design was carried out among 874 randomly selected mothers/caregivers of children aged 12–23 months. A structured questionnaire was adapted and data were collected through face-to-face interviews and review of vaccination cards. Data were coded and analyzed using the Stata version 14 software. A binary logistic regression model was utilized to identify the determinant factors. The predictor of partial immunization was presented by an adjusted odds ratio with a 95% confidence interval. A p-value of < 0.05 was used to establish statistical significance. Result The prevalence of partial immunization was 31.4% (95% CI: 28–35). The dropout rate between the first and third pentavalent vaccine was 17%. Being female child [AOR = 0.73, 95% CI: 0.52–0.95], 18–20 month child [AOR = 1.6, 95% CI: 1.1- 2.4], the child born to mothers who heard about vaccination [AOR = 3.9, 95%CI: 1.92- 8.01], a child born to mother who did not receive immunization counselling [AOR = 1.65, 95%CI: 1.15–2.36], and child whose mother walk 15–30 min, 31–60 min, and > 60 min to reach nearby health facilities [AOR = 1.94, 95% CI: 1.1–3.45], [AOR = 4.5, 95% CI: 2.47–8.15], and [AOR = 3.45, 95% CI: 1.59- 7.48] respectively were factors significantly associated with partial vaccination. Conclusions The prevalence of partial immunization is high compared to other studies. As a result, to decrease the proportion of defaulters and to increase immunization coverage, maternal health care utilization like antenatal care follow-up and mother knowledge about the importance of the vaccine need to be sought cautiously.
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Affiliation(s)
- Menberu Muluye
- Haramaya Health Office in Haramaya, East Hararge Zone, Oromia region, Harar, Ethiopia
| | - Lemessa Oljira
- School of Public Health, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Addis Eyeberu
- School of Nursing and Midwifery, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia.
| | - Tamirat Getachew
- School of Nursing and Midwifery, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Adera Debella
- School of Nursing and Midwifery, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Alemayehu Deressa
- School of Public Health, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Merga Dheresa
- School of Nursing and Midwifery, College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
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Kayembe-Ntumba HC, Vangola F, Ansobi P, Kapour G, Bokabo E, Mandja BA, Bompangue D. Vaccination dropout rates among children aged 12-23 months in Democratic Republic of the Congo: a cross-sectional study. Arch Public Health 2022; 80:18. [PMID: 34986887 PMCID: PMC8728983 DOI: 10.1186/s13690-021-00782-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Accepted: 12/24/2021] [Indexed: 11/27/2022] Open
Abstract
Background Overall, 1.8 million children fail to receive the 3-dose series for diphtheria, tetanus and pertussis each year in the Democratic Republic of the Congo (DRC). Currently, an emergency plan targeting 9 provinces including Kinshasa, the capital of the DRC, is launched to reinforce routine immunization. Mont Ngafula II was the only health district that experienced high vaccination dropout rates for nearly five consecutive years. This study aimed to identify factors predicting high immunization dropout rates among children aged 12-23 months in the Mont Ngafula II health district. Methods A cross-sectional household survey was conducted among 418 children in June-July 2019 using a two-stage sampling design. Socio-demographic and perception data were collected through a structured interviewer-administered questionnaire. The distribution of 2017-2018 immunization coverage and dropout rate was extracted from the local health district authority and mapped. Logistic random effects regression models were used to identify predictors of high vaccination dropout rates. Results Of the 14 health areas in the Mont Ngafula II health district, four reported high vaccine coverage, only one recorded low vaccine coverage, and three reported both low vaccine coverage and high dropout rate. In the final multivariate logistic random effects regression model, the predictors of immunization dropout among children aged 12-23 months were: living in rural areas, unavailability of seats, non-compliance with the order of arrival during vaccination in health facilities, and lack of a reminder system on days before the scheduled vaccination. Conclusions Our results advocate for prioritizing targeted interventions and programs to strengthen interpersonal communication between immunization service providers and users during vaccination in health facilities and to implement an SMS reminder system on days before the scheduled vaccination.
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Affiliation(s)
- Harry-César Kayembe-Ntumba
- Ecology and Control of Infectious Diseases Unit, Department of Basic Sciences, Faculty of Medicine, University of Kinshasa, Kin XI, BP: 834, Kinshasa, Democratic Republic of the Congo.
| | - Felly Vangola
- Master of Ecology of Infectious Diseases, Natural Hazards and Risk Management, Faculty of Medicine, University of Kinshasa, Kinshasa, Democratic Republic of the Congo
| | - Papy Ansobi
- Ecology and Control of Infectious Diseases Unit, Department of Basic Sciences, Faculty of Medicine, University of Kinshasa, Kin XI, BP: 834, Kinshasa, Democratic Republic of the Congo
| | - Germain Kapour
- Ecology and Control of Infectious Diseases Unit, Department of Basic Sciences, Faculty of Medicine, University of Kinshasa, Kin XI, BP: 834, Kinshasa, Democratic Republic of the Congo
| | - Eric Bokabo
- Ecology and Control of Infectious Diseases Unit, Department of Basic Sciences, Faculty of Medicine, University of Kinshasa, Kin XI, BP: 834, Kinshasa, Democratic Republic of the Congo
| | - Bien-Aimé Mandja
- Ecology and Control of Infectious Diseases Unit, Department of Basic Sciences, Faculty of Medicine, University of Kinshasa, Kin XI, BP: 834, Kinshasa, Democratic Republic of the Congo
| | - Didier Bompangue
- Ecology and Control of Infectious Diseases Unit, Department of Basic Sciences, Faculty of Medicine, University of Kinshasa, Kin XI, BP: 834, Kinshasa, Democratic Republic of the Congo.,Chrono-Environnement Laboratory, CNRS, UMR 6249, University of Bourgogne Franche- Comté, Besançon, France
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Porth JM, Wagner AL, Treleaven E, Fleischer NL, Mutua MK, Braun TM, Boulton ML. Childhood vaccination timeliness following maternal migration to an informal urban settlement in Kenya. Vaccine 2021; 40:627-639. [PMID: 34952757 DOI: 10.1016/j.vaccine.2021.12.017] [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: 05/24/2021] [Revised: 12/06/2021] [Accepted: 12/08/2021] [Indexed: 11/16/2022]
Abstract
INTRODUCTION Timely receipt of recommended vaccines is a proven strategy to reduce preventable under-five deaths. Kenya has experienced impressive declines in child mortality from 111 to 43 deaths per 1000 live births between 1980 and 2019. However, considerable inequities in timely vaccination remain, which unnecessarily increases risk for serious illness and death. Maternal migration is a potentially important driver of timeliness inequities, as the social and financial stressors of moving to a new community may require a woman to delay her child's immunizations. This analysis examined how maternal migration to informal urban settlements in Nairobi, Kenya influenced childhood vaccination timeliness. METHODS Data came from the Nairobi Urban Health and Demographic Surveillance System, 2002-2018. Migration exposures were migrant status (migrant, non-migrant), migrant origin (rural, urban), and migrant type (first-time, circular [previously resided in settlement]). Age at vaccine receipt (vaccination timeliness) was calculated for all basic vaccinations. Accelerated failure time models were used to investigate relationships between migration exposures and vaccination timeliness. Confounding was addressed using propensity score weighting. RESULTS Over one-third of the children of both migrants and non-migrants received at least one dose late or not at all. Unweighted models showed the children of migrants had shorter time to OPV1 and DPT1 vaccine receipt compared to the children of non-migrants. After accounting for confounding only differences in timeliness for DPT1 remained, with the children of migrants receiving DPT1 significantly earlier than the children of non-migrants. Timeliness was comparable among migrants with rural and urban origins and among first-time and circular migrants. CONCLUSION Although a substantial proportion of children in Nairobi's informal urban settlements do not receive timely vaccination, this analysis found limited evidence that maternal migration and migration characteristics were associated with delays for most doses. Future research should seek to elucidate potential drivers of low vaccination timeliness in Kenya.
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Affiliation(s)
- Julia M Porth
- Department of Epidemiology, School of Public Health, University of Michigan, USA; Global Institute for Vaccine Equity, University of Michigan, USA.
| | - Abram L Wagner
- Department of Epidemiology, School of Public Health, University of Michigan, USA; Global Institute for Vaccine Equity, University of Michigan, USA
| | | | - Nancy L Fleischer
- Department of Epidemiology, School of Public Health, University of Michigan, USA
| | | | - Thomas M Braun
- Department of Biostatistics, School of Public Health, University of Michigan, USA
| | - Matthew L Boulton
- Department of Epidemiology, School of Public Health, University of Michigan, USA; Global Institute for Vaccine Equity, University of Michigan, USA; Department of Internal Medicine, Division of Infectious Disease, University of Michigan Medical School, USA
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van Heemskerken PG, Decouttere CJ, Broekhuizen H, Vandaele NJ. Understanding the complexity of demand-side determinants on vaccine uptake in sub-Saharan Africa. Health Policy Plan 2021; 37:281-291. [PMID: 34918093 DOI: 10.1093/heapol/czab139] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Revised: 07/28/2021] [Accepted: 11/16/2021] [Indexed: 11/13/2022] Open
Abstract
Routine vaccination annually prevents millions of deaths worldwide but is underutilized in sub-Saharan Africa (SSA). The complexity of socio-cultural factors impacting vaccine uptake is not well understood. Hence, this paper aims to review the socio-cultural determinants of vaccine uptake and visualize their interrelationships. We conducted a literature search using Pubmed and Embase databases, including articles published from 2000 to 2019 describing socio-cultural demand-side determinants for vaccine uptake. Using the Andersen and Newman Framework of Health Services Utilization, demand-side determinants were categorized as predisposing, enabling or need factors. A qualitative system dynamics approach was employed to visualize how these factors and their dynamic interrelationships influence vaccine uptake. This visualization, by means of a causal-loop diagram (CLD), was mostly based on a qualitative input, with the majority being statements of the authors. These statements were abstracted from the papers found in the review. Quantification was done by counting direct (statistical) associations between each determinant and 'timely and full routine immunization coverage'. A total of 90 articles, primarily from Nigeria (n = 23), Ethiopia (n = 17) and Kenya (n = 11), met the inclusion criteria. We find that maternal autonomy and the perceived benefits caregivers attach to vaccination and exert their influences on many other factors through several feedback loops, thereby influencing timely and full routine immunization coverage. Utilization of health services (supply-related) and access to information (demand-related) were considered as high-potential leverage points. Quantification has shown that maternal autonomy and perceived benefit have an unclear evidence base. Future research should focus on these key players as they play a central role in multiple complex pathways, through which they could influence the uptake of vaccines in SSA.
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Affiliation(s)
- Phylisha G van Heemskerken
- Department of Health Evidence, Radboud University Medical Centre, Geert Grooteplein 21, Nijmegen 6525 EZ, The Netherlands
| | | | - Henk Broekhuizen
- Department of Health Evidence, Radboud University Medical Centre, Geert Grooteplein 21, Nijmegen 6525 EZ, The Netherlands.,Department of Health and Society, Wageningen University and Research, Hollandseweg 1, 6706 KN, Wageningen 3000, The Netherlands
| | - Nico J Vandaele
- Access-To-Medicines Research Center, KU Leuven, Naamsestraat 69, Leuven, Belgium
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11
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Sidze EM, Wekesah FM, Kisia L, Abajobir A. Inequalities in Access and Utilization of Maternal, Newborn and Child Health Services in sub-Saharan Africa: A Special Focus on Urban Settings. Matern Child Health J 2021; 26:250-279. [PMID: 34652595 PMCID: PMC8888372 DOI: 10.1007/s10995-021-03250-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/30/2021] [Indexed: 12/29/2022]
Abstract
OBJECTIVES The aim of this paper is to share the results of a systematic review on the state of inequalities in access to and utilization of maternal, newborn and child health (MNCH) services in the sub-Saharan African region. The focus of the review was on urban settings where growing needs and challenges have been registered over the past few years due to rapid increase in urban populations and urban slums. METHODS The review was conducted according to Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines. Studies published in English between 2000 and 2019 were included. A narrative synthesis of both qualitative and quantitative data was undertaken. The record for registration in PROSPERO was CRD42019122066. RESULTS The review highlights a great variation in MNCH services utilization across urban sub-Saharan Africa (SSA). The main aspects of vulnerability to unequal and poor MNCH services utilization in urban settings of the region include poverty, low level of education, unemployment, lower socioeconomic status and poor livelihoods, younger maternal age, low social integration and social support, socio-cultural taboos, residing in slums, and being displaced, refugee, or migrant. At the health system level, persistent inequalities are associated with distance to health facility, availability of quality services and discriminating attitudes from health care personnel. CONCLUSION Context-specific intervention programs that aim at resolving the identified barriers to access and use MNCH services, particularly for the most vulnerable segments of urban populations, are essential to improve the overall health of the region and universal health coverage (UHC) targets.
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Affiliation(s)
- E M Sidze
- African Population and Health Research Center (APHRC), APHRC Campus, 2nd Floor, Manga Close off Kirawa Road, P.O. Box 10787-00100, Nairobi, Kenya.
| | - F M Wekesah
- African Population and Health Research Center (APHRC), APHRC Campus, 2nd Floor, Manga Close off Kirawa Road, P.O. Box 10787-00100, Nairobi, Kenya
| | - L Kisia
- African Population and Health Research Center (APHRC), APHRC Campus, 2nd Floor, Manga Close off Kirawa Road, P.O. Box 10787-00100, Nairobi, Kenya
| | - A Abajobir
- African Population and Health Research Center (APHRC), APHRC Campus, 2nd Floor, Manga Close off Kirawa Road, P.O. Box 10787-00100, Nairobi, Kenya
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12
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Woldu Anbesu E, Abubeker SA, Berhe BM. Age-appropriate vaccination practice and associated factors among mothers of children aged less than one year in the pastoral community of Afar region, Ethiopia. Hum Vaccin Immunother 2021; 17:3178-3185. [PMID: 34062099 DOI: 10.1080/21645515.2021.1919480] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Abstract
Achieving and maintaining high-level immunization coverage is the priority of the health-care delivery system. However, any delay in receiving the vaccine leaves youngsters inadequately protected. Timely vaccination has scarcely been reported and given little attention in developing nations like Ethiopia, which hinders effective interventions. Therefore, this study aimed to assess age-appropriate vaccination practice and associated factors among mothers of children aged less than one year in the pastoral community. A community-based cross-sectional study has conducted among 340 mothers/caregivers of children aged less than one year in Samara-logia city administration. A systematic random sampling technique was employed to identify and enroll mothers-child paired. The logistic regression analysis had done to identify the factors associated with age-appropriate vaccination practice. The statistical association had measured, and a p-value < 0.05 was considered statistically significant. In this study, a total of 331 mothers/caregivers-child pairs participated with a response rate of 97.3%. The age-appropriate vaccination practice was 43.7% (95% CI, 38%, 49.5%). Mothers who had higher educational level (Adjusted odds ratio (AOR)) = AOR = 2.89, 95% CI (1.14, 7.3), antenatal care follow-up (AOR = 2.1, 95% CI (1.04, 4.1)), and had good knowledge on vaccination (AOR = 3.1, 95% CI (1.4, 6.78)) were associated with increased odds of age-appropriate vaccination practice.
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Affiliation(s)
- Etsay Woldu Anbesu
- Department of Public Health, College of Medical and Health Sciences, Samara University, Samara, Ethiopia
| | - Seada Ali Abubeker
- Department of Neglected Tropical Disease, Afar Regional Health Bureau, Samara, Ethiopia
| | - Brhanu Medhin Berhe
- Department of Public Health, College of Medical and Health Sciences, Samara University, Samara, Ethiopia
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13
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Porth JM, Treleaven E, Fleischer NL, Mutua MK, Boulton ML. The influence of maternal migration on child vaccination in Kenya: An inverse probability of treatment-weighted analysis. Int J Infect Dis 2021; 106:105-114. [PMID: 33781901 DOI: 10.1016/j.ijid.2021.03.067] [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: 12/18/2020] [Revised: 03/22/2021] [Accepted: 03/23/2021] [Indexed: 10/21/2022] Open
Abstract
OBJECTIVES Kenya has substantially improved child mortality between 1990 and 2019, with under-5 mortality decreasing from 104 to 43 deaths per 1000 live births. However, only two-thirds of Kenyan children receive all recommended vaccines by 1 year, making it essential to identify undervaccinated subpopulations. Internal migrants are a potentially vulnerable group at risk of decreased access to healthcare. This analysis explored how maternal migration within Kenya influences childhood vaccination. METHODS Data were from the 2014 Kenya Demographic and Health Survey, a nationally representative cross-sectional survey. Logistic regressions assessed relationships between maternal migration and full and up-to-date child vaccination using inverse probability of treatment weighting. Two exposure variables were examined: migration status and stream (e.g. rural-urban). Multiple imputation was used to impute up-to-date status for children without vaccination cards to reduce selection bias. RESULTS After accounting for selection and confounding biases, all relationships between migration status and migration stream and full and up-to-date vaccination became statistically insignificant. CONCLUSIONS Null findings indicate that, in Kenya, characteristics enabling migration, rather than the process of migration itself, drive differential vaccination behavior between migrants and non-migrants. This finding is an important deviation from previous literature, which did not rigorously address important biases.
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Affiliation(s)
- Julia M Porth
- Department of Epidemiology, School of Public Health, University of Michigan, USA; Global Institute for Vaccine Equity, University of Michigan, USA.
| | | | - Nancy L Fleischer
- Department of Epidemiology, School of Public Health, University of Michigan, USA
| | - Martin K Mutua
- African Population and Health Research Center, Nairobi, Kenya
| | - Matthew L Boulton
- Department of Epidemiology, School of Public Health, University of Michigan, USA; Global Institute for Vaccine Equity, University of Michigan, USA; Department of Internal Medicine, Division of Infectious Disease, University of Michigan Medical School, USA
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14
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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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15
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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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16
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Hargono A, Megatsari H, Artanti KD, Nindya TS, Wulandari RD. Ownership of Mother and Children's Health Book and Complete Basic Immunization Status in Slums and Poor Population. J Public Health Res 2020; 9:1809. [PMID: 32728555 PMCID: PMC7376493 DOI: 10.4081/jphr.2020.1809] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2020] [Accepted: 06/13/2020] [Indexed: 11/23/2022] Open
Abstract
Background: The percentage of complete immunization in urban areas is higher than rural areas. The purpose of the study was to analyze the relationship between ownership of Maternal and Child Health (MCH) books with Complete Basic Immunization (CBI) coverage in slums and poor areas. Design and Methods: A rapid survey was conducted in selected slums and poor groups based on medical records from Public Health Center. Informants were mothers with a sample of 325 infants aged 12 to 23 months. Results: The lowest coverage of CBI for slum and poor residents is Pasuruan, which is 55.4%. The results of statistical analysis showed that there was a significant relationship between ownership of MCH books and the complete coverage of basic immunization in Malang (P = 0.000; PR = 3.682); Pasuruan (P = 0.002; PR = 1.854); Sidoarjo (P = 0.000; PR = 4.042); Surabaya (P = 0.000; PR = 2.425). Conclusions: It is recommended that the government should improve access to complete immunization programs in slums and poor population. Significance for public health Low immunization coverage makes people living in a slum unhealthy and at high risk of developing infectious diseases. Maternal and Child Health (MCH) Book is a source of information about the program and immunization status of the community. This study analyzes the relationship of MCH ownership with basic immunization completeness status in the slums and poor area. Supporting and increasing access to immunization programs is expected to increase immunization coverage in the slums and poor groups.
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Affiliation(s)
| | | | | | | | - Ratna Dwi Wulandari
- Department of Health Administration and Policy, Faculty of Public Health, Universitas Airlangga, Surabaya, Indonesia
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17
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Obanewa OA, Newell ML. The role of place of residency in childhood immunisation coverage in Nigeria: analysis of data from three DHS rounds 2003-2013. BMC Public Health 2020; 20:123. [PMID: 31996184 PMCID: PMC6988360 DOI: 10.1186/s12889-020-8170-6] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2019] [Accepted: 01/07/2020] [Indexed: 11/10/2022] Open
Abstract
Background In 2017, about 20% of the world’s children under 1 year of age with incomplete DPT vaccination lived in Nigeria. Fully-immunised child coverage (FIC), which is the percentage of children aged 12–23 months who received all doses of routine infant vaccines in their first year of life in Nigeria is low. We explored the associations between child, household, community and health system level factors and FIC, in particular focussing on urban formal and slum, and rural residence, using representative Nigeria Demographic Health Survey (NDHS) data from 2003, 2008 and 2013. Method Multilevel logistic regression models were applied for quantitative analyses of NDHS 2003, 2008 and 2013 data, singly, pooled overall and stratified by rural/urban, and within urban by formal and slum. We also quantify Population Attributable Risk (PAR) of FIC. Results FIC for rural, urban formal and slum rose from 7.4, 25.6 and 24.9% respectively in 2003 to 15.8, 45.5 and 38.5% in 2013, and varied across sociodemographics. In pooled NDHS analysis, overall and stratified, final FIC adjusted odds (aOR) were: 1. Total population - delivery place (health facility vs home, aOR = 1.13, 95% CI = 0.73–1.73), maternal education (higher vs no education, aOR = 3.92, 95% CI = 1.79–8.59) and place of residence (urban vs rural, aOR = 1.69, 95% CI = 0.89–3.22). 2. Rural, urban formal and slum stratified: A.Rural – delivery place (aOR = 1.47, 95% CI = 1.12–1.94), maternal education (aOR = 4.99, 95% CI = 2.48–10.06). B.Urban formal - delivery place (aOR = 2.62, 95% CI = 1.43–4.79), maternal education level (aOR = 9.18, 95% CI = 3.05–27.64). C.Slums - delivery place (aOR = 5.39, 95% CI = 2.18–13.33), maternal education (aOR = 5.03, 95% CI = 1.52–16.65). The PAR revealed the highest percentage point increase in FIC would be achieved in all places of residence by maternal higher education: rural-38.15, urban formal-22.88 and slum 23.76, while non-attendance of antenatal care was estimated to lead to the largest reduction in FIC. Conclusion Although low FIC in rural areas may be largely due to lack of health facilities and immunisation education, the intra-urban disparity is mostly unexplained, and requires further qualitative and interventional research. We show the FIC point increase that can be achieved if specific sociodemographic variable (risk) are addressed in the various communities, thus informing prioritisation of interventions.
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Affiliation(s)
- Olayinka Aderopo Obanewa
- Global Health Research Institute, School of Human Development and Health, Faculty of Medicine, University of Southampton, Southampton, SO17 1BJ, UK.
| | - Marie Louise Newell
- Global Health Research Institute, School of Human Development and Health, Faculty of Medicine, University of Southampton, Southampton, SO17 1BJ, UK.,School of Public Health, Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa
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18
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Bierhoff M, Pinyopornpanish K, Pinyopornpanish K, Tongprasert F, Keereevijit A, Rijken M, Chu CS, Nosten F, Perfetto J, van Vugt M, Mcgready R, Angkurawaranon C. Retrospective Review of Documentation Practices of Hepatitis B Immunoglobulin, Birth Dose, and Vaccination at the Hospital of Birth, in Thai Nationals and Migrants in Northern Thailand. Open Forum Infect Dis 2019; 6:ofz518. [PMID: 31890723 PMCID: PMC6934156 DOI: 10.1093/ofid/ofz518] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2019] [Accepted: 12/06/2019] [Indexed: 12/18/2022] Open
Abstract
Background Vaccination remains the mainstay of prevention of hepatitis B virus (HBV) including birth dose and hepatitis B immunoglobulins (HBIGs). National estimates of vaccination coverage exclude migrants. The objective of this study is to investigate documentation practices of HBV-related infant vaccinations in Northern Thailand including migrants. Methods This is a retrospective review of hospital records of women who birthed infants in 2015 at Maharaj Nakorn Hospital, Chiang Mai (CM) or on the Thailand-Myanmar border, Tak. Results Of 2522 women, 987 were from CM (861 Thai nationals, 126 migrants) and 1535 were from Tak (651 Thai residence and 884 Myanmar residence). In CM, documentation for the birth dose vaccine (999 of 999, 100%) and HBIG was complete. In Tak, documentation was 1441 of 1549 (93%) for birth dose and 26 of 34 (76.5%) for HBIG, with missed opportunities including home delivery, delay in obtaining hepatitis B e-antigen status, and limitations of the records. Expanded Program of Immunization (EPI) documentation of 3 follow-up vaccinations dwindled with subsequent doses and distance, and complete documentation of 3 HBV EPI vaccines at the hospital of birth was low, 41.5% (1056 of 2547), but equitable for Thai or migrant status. Conclusions This review provides strong support for excellent documentation of HBIG and birth dose vaccination in urban and rural settings, and in migrants, consistent with Thailand's vaccination policy and practice. Documentation of the 3 HBV EPI at the hospital of birth decreases with sequential doses, especially in families further away. Innovative data linkage is required to prove coverage and identify gaps.
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Affiliation(s)
- M Bierhoff
- Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Mahidol University, Mae Sot, Thailand.,Division of Infectious Diseases, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | | | - Kanokwan Pinyopornpanish
- Division of Gastroenterology, Department of Internal Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - F Tongprasert
- Department of Obstetrics and Gynecology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Arunrot Keereevijit
- Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Mahidol University, Mae Sot, Thailand
| | - M Rijken
- Utrecht University Medical Centre and Julius Centre Global Health, Utrecht, The Netherlands
| | - C S Chu
- Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Mahidol University, Mae Sot, Thailand.,Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine Research Building, University of Oxford, Oxford, United Kingdom
| | - F Nosten
- Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Mahidol University, Mae Sot, Thailand.,Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine Research Building, University of Oxford, Oxford, United Kingdom
| | - J Perfetto
- New York University School of Medicine, New York, New York, USA
| | - M van Vugt
- Division of Infectious Diseases, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - R Mcgready
- Shoklo Malaria Research Unit, Mahidol-Oxford Tropical Medicine Research Unit, Mahidol University, Mae Sot, Thailand.,Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine Research Building, University of Oxford, Oxford, United Kingdom
| | - C Angkurawaranon
- Department of Family Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
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19
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Anglewicz P, Kidman R, Madhavan S. Internal migration and child health in Malawi. Soc Sci Med 2019; 235:112389. [PMID: 31279254 DOI: 10.1016/j.socscimed.2019.112389] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2018] [Revised: 05/01/2019] [Accepted: 06/28/2019] [Indexed: 11/18/2022]
Abstract
A strong and consistent association between migration and health has been found in many settings, but the overwhelming focus of this research has been on adults. In addition, identifying the effect of migration on health largely remains an unresolved challenge, due in part to the inability to distinguish between the effect of migration on health and the selection of children of differing health status into migration streams. In this research we examine the relationship between internal migration and child health in Malawi. We use longitudinal panel data with pre- and post-migration health measures for children and their mothers, which permits us to measure both migration health selection and the effect of migration on health. We also examine if child health changes over time in post-migration destinations. We do not find evidence of migration health selection: children who move have similar pre-migration health status to non-migrant children. We find that the impact of migration on child health is mediated by mothers' characteristics. Before controlling for mothers' health status, we find a strong negative impact of migration on health, particularly for children moving to rural areas or cities, and children moving due to changes in mothers' marital status. After controlling for mothers' health status, however, the negative impact of migration on child health disappears. We also find that child health is worse with longer durations spent in post-migration residence, compared to children who don't move.
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Affiliation(s)
- Philip Anglewicz
- Johns Hopkins Bloomberg School of Public Health, Department of Population, Family, and Reproductive Health, 615 N. Wolfe Street, 21205 Baltimore MD United States.
| | - Rachel Kidman
- Population and Preventive Medicine, Department of Family, Population and Preventive Medicine, Division of Evaluative Sciences, Division of Community Health, Program in Public Health, Stony Brook, NY 11794, United States.
| | - Sangeetha Madhavan
- Maryland Population Research Center, Departments of African American Studies & Sociology, University of Maryland, 1119 Taliaferro Hall, College Park, MD 20742, United States.
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20
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Horng L, Kakoly NS, Abedin J, Luby SP. Effect of household relocation on child vaccination and health service utilisation in Dhaka, Bangladesh: a cross-sectional community survey. BMJ Open 2019; 9:e026176. [PMID: 30878989 PMCID: PMC6429946 DOI: 10.1136/bmjopen-2018-026176] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
OBJECTIVE To explore the relationship between household relocation and use of vaccination and health services for severe acute respiratory illness (ARI) among children in Dhaka, Bangladesh. DESIGN Analysis of cross-sectional community survey data from a prior study examining the impact of Haemophilus influenzae type b vaccine introduction in 2009 on meningitis incidence in Bangladesh. SETTING Communities surrounding two large paediatric hospitals in Dhaka, Bangladesh. PARTICIPANTS Households with children under 5 years old who either recently relocated <12 months or who were residentially stable living >24 months in their current residence (total n=10 020) were selected for this study. PRIMARY OUTCOME MEASURES Full vaccination coverage among children aged 9-59 months and visits to a qualified medical provider for severe ARI among children under 5 years old. RESULTS Using vaccination cards with maternal recall, full vaccination was 80% among recently relocated children (n=3795) and 85% among residentially stable children (n=4713; χ2=37.2, p<0.001). Among children with ARI in the prior year, 69% of recently relocated children (n=695) had visited a qualified medical provider compared with 82% of residentially stable children (n=763; χ2=31.9, p<0.001). After adjusting for demographic and socioeconomic characteristics, recently relocated children were less likely to be fully vaccinated (prevalence ratio [PR] 0.97; 95% CI 0.95 to 0.99; p=0.016) and to have visited a qualified medical provider for ARI (PR 0.88; 95% CI 0.84 to 0.93; p<0.001). CONCLUSIONS Children in recently relocated households in Dhaka, Bangladesh, have decreased use of vaccination and qualified health services for severe ARI.
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Affiliation(s)
- Lily Horng
- Infectious Diseases and Geographic Medicine, Stanford University, Stanford, California, USA
| | - Nadira Sultana Kakoly
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Jaynal Abedin
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Stephen P Luby
- Infectious Diseases and Geographic Medicine, Stanford University, Stanford, California, USA
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
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Adebowale A, Obembe T, Bamgboye E. Relationship between household wealth and childhood immunization in core-North Nigeria. Afr Health Sci 2019; 19:1582-1593. [PMID: 31148987 PMCID: PMC6531962 DOI: 10.4314/ahs.v19i1.33] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Childhood immunization rate is lowest in the core-North Nigeria. We examined the relationship between inequality in household wealth and complete childhood immunization in that part of the country. METHODS A cross-sectional survey was conducted among 4079 mothers with children 12-23 months of age. Children were considered 'fully-immunized' if they received all the vaccines included in the immunization schedule. Data were analyzed using descriptive statistics and logistic regression models (α=5.0%). RESULTS About 39% and 5.0% children of the rich and poor received complete immunization respectively. Also, 64.2% and 49.6% children of the rich women received BCG and DPT 3 compared to 15.9% and 8.7% observed among the children of the poor. Higher proportion of children from poor households (40.6%) received no immunization than 20.8% found from the rich households. The likelihood of receiving complete immunization was 1.95(C.I=1.35-2.80, p<0.001) times higher among the children of the rich than the poor. Other important predictors of childhood immunization were age, religion, media access, working status, husband's education, prenatal attendants and delivery place. CONCLUSION Disparities existed in childhood immunization between the poor and rich in the core-North part of Nigeria. Policy makers should institute effective interventions that will assist children from poor households to improve their immunization access.
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Affiliation(s)
- Ayo Adebowale
- University of Cape Town, Centre for Actuarial research
- University of Ibadan, Epidemiology and Medical statistics
| | - Taiwo Obembe
- University of Ibadan, Health Policy and Management
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Bawa S, Afolabi M, Abdelrahim K, Abba G, Ningi A, Tafida SY, Tegegne SG, Warigon C, Nomhwange T, Umar SA, Aregay A, Fanti A, Ahmed B, Nsubuga P, Adamu U, Braka F, Wondimagegnehu A, Shuaib F. Transboundary nomadic population movement: a potential for import-export of poliovirus. BMC Public Health 2018; 18:1316. [PMID: 30541502 PMCID: PMC6292162 DOI: 10.1186/s12889-018-6190-2] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Background Nomadic populations have a considerably higher risk of contracting a number of diseases but, despite the magnitude of the public health risks involved, they are mostly underserved with few health policies or plans to target them. Nomadic population movements are shown to be a niche for the transmission of diseases, including poliomyelitis. The nomadic routes traverse the northern states of Nigeria to other countries in the Lake Chad subregion. As part of the February 2016 polio supplemental immunization activity (SIA) plans in Bauchi state, a review of nomadic routes and populations identified a nomadic population who originated from outside the international borders of Nigeria. This study describes the engagement process for a transboundary nomadic population and the interventions provided to improve population immunity among them while traversing through Nigeria. Methods This was an intervention study which involved a cross-sectional mixed-method (quantitative and qualitative) survey. Information was collected on the nomadic pastoralists entry and exit points, resting points, and health-seeking behavior using key informant interviews and semistructured questionnaire. Transit vaccination teams targeted the groups with oral polio vaccines (OPVs) and other routine antigens along identified routes during the months of February to April 2016. Mobile health teams provided immunization and other child and maternal health survival interventions. Results A total of 2015 children aged under 5 years were vaccinated with OPV, of which 264 (13.1%) were zero-dose during the February 2016 SIAs while, in the March immunization plus days (IPDs), 1864 were immunized of which 211 (11.0%) were zero-dose. A total of 296 children aged under 1 year old were given the first dose of pentavalent vaccine (penta 1), while 119 received the third dose (penta 3), giving a dropout rate of 59.8%. Conclusions Nomadic pastoralists move across international borders and there is a need for transboundary policies among the countries in the Lake Chad region to improve population immunity and disease surveillance through a holistic approach using the One-health concept.
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Affiliation(s)
- Samuel Bawa
- World Health Organization, Country Representative Office, Abuja, Nigeria.
| | | | | | - Goni Abba
- World Health Organization, Bauchi State Office, Bauchi, Nigeria
| | - Adamu Ningi
- World Health Organization, Bauchi State Office, Bauchi, Nigeria
| | | | - Sisay G Tegegne
- World Health Organization, Country Representative Office, Abuja, Nigeria
| | - Charity Warigon
- World Health Organization, Country Representative Office, Abuja, Nigeria
| | - Terna Nomhwange
- World Health Organization, Country Representative Office, Abuja, Nigeria
| | | | - Aron Aregay
- World Health Organization, Country Representative Office, Abuja, Nigeria
| | - Ahmed Fanti
- Bauchi state Primary Health Care Development Agency, Bauchi, Nigeria
| | - Bakoji Ahmed
- Bauchi state Primary Health Care Development Agency, Bauchi, Nigeria
| | | | - Usman Adamu
- National Primary Health Care Development Agency, Abuja, Nigeria
| | - Fiona Braka
- World Health Organization, Country Representative Office, Abuja, Nigeria
| | | | - Faisal Shuaib
- National Primary Health Care Development Agency, Abuja, Nigeria
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Ijarotimi IT, Fatiregun AA, Adebiyi OA, Ilesanmi OS, Ajumobi O. Urban-rural differences in immunisation status and associated demographic factors among children 12-59 months in a southwestern state, Nigeria. PLoS One 2018; 13:e0206086. [PMID: 30395617 PMCID: PMC6218029 DOI: 10.1371/journal.pone.0206086] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2018] [Accepted: 10/05/2018] [Indexed: 11/21/2022] Open
Abstract
Vaccine preventable diseases (VPDs) are a leading course of child under-five mortality in sub-Saharan Africa. A target of 95% immunization coverage is necessary for the sustained control of VPDs. This study aims to determine the immunization status and its associated demo-graphic factors among children 12–59 months old in Akinyele Local Government area (LGA), Oyo State, Nigeria. A community-based cross-sectional study was carried out in one urban and one rural ward of Akinyele LGA. Fourhundred and forty-four (449) Under-five children were selected by multistage sampling technique. Data were collected from caregivers using interviewer administered questionnaires. Odds ratios at 95% CIand Chi square at 5% significant level were computed to identify the factors associated with non or partial immunisation. Multiple logistics regression at 5% significance level was done to determine the socio-demographic determinants of immunisation status. Overall, 449 children aged 12–59 months were surveyed of which 213(47.4%) were males and 236(52.6%) were from urban area. Overall, 365(81.3%) was fully immunized, 75(16.7%) was partially immunized and 9(2.0%) had never been immunized. Predictors of a child being partially or un-immunised were being in the fourth wealth quintile (AOR 7.9; 95%CI: 2.7–18.0), poorest wealth quintile (AOR 14.5; 95%CI 4.2–20.5), having a mother with no education (AOR 6.4; 95%CI: 2.9–14.1) and a mother that practiced Islam (AOR: 2.2; 95%CI: 1.3–3.7). Immunisation coverage was somewhat high but still suboptimal among the study population. Strategies that improve female literacy and those that target religious institutions may be effective in improving immunisation uptake.
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Affiliation(s)
- Ibidolapo T. Ijarotimi
- Nigeria Field Epidemiology and Laboratory Training Program, Asokoro, Abuja, Nigeria
- * E-mail:
| | | | | | - Olayinka S. Ilesanmi
- Nigeria Field Epidemiology and Laboratory Training Program, Asokoro, Abuja, Nigeria
| | - Olufemi Ajumobi
- Nigeria Field Epidemiology and Laboratory Training Program, Asokoro, Abuja, Nigeria
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Kusuma Y, Kaushal S, Sundari A, Babu B. Access to childhood immunisation services and its determinants among recent and settled migrants in Delhi, India. Public Health 2018; 158:135-143. [DOI: 10.1016/j.puhe.2018.03.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2017] [Revised: 02/27/2018] [Accepted: 03/01/2018] [Indexed: 11/25/2022]
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Abstract
The objective of this project was to document and increase vaccine coverage in migrant school children on the Thailand-Myanmar border. Migrant school children (n = 12,277) were enrolled in a school-based immunization program in four Thai border districts. The children were evaluated for vaccination completion and timing, for six different vaccines: Bacille Calmette-Guerin (BCG); Oral Polio vaccine (OPV); Hepatitis B vaccine (HepB); Diphtheria, Pertussis and Tetanus vaccine (DTP); Measles Containing Vaccine or Measles, Mumps and Rubella vaccine (MMR); Tetanus and Diphtheria containing vaccine (Td). Vaccine coverage proportions for BCG, OPV3, DTP3, HepB3 and measles containing vaccine were 92.3, 85.3, 63.8, 72.2, and 90.9 % respectively. Most children were able to receive vaccines in a time appropriate manner. School-based immunization programs offer a suitable vaccine delivery mechanism for hard-to-reach populations. However, these data suggest overall low vaccine coverage in migrant populations. Further efforts toward improving appropriate vaccine coverage and methods of retaining documentation of vaccination in mobile migrant populations are necessary for improved health.
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Ozawa S, Wonodi C, Babalola O, Ismail T, Bridges J. Using best-worst scaling to rank factors affecting vaccination demand in northern Nigeria. Vaccine 2017; 35:6429-6437. [PMID: 29037575 DOI: 10.1016/j.vaccine.2017.09.079] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2016] [Revised: 08/25/2017] [Accepted: 09/26/2017] [Indexed: 10/18/2022]
Abstract
BACKGROUND Understanding and ranking the reasons for low vaccination uptake among parents in northern Nigeria is critical to implement effective policies to save lives and prevent illnesses. This study applies best-worst scaling (BWS) to rank various factors affecting parents' demand for routine childhood immunization. METHODS We conducted a household survey in Nahuche, Zamfara State in northern Nigeria. Nearly two hundred parents with children under age five were asked about their views on 16 factors using a BWS technique. These factors focused on known attributes that influence the demand for childhood immunization, which were identified from a literature review and reviewed by a local advisory board. The survey systematically presented parents with subsets of six factors and asked them to choose which they think are the most and least important in decisions to vaccinate children. We used a sequential best-worst analysis with conditional logistic regression to rank factors. RESULTS The perception that vaccinating a child makes one a good parent was the most important motivation for parents in northern Nigeria to vaccinate children. Statements related to trust and social norms were ranked higher in importance compared to those that highlighted perceived benefits and risks, healthcare service, vaccine information, or opportunity costs. Fathers ranked trust in the media and views of their leaders to be of greatest importance, whereas mothers placed greater importance on social perceptions and norms. Parents of children without routine immunization ranked their trust in local leaders about vaccines higher in considerations, and the media's views lower, compared to parents with children who received routine immunization. CONCLUSIONS Framing immunization messages in the context of good parenting and hearing these messages from trusted information sources may motivate parental uptake of childhood vaccines. These results are useful to policymakers to prioritize resources in order to increase awareness and demand for childhood immunization.
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Affiliation(s)
- Sachiko Ozawa
- Division of Practice Advancement and Clinical Education, UNC Eshelman School of Pharmacy, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA; Department of Maternal and Child Health, UNC Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
| | - Chizoba Wonodi
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Olufemi Babalola
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Tukur Ismail
- Department of Social and Preventive Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - John Bridges
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA; Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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Akinyemi JO, Odimegwu CO, Adebowale AS. The effect of internal migration, individual and contextual characteristics on contraceptive use among Nigerian women. Health Care Women Int 2017. [PMID: 28644720 DOI: 10.1080/07399332.2017.1345908] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
We investigated the relation of internal migration to contraceptive use and adjusted for individual and contextual (community) characteristics. Multilevel logistic regression models were fitted to nationally representative data of 28,876 women from 884 communities in Nigeria. Only about one out of every 10 women (10.4%) currently used a contraceptive method. Contraceptive prevalence according to the migration status were rural-urban (12.5%), urban-rural (13.8%), rural nonmigrants (6.2%) and urban nonmigrants (17.1%). The relationship between internal migration and contraceptive use was fully explained by individual and community characteristics. Programs aimed at increasing contraceptive prevalence should address contextual challenges alongside socioeconomic factors.
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Affiliation(s)
- Joshua O Akinyemi
- a Demography and Population Studies Programme, Schools of Public Health and Social Sciences , University of the Witwatersrand , Johannesburg , South Africa.,b Department of Epidemiology and Medical Statistics, Faculty of Public Health, College of Medicine , University of Ibadan , Ibadan , Nigeria
| | - Clifford O Odimegwu
- a Demography and Population Studies Programme, Schools of Public Health and Social Sciences , University of the Witwatersrand , Johannesburg , South Africa
| | - Ayo S Adebowale
- b Department of Epidemiology and Medical Statistics, Faculty of Public Health, College of Medicine , University of Ibadan , Ibadan , Nigeria
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Crocker-Buque T, Mindra G, Duncan R, Mounier-Jack S. Immunization, urbanization and slums - a systematic review of factors and interventions. BMC Public Health 2017; 17:556. [PMID: 28595624 PMCID: PMC5465583 DOI: 10.1186/s12889-017-4473-7] [Citation(s) in RCA: 76] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2016] [Accepted: 05/28/2017] [Indexed: 12/23/2023] Open
Abstract
Background In 2014, over half (54%) of the world’s population lived in urban areas and this proportion will increase to 66% by 2050. This urbanizing trend has been accompanied by an increasing number of people living in urban poor communities and slums. Lower immunization coverage is found in poorer urban dwellers in many contexts. This study aims to identify factors associated with immunization coverage in poor urban areas and slums, and to identify interventions to improve coverage. Methods We conducted a systematic review, searching Medline, Embase, Global Health, CINAHL, Web of Science and The Cochrane Database with broad search terms for studies published between 2000 and 2016. Results Of 4872 unique articles, 327 abstracts were screened, leading to 63 included studies: 44 considering factors and 20 evaluating interventions (one in both categories) in 16 low or middle-income countries. A wide range of socio-economic characteristics were associated with coverage in different contexts. Recent rural-urban migration had a universally negative effect. Parents commonly reported lack of awareness of immunization importance and difficulty accessing services as reasons for under-immunization of their children. Physical distance to clinics and aspects of service quality also impacted uptake. We found evidence of effectiveness for interventions involving multiple components, especially if they have been designed with community involvement. Outreach programmes were effective where physical distance was identified as a barrier. Some evidence was found for the effective use of SMS (text) messaging services, community-based education programmes and financial incentives, which warrant further evaluation. No interventions were identified that provided services to migrants from rural areas. Conclusion Different factors affect immunization coverage in different urban poor and slum contexts. Immunization services should be designed in collaboration with slum-dwelling communities, considering the local context. Interventions should be designed and tested to increase immunization in migrants from rural areas. Electronic supplementary material The online version of this article (doi:10.1186/s12889-017-4473-7) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Tim Crocker-Buque
- Health Protection Research Unit in Immunisation, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, London, WC1H 9SH, UK.
| | - Godwin Mindra
- Programme Division, Health Section, UNICEF Headquarters, 3 United Nations Plaza, New York, 10017, USA
| | - Richard Duncan
- Programme Division, Health Section, UNICEF Headquarters, 3 United Nations Plaza, New York, 10017, USA
| | - Sandra Mounier-Jack
- Health Protection Research Unit in Immunisation, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, London, WC1H 9SH, UK
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Adeloye D, Jacobs W, Amuta AO, Ogundipe O, Mosaku O, Gadanya MA, Oni G. Coverage and determinants of childhood immunization in Nigeria: A systematic review and meta-analysis. Vaccine 2017; 35:2871-2881. [PMID: 28438406 DOI: 10.1016/j.vaccine.2017.04.034] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2016] [Revised: 03/01/2017] [Accepted: 04/12/2017] [Indexed: 11/26/2022]
Abstract
INTRODUCTION The proportion of fully immunized children in Nigeria is reportedly low. There are concerns over national immunization data quality, with this possibly limiting country-wide response. We reviewed publicly available evidence on routine immunization across Nigeria to estimate national and zonal coverage of childhood immunization and associated determinants. METHODS A systematic search of Medline, EMBASE, Global Health and African Journals Online (AJOL) was conducted. We included population-based studies on childhood immunization in Nigeria. A random effects meta-analysis was conducted on extracted crude rates to arrive at national and zonal pooled estimates for the country. RESULTS Our search returned 646 hits. 21 studies covering 25 sites and 26,960 children were selected. The estimated proportion of fully immunized children in Nigeria was 34.4% (95% confidence interval [CI]: 27.0-41.9), with South-south zone having the highest at 51.5% (95% CI: 20.5-82.6), and North-west the lowest at 9.5% (95% CI: 4.6-14.4). Mother's social engagements (OR=4.0, 95% CI: 1.9-8.1) and vaccines unavailability (OR=3.9, 95% CI: 1.2-12.3) were mostly reported for low coverage. Other leading determinants were vaccine safety concerns (OR=3.0, 95% CI: 0.9-9.4), mother's low education (OR=2.5, 95% CI: 1.8-3.6) and poor information (OR=2.0, 95% CI: 0.8-4.7). CONCLUSION Our study suggests a low coverage of childhood immunization in Nigeria. Due to the paucity of data in the Northern states, we are still uncertain of the quality of evidence presented. It is hoped that this study will prompt the needed research, public health and policy changes toward increased evenly-spread coverage of childhood immunization in the country.
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Affiliation(s)
- Davies Adeloye
- Demography and Social Statistics, Covenant University, PMB 1023, Ota, Ogun State, Nigeria; Centre for Global Health Research, Usher Institute, University of Edinburgh, UK.
| | - Wura Jacobs
- Department of Health Science, California State University, Fullerton, CA, USA
| | - Ann O Amuta
- Department of Health Studies, Texas Woman's University, Denton, TX, USA
| | - Oluwatomisin Ogundipe
- Economics and Development Studies, Covenant University, PMB 1023, Ota, Ogun State, Nigeria
| | - Oluwaseun Mosaku
- Computer and Information Sciences, Covenant University, PMB 1023, Ota, Ogun State, Nigeria
| | - Muktar A Gadanya
- Department of Community Medicine, Aminu Kano Teaching Hospital/Bayero University, Kano, Nigeria
| | - Gbolahan Oni
- Demography and Social Statistics, Covenant University, PMB 1023, Ota, Ogun State, Nigeria
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Baguune B, Ndago JA, Adokiya MN. Immunization dropout rate and data quality among children 12-23 months of age in Ghana. ACTA ACUST UNITED AC 2017; 75:18. [PMID: 28428878 PMCID: PMC5392923 DOI: 10.1186/s13690-017-0186-8] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2016] [Accepted: 02/21/2017] [Indexed: 11/24/2022]
Abstract
Background Immunization against diseases is one of the most important public health interventions with cost effective means to preventing childhood morbidity, mortality and disability. However, a proportion of children particularly in Africa are not fully immunized with the recommended vaccines. Thus, many children are still susceptible to the Expanded Program on Immunization (EPI) targeted diseases. The objective of this study was to determine the immunization dropout rate and data quality among children aged 12–23 months in Techiman Municipality, Ghana. Methods A cross-sectional cluster survey was conducted among 600 children. Data was collected using semi-structured questionnaire through face-to-face interviews. Before the main data collection, the tools were pre-tested in three different communities in the Municipality. The mothers/caregivers were interviewed, extracted information from the child immunization cards and observation employed to confirm the presence of Bacillus Calmette-Guerin (BCG) scar on each child. Routine immunization data was also extracted from immunization registers and annual reports in the Municipality. Results Immunization coverage for each of the fifteen vaccines doses is above 90.0% while full childhood immunized status is 89.5%. Immunization dropout rate was 5.6% (using BCG and Measles as proxy vaccines). This is lower than the 10.0% cutoff point by World Health Organization. However, routine administrative data was characterized by some discrepancies (e.g. > 100.0% immunization coverage for each of the vaccines) and high dropout rate (BCG - Measles = 31.5%). Binary regression was performed to determine predictors of dropout rate. The following were statistically significant: married (OR = 0.31; 95% = CI 0.15–0.62; and p = 0.001), Christianity (OR = 0.27; 95% CI = 0.13–0.91; and p < 0.001), female child (OR = 0.50; 95% CI = 0.26–0.91; and p = 0.024) and possession of immunization card (OR = 50.3; 95% CI = 14.40–175.92; and p < 0.001) were found to be associated with immunization dropout. Conclusion Childhood full immunized status (89.5%) and immunization coverages (>90%) are high while dropout rate is lower than the recommended cutoff point by WHO. However, immunization data quality remains inadequate. Thus, health education and orientation of service providers is urgently needed. In addition, immunization registers and data quality are issues that require attention.
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Affiliation(s)
- Benjamin Baguune
- Department of Community Health, School of Allied Health Sciences, University for Development Studies, Tamale, Ghana.,School of Hygiene, Environmental Health Programme, Ministry of Health, Box 88, Tamale, Ghana
| | - Joyce Aputere Ndago
- Department of Nursing, School of Allied Health Sciences, University for Development Studies, Tamale, Ghana
| | - Martin Nyaaba Adokiya
- Department of Community Health, School of Allied Health Sciences, University for Development Studies, Tamale, Ghana
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Sibeudu FT, Uzochukwu BSC, Onwujekwe OE. Investigating socio-economic inequity in access to and expenditures on routine immunization services in Anambra state. BMC Res Notes 2017; 10:78. [PMID: 28143605 PMCID: PMC5286773 DOI: 10.1186/s13104-017-2407-1] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2016] [Accepted: 01/25/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Addressing existing inequities in the utilization of priority health services such as routine immunization is a current public health priority. Increasing access to routine immunization from the current low levels amongst all socio-economic status groups in Nigeria is challenging. However, little is known on the level of SES inequity in utilization of routine immunization services and such information which will inform the development of strategies for ensuring equitable provision of routine immunization services in the country. The study was a cross sectional household survey, which was undertaken in two randomly selected communities in Anambra State, southeast Nigeria. A pre-tested interviewer administered questionnaire was used to collect data on levels of access to RI by children under-2 years from randomly selected households. In each household, data was collected from the primary care givers or their representative (in their absence). The relationship between access to routine immunization and socio-economic status of households and other key variables was explored in data analysis. RESULT Households from high socio-economic status (well-off) groups utilized routine immunization services more than those that belong to low socio-economic status (poor) groups (X2 = 9.97, p < 0.002). It was found that higher percentage of low socio-economic status households compared to the high socio-economic status households received routine immunization services at public health facilities. Households that belong to low socio-economic status groups had to travel longer distance to get to health facilities consequently incurring some transportation cost. The mean expenditures on service charge for routine immunization services (mostly informal payments) and transportation were US$1.84 and US$1.27 respectively. Logistic regression showed that access to routine immunization was positively related to socio-economic status and negatively related to distant of a household to a health facility. CONCLUSION Ability to pay affects access to services, even when such services are free at point of consumption with lower socio-economic status groups having less access to services and also having other constraints such as transportation. Hence, innovative provision methods that will bring routine immunization services closer to the people and eliminate all formal and informal user fees for routine immunization will help to increase and improve equitable coverage with routine immunization services.
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Affiliation(s)
- Florence T. Sibeudu
- Department of Nursing Science, NnamdiAzikiwe University, Nnewi Campus, Nnewi, Nigeria
- Department of Health Administration and Management, University of Nigeria, Enugu Campus, Enugu, Nigeria
| | - Benjamin S. C. Uzochukwu
- Department of Community Medicine, University of Nigeria, Enugu Campus, Enugu, Nigeria
- Health Policy Research Group, Department of Pharmacology and Therapeutics, University of Nigeria, Enugu Campus, Enugu, Nigeria
| | - Obinna E. Onwujekwe
- Health Policy Research Group, Department of Pharmacology and Therapeutics, University of Nigeria, Enugu Campus, Enugu, Nigeria
- Department of Health Administration and Management, University of Nigeria, Enugu Campus, Enugu, Nigeria
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Adebowale SA, Morakinyo OM, Ana GR. Housing materials as predictors of under-five mortality in Nigeria: evidence from 2013 demographic and health survey. BMC Pediatr 2017; 17:30. [PMID: 28103828 PMCID: PMC5248529 DOI: 10.1186/s12887-016-0742-3] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2016] [Accepted: 11/28/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Nigeria is among countries with high Under-Five Mortality (U5M) rates worldwide. Both maternal and childhood factors have been linked to U5M in the country. However, despite the growing global recognition of the association between housing and quality of life, the role of housing materials as predictors of U5M remain largely unexplored in Nigeria. This study, therefore, investigated the relationship between housing materials and U5M in Nigeria. METHODS The study utilised the 2013 Nigeria Demographic and Health Survey data. A representative sample of 40,680 households was selected for the survey. The sample included 18,516 women of reproductive age who had given birth in the past 5 years prior the survey; with attention on the survival status of the index child (the most recent delivery). Data were analysed using descriptive statistics, Chi-square, Cox-proportional hazard and Brass 2-parameter models (α = 0.05). RESULTS The hazard ratio of U5M was 1.46 (C.I = 1.02-1.47, p < 0.001) and 1.23 (C.I = 1.24-1.71, p < 0.001) higher among children who lived in houses built with inadequate and moderate housing materials respectively than those in good housing materials. Under-five deaths show a downward trend (slope = -0.4871) relative to the housing materials assessment score. The refined U5M rate was 143.5, 127.0 and 90.8 per 1000 live birth among women who live in houses built with inadequate, moderate and adequate housing materials respectively. Other predictors of U5M were; the size of the child at birth, preceding birth interval, prenatal care provider, residence and education. Under-five death reduces with increasing maternal level of; education, wealth quintile, media exposure and housing material type and mostly experienced by Muslim women (6.0%), rural women (6.5%) and women residence in the North-West geopolitical zones (6.9%). CONCLUSIONS Living in houses built with poor housing materials promoted U5M in Nigeria. Provision of sustainable housing by the government and the maintenance of existing housing stock to healthful conditions will play a significant role in reducing the burden of U5M in Nigeria.
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Affiliation(s)
- Stephen Ayo Adebowale
- Department of Epidemiology and Medical Statistics, Faculty of Public Health, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Oyewale Mayowa Morakinyo
- Department of Environmental Health Sciences, Faculty of Public Health, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Godson Rowland Ana
- Department of Environmental Health Sciences, Faculty of Public Health, College of Medicine, University of Ibadan, Ibadan, Nigeria
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Abstract
SummaryThis study aimed to understand access to maternal health care and the factors shaping it amongst poor migrants in Mumbai, India. A cross-sectional mixed methods approach was used. It included multistage cluster sampling and face-to-face interviews, through structured interview schedules, of 234 migrant women who had delivered in the two years previous to the date they were interviewed. Qualitative in-depth interviews of migrant women, health care providers and health officials were also conducted to understand community and provider perspectives. The results showed that access to antenatal care was poor among migrants with less than a third of them receiving basic antenatal care and a quarter delivering at home. Multivariate analysis highlighted that amongst migrant women those who stayed in Mumbai during pregnancy and delivery had better access to maternal health care than those who went back to their home towns. Poor maternal health care was also due to weaker demand for health care as a result of the lack of felt-need among migrants due to socio-cultural factors and lack of social support for, and knowledge of, health facilities in the city. Supply-side factors such as inadequate health infrastructure at primary and secondary levels, lack of specific strategies to improve access to health care for migrants and cumbersome administrative procedures that exclude migrants from certain government programmes all need to be addressed. Migrants should be integral to the urban development process and policies should aim at preventing their exclusion from basic amenities and their entitlements as citizens.
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Awoh AB, Plugge E. Immunisation coverage in rural-urban migrant children in low and middle-income countries (LMICs): a systematic review and meta-analysis. J Epidemiol Community Health 2016; 70:305-11. [PMID: 26347277 PMCID: PMC4789817 DOI: 10.1136/jech-2015-205652] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2015] [Revised: 07/06/2015] [Accepted: 08/04/2015] [Indexed: 11/04/2022]
Abstract
BACKGROUND The majority of children who die from vaccine-preventable diseases (VPDs) live in low-income and-middle-income countries (LMICs). With the rapid urbanisation and rural-urban migration ongoing in LMICs, available research suggests that migration status might be a determinant of immunisation coverage in LMICs, with rural-urban migrant (RUM) children being less likely to be immunised. OBJECTIVES To examine and synthesise the data on immunisation coverage in RUM children in LMICs and to compare coverage in these children with non-migrant children. METHODS A multiple database search of published and unpublished literature on immunisation coverage for the routine Expanded Programme on Immunisation (EPI) vaccines in RUM children aged 5 years and below was conducted. Following a staged exclusion process, studies that met the inclusion criteria were assessed for quality and data extracted for meta-analysis. RESULTS Eleven studies from three countries (China, India and Nigeria) were included in the review. There was substantial statistical heterogeneity between the studies, thus no summary estimate was reported for the meta-analysis. Data synthesis from the studies showed that the proportion of fully immunised RUM children was lower than the WHO bench-mark of 90% at the national level. RUMs were also less likely to be fully immunised than the urban-non-migrants and general population. For the individual EPI vaccines, all but two studies showed lower immunisation coverage in RUMs compared with the general population using national coverage estimates. CONCLUSIONS This review indicates that there is an association between rural-urban migration and immunisation coverage in LMICs with RUMs being less likely to be fully immunised than the urban non-migrants and the general population. Specific efforts to improve immunisation coverage in this subpopulation of urban residents will not only reduce morbidity and mortality from VPDs in migrants but will also reduce health inequity and the risk of infectious disease outbreaks in wider society.
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Affiliation(s)
- Abiyemi Benita Awoh
- Nuffield Department of Medicine, Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, Oxfordshire, UK
| | - Emma Plugge
- Nuffield Department of Medicine, Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, Oxfordshire, UK
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Negussie A, Kassahun W, Assegid S, Hagan AK. Factors associated with incomplete childhood immunization in Arbegona district, southern Ethiopia: a case--control study. BMC Public Health 2016; 16:27. [PMID: 26757893 PMCID: PMC4711011 DOI: 10.1186/s12889-015-2678-1] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2014] [Accepted: 12/22/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The prevention of child mortality through immunization is one of the most cost-effective and widely applied public health interventions. In Ethiopia, the Expanded Program on Immunization (EPI) schedule is rarely completed as planned and the full immunization rate is only 24%. The objective of this study was to identify determinant factors of incomplete childhood immunization in Arbegona district, Sidama zone, southern Ethiopia. METHODS A community based unmatched case-control study was undertaken among randomly selected children aged 12 to 23 months and with a total sample size of 548 (183 cases and 365 controls). A multi-stage sampling technique was used to get representative cases and controls. Data was collected using a structured questionnaire and analyzed using SPSS version 16 statistical software. Bivariate and multiple logistic regression analyses were done to identify independent factors for incomplete immunization status of children. Qualitative data were also generated and analyzed using thematic framework. RESULTS The incomplete immunization status of children was significantly associated with young mothers (AOR = 9.54; 95% CI = 5.03, 18.09), being born second to fourth (AOR = 3.64; 95% CI = 1.63, 8.14) and being born fifth or later in the family (AOR = 5.27; 95% CI = 2.20, 12.64) as compared to being born first, a mother's lack of knowledge about immunization benefits (AOR = 5.51; 95% CI = 1.52, 19.94) and a mother's negative perception of vaccine side effects (AOR = 1.92; 95% CI = 1.01, 3.70). The qualitative finding revealed that the migration of mothers and unavailability of vaccines on appointed immunization dates were the major reasons for partial immunization of children. CONCLUSION To reduce the number of children with incomplete immunization status, the Arbegona district needs to consider specific planning for mothers with these risk profiles. A focus on strengthening health communication activities to raise immunization awareness and address concerns of vaccine side effects at community level is also needed. This could be achieved through integrating the immunization service to other elements of primary health care.
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Affiliation(s)
- Abel Negussie
- Department of Social and Population Health, Yirgalem Medical Science College, Yirgalem, Ethiopia.
| | - Wondewosen Kassahun
- Department of Epidemiology and Biostatistics, College of Public Health and Medicine, Jimma University, Jimma, Ethiopia.
| | - Sahilu Assegid
- Department of Epidemiology and Biostatistics, College of Public Health and Medicine, Jimma University, Jimma, Ethiopia.
| | - Ada K Hagan
- Department of Microbiology and Immunology, Hanna Lab, University of Michigan Medical School, Ann Harbor, USA.
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Tchidjou HK, Vescio MF, Sanou Sobze M, Souleyman A, Stefanelli P, Mbabia A, Moussa I, Gentile B, Colizzi V, Rezza G. Low vaccine coverage among children born to HIV infected women in Niamey, Niger. Hum Vaccin Immunother 2016; 12:540-4. [PMID: 26237156 PMCID: PMC5049730 DOI: 10.1080/21645515.2015.1069451] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2015] [Revised: 06/10/2015] [Accepted: 06/30/2015] [Indexed: 10/23/2022] Open
Abstract
BACKGROUND The effect of mother's HIV-status on child vaccination is an important public health issue in countries with high HIV prevalence. We conducted a study in a primary healthcare center located in Niamey, the capital of Niger, which offers free of charge services to HIV positive and/or underprivileged mothers, with the aim of assessing: 1) vaccination coverage for children 0-36 months old, born to HIV-infected mothers, and 2) the impact of maternal HIV status on child vaccination. METHODS Mothers of children less than 36 months old attending the center were interviewed, to collect information on vaccines administered to their child, and family's socio-demographic characteristics. RESULTS Overall, 502 children were investigated. Children of HIV-seropositive mothers were less likely to receive follow up vaccinations for Diphtheria-Tetanus-Pertussis (DTP) than those of HIV-seronegative mothers, with a prevalence ratio (PR) of 2.03 (95%CI: 1.58-2.61). Children born to HIV-seropositive mothers were less likely to miss vaccination for MMR than those born to HIV negative mothers, with a RR of 0.46 (95%CI: 0.30-0.72). CONCLUSIONS Vaccine coverage among children born to HIV infected mothers was rather low. It is important to favor access to vaccination programs in this population.
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Affiliation(s)
| | - Maria Fenicia Vescio
- Department of Infectious; Parasitic and Immunomediated Diseases; Istituto Superiore di Sanità; Rome, Italy
| | | | | | - Paola Stefanelli
- Department of Infectious; Parasitic and Immunomediated Diseases; Istituto Superiore di Sanità; Rome, Italy
| | - Adalbert Mbabia
- Department of Public Health; University of Rome “Tor Vergata”; Rome, Italy
| | - Ide Moussa
- National Coordination for Intersectoral Coordination for the Response against STI/HIV/AIDS; Niamey, Niger
| | - Bruno Gentile
- Italian Cooperation of Sub-Saharan Africa; Niamey, Niger
| | - Vittorio Colizzi
- Department of Biology; University of Rome “Tor Vergata”; Rome, Italy
| | - Giovanni Rezza
- Department of Infectious; Parasitic and Immunomediated Diseases; Istituto Superiore di Sanità; Rome, Italy
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Smith-Greenaway E, Madhavan S. Maternal migration and child health: An analysis of disruption and adaptation processes in Benin. SOCIAL SCIENCE RESEARCH 2015; 54:146-58. [PMID: 26463540 PMCID: PMC4833091 DOI: 10.1016/j.ssresearch.2015.06.005] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/01/2014] [Revised: 03/12/2015] [Accepted: 06/08/2015] [Indexed: 05/28/2023]
Abstract
Children of migrant mothers have lower vaccination rates compared to their peers with non-migrant mothers in low-income countries. Explanations for this finding are typically grounded in the disruption and adaptation perspectives of migration. Researchers argue that migration is a disruptive process that interferes with women's economic well-being and social networks, and ultimately their health-seeking behaviors. With time, however, migrant women adapt to their new settings, and their health behaviors improve. Despite prominence in the literature, no research tests the salience of these perspectives to the relationship between maternal migration and child vaccination. We innovatively leverage Demographic and Health Survey data to test the extent to which disruption and adaptation processes underlie the relationship between maternal migration and child vaccination in the context of Benin-a West African country where migration is common and child vaccination rates have declined in recent years. By disaggregating children of migrants according to whether they were born before or after their mother's migration, we confirm that migration does not lower children's vaccination rates in Benin. In fact, children born after migration enjoy a higher likelihood of vaccination, whereas their peers born in the community from which their mother eventually migrates are less likely to be vaccinated. Although we find no support for the disruption perspective of migration, we do find evidence of adaptation: children born after migration have an increased likelihood of vaccination the longer their mother resides in the destination community prior to their birth.
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Affiliation(s)
| | - Sangeetha Madhavan
- Institute of Behavioral Science, University of Colorado Boulder, USA; MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa; Department of African and African-American Studies, University of Maryland, USA
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Nath L, Kaur P, Tripathi S. Evaluation of the Universal Immunization Program and Challenges in Coverage of Migrant Children in Haridwar, Uttarakhand, India. Indian J Community Med 2015; 40:239-45. [PMID: 26435596 PMCID: PMC4581143 DOI: 10.4103/0970-0218.164389] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Studies show that immunization among migrant children is poor. India has a dropout rate of 17.7% between Bacillus Calmette-Guιrin (BCG) and measles (District Level Household Survey (DLHS)-3). Haridwar district had the highest dropout rate of 27.4% from BCG to diphtheria, pertussis, and tetanus (DPT) 3 (DLHS-3) in Uttarakhand. We evaluated the Universal Immunization Programme (UIP) among migrants in Haridwar in two blocks. MATERIALS AND METHODS We developed input, process, and output indicators on infrastructure, human resources, and service delivery. A facility, session site and cross-sectional survey of 180 children were done and proportions for various indicators were estimated. We determined factors associated with not taking vaccination using multivariate analysis. RESULTS We surveyed 11 cold chain centers, 25 subcenters, 14 sessions, and interviewed 180 mothers. Dropouts were supposed to be tracked using vaccination card counterfoils and tracking registers. The dropout rate from BCG to DPT3 was 30%. Lack of knowledge (adjusted odds ratio (AOR) 6.6,95% confidence interval (CI) 2.6-16.7), mother not being decision maker (AOR 4.0,95%CI 1.7-9.2), lack of contact by Accredited Social Health Activist (ASHA; AOR 3.0,95%CI 1.1-7.7), not being given four post-vaccination messages (AOR 7.7, 95% CI 2.9-20.2), and longer duration of stay in Haridwar (AOR 3.0 95% 1.9-7.6) were risk factors for nonimmunization. The reasons stated by mothers included lack of awareness of session site location (67%) and belief that child should only be vaccinated in their resident district (43%). CONCLUSIONS There was low immunization coverage among migrants within adequate supervision, poor cold chain maintenance, and improper tracking of dropouts. Mobile immunization teams, prelisting of migrant children, and change in incentives of ASHAs for child tracking were needed. A monitoring plan for sessions and cold chain needed enforcement.
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Affiliation(s)
- Latika Nath
- Master of Public Health scholar, National Institute of Epidemiology, Chennai, Tamil Nadu, India
| | - Prabhdeep Kaur
- Scientist C, Department of Health Systems Research, National Institute of Epidemiology, Chennai, Tamil Nadu, India
| | - Saurabh Tripathi
- Surveillance Medical Officer, National Polio Surveillance Project, Haridwar, Uttarakhand, India
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Level of immunization coverage and associated factors among children aged 12-23 months in Lay Armachiho District, North Gondar Zone, Northwest Ethiopia: a community based cross sectional study. BMC Res Notes 2015; 8:239. [PMID: 26071403 PMCID: PMC4467673 DOI: 10.1186/s13104-015-1192-y] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2014] [Accepted: 05/20/2015] [Indexed: 11/10/2022] Open
Abstract
Background Immunization against childhood disease is one of the most important public health interventions with cost effective means to preventing childhood morbidity, mortality and disability. However, complete immunization coverage remains low particularly in rural areas of Ethiopia. This study aimed to assess the level of immunization coverage and associated factors in Lay Armachiho District, North Gondar zone, Northwest Ethiopia. A community based cross-sectional study was conducted in March, 2014 among 751 pairs of mothers to children aged 12–23 months in Lay Armachiho District. A two stage sampling technique was employed. Logistic regression analysis was carried out to compute association between factors and immunization status of children. Backwards stepwise regression method was used and those variables significant at p value 0.05 were considered statistically significant. Results Seventy-six percent of the children were fully immunized during the study period. Dropout rate was 6.5% for BCG to measles, 2.7% for Penta1 to Penta3 and 4.5% for Pnemonia1 to Pnemonia3. The likelihood of children to be fully immunized among mothers who identified the number of sessions needed for vaccination were higher than those who did not [AOR = 2.8 (95% C1 = 1.89, 4.2)]. Full immunization status of children was higher among mothers who know the age at which the child become fully immunized than who did not know [AOR = 2.93 (95% CI = 2.02, 4.3)]. Taking tetanus toxoid immunization during pregnancy showed statistically significant association with full immunization of children [AOR 1.6 (95% CI = 1.06, 2.62)]. Urban children were more likely to be fully immunized than rural [AOR = 1.82 (95% CI = 1.15, 2.80)] and being male were more likely to be fully immunized than female [AOR = 1.80 (95% CI = 1.26, 2.6)]. Conclusion and recommendation Vaccination coverage was low compared to the Millennium Development Goals target. It is important to increase and maintain the immunization level to the intended target. Efforts should be made to promote women‘s’ awareness on tetanus toxoid immunization, when the child should start vaccination, number of sessions needed to complete immunization, and when a child become complete vaccination to improve immunization coverage through health development army and health professionals working at antenatal care, postnatal care and immunization units.
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Sharma V, Singh A, Sharma V. Provider's and user's perspective about immunization coverage among migratory and non-migratory population in slums and construction sites of Chandigarh. J Urban Health 2015; 92:304-12. [PMID: 25690459 PMCID: PMC4411318 DOI: 10.1007/s11524-015-9939-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Strengthening routine immunization is a corner stone for countries to achieve the United Nations Millennium Development Goal 4 (MDG 4) which aims to reduce under-five mortality by two-thirds and MDG 5 improving maternal health compared to 1990 estimates by 2015. The poor urban newborns are more vulnerable to many health and nutrition problems compared to the non-poor urban counterparts. Therefore there is a need to strengthen health system to cater the needs of urban poor. Standardized WHO30*7 cluster sampling for slums and convenience sampling for construction sites. In depth interviews were conducted for user's as well as provider's perspective about immunization coverage. Two hundred ten children and 210 mothers were enrolled in slums and 100 were sampled from construction sites. The slum workers are considered as non-migratory groups whereas construction site workers are considered as migratory population. Among children, 23 % were fully immunized, 73 % were partially immunized and 3 % were unimmunized in non-migratory population whereas 3 % were fully immunized, 91 % were partially immunized and 6 % were unimmunized in migratory population. Among mothers, 43 and 39 % were fully immunized, 13 and 15 % partially immunized and 43 and 46 % were unimmunized in non-migratory and migratory population, respectively. The various reasons attributed for low coverage are (a) dissatisfaction of the users with the service delivery and procedural delays (bureaucracy), (b) lack of faith in health workers,
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Affiliation(s)
- Vikas Sharma
- Centre for Public Health, IEAST, Panjab University, Chandigarh, India,
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Adedini SA, Odimegwu C, Imasiku EN, Ononokpono DN. Unmet need for family planning: implication for under-five mortality in Nigeria. JOURNAL OF HEALTH, POPULATION, AND NUTRITION 2015; 33:187-206. [PMID: 25995735 PMCID: PMC4438662] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
There are gaps in evidence on whether unmet need for family planning has any implication for under-five mortality in Nigeria. This study utilized 2008 Nigeria Demographic and Health Survey data to examine the effect of unmet need on under-five mortality. Cox regression analysis was performed on 28,647 children born by a nationally-representative sample of 18,028 women within the five years preceding the survey. Findings indicated elevated risks of under-five death for children whose mothers had unmet need for spacing [Hazard ratio (HR): 1.60, confidence interval (CI) 1.37-1.86, p<0.001] and children whose mothers had unmet need for limiting (HR: 1.78, CI 1.48-2.15, p<0.001) compared to children whose mothers had met need. These findings were consistent after adjusting for the effects of factors that could confound the association. Findings of this study underscore the need to address the present level of unmet need for family planning in Nigeria, if the country would achieve meaningful reduction in under-five mortality.
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Affiliation(s)
- Sunday Adepoju Adedini
- Demography and Population Studies Programme, Schools of Public Health and Social Sciences, University of the Witwatersrand, Johannesburg, South Africa
- Demography and Social Statistics Department, Obafemi Awolowo University, Ile-Ife, Nigeria
| | - Clifford Odimegwu
- Demography and Population Studies Programme, Schools of Public Health and Social Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Eunice Ntwala Imasiku
- Demography and Population Studies Programme, Schools of Public Health and Social Sciences, University of the Witwatersrand, Johannesburg, South Africa
- Department of Geography, University of Zambia, Lusaka, Zambia
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Glatman-Freedman A, Nichols K. The effect of social determinants on immunization programs. Hum Vaccin Immunother 2014; 8:293-301. [DOI: 10.4161/hv.19003] [Citation(s) in RCA: 69] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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McGlynn N, Wilk P, Luginaah I, Ryan BL, Thind A. Increased use of recommended maternal health care as a determinant of immunization and appropriate care for fever and diarrhoea in Ghana: an analysis pooling three demographic and health surveys. Health Policy Plan 2014; 30:895-905. [PMID: 25148844 DOI: 10.1093/heapol/czu090] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/07/2014] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVE Enhancing maternal and child health are key Millennium Development Goals (MDGs). This study examined whether increased utilization of recommended maternal health care (MHC), is associated with factors that improve children's health; specifically, complete immunization and appropriate care for fever and diarrhoea in Ghana. DESIGN Data from the 1998, 2003, and 2008 Ghana Demographic and Health Surveys were pooled for a nationally representative sample of 6786 women aged 15-49 years who had a child in the previous 5 years. Children aged 12-23 months were considered fully immunized if they received all eight basic immunizations. Appropriate care for children under-five was receipt of medical treatment for fever or oral rehydration therapy for diarrhoea. The effect of recommended MHC utilization (characterized as poor, intermediate or best use) on immunization and appropriate care for fever and diarrhoea was determined through logistic regression with Andersen's Behavioural Model guiding co-variate selection. RESULTS Increased MHC utilization (reference: intermediate MHC use) increased the odds of immunization [poor use: odds ratio (OR) = 0.54, 95% confidence interval (CI): 0.42-0.69; best use: OR = 1.29, 95% CI: 1.01-1.67], as well as appropriate care for fever (poor use: OR = 0.55, 95% CI: 0.35-0.88; best use: OR = 1.72, 95% CI: 1.17-2.52) and diarrhoea (poor use: OR = 0.63, 95% CI: 0.43-0.93). Survey year and region also predicted each outcome. Other determinants of immunization were maternal education, ethnicity, religion, media exposure, wealth and birth weight. Determinants of appropriate care for fever included paternal education, media exposure and wealth, and for diarrhoea, child's age and birth weight. CONCLUSION This study proposes a linkage between MDGs; initiatives to improve maternal health through promoting increased use of recommended MHC may enhance children's health-related care. This could be useful for countries with limited resources in achieving MDGs, especially in sub-Saharan Africa where under-five mortality is the highest.
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Affiliation(s)
| | - Piotr Wilk
- Department of Epidemiology and Biostatistics, Children's Health Research Institute
| | | | - Bridget L Ryan
- Department of Epidemiology and Biostatistics, Centre for Studies in Family Medicine and
| | - Amardeep Thind
- Department of Epidemiology and Biostatistics, Centre for Studies in Family Medicine and Schulich Interfaculty Program of Public Health, Western University, 1151 Richmond Street, London, ON N6A 3K7, Canada
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Adedini SA, Odimegwu C, Imasiku EN, Ononokpono DN. Ethnic differentials in under-five mortality in Nigeria. ETHNICITY & HEALTH 2014; 20:145-62. [PMID: 24593689 PMCID: PMC4337727 DOI: 10.1080/13557858.2014.890599] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/31/2012] [Accepted: 12/23/2013] [Indexed: 06/03/2023]
Abstract
OBJECTIVE There are huge regional disparities in under-five mortality in Nigeria. While a region within the country has as high as 222 under-five deaths per 1000 live births, the rate is as low as 89 per 1000 live births in another region. Nigeria is culturally diverse as there are more than 250 identifiable ethnic groups in the country; and various ethnic groups have different sociocultural values and practices which could influence child health outcome. Thus, the main objective of this study was to examine the ethnic differentials in under-five mortality in Nigeria. DESIGN The study utilized 2008 Nigeria Demographic and Health Survey (NDHS) data. We analyzed data from a nationally representative sample drawn from 33,385 women aged 15-49 that had a total of 104,808 live births within 1993-2008. In order to examine ethnic differentials in under-five mortality over a sufficiently long period of time, our analysis considered live births within 15 years preceding the 2008 NDHS. The risks of death in children below age five were estimated using Cox proportional regression analysis. Results were presented as hazard ratios (HR) with 95% confidence intervals (CI). RESULTS The study found substantial differentials in under-five mortality by ethnic affiliations. For instance, risks of death were significantly lower for children of the Yoruba tribes (HR: 0.39, CI: 0.37-0.42, p < 0.001), children of Igbo tribes (HR: 0.58, CI: 0.55-0.61, p < 0.001) and children of the minority ethnic groups (HR: 0.66, CI: 0.64-0.68, p < 0.001), compared to children of the Hausa/Fulani/Kanuri tribes. Besides, practices such as plural marriage, having higher-order births and too close births showed statistical significance for increased risks of under-five mortality (p < 0.05). CONCLUSION The findings of this study stress the need to address the ethnic norms and practices that negatively impact on child health and survival among some ethnic groups in Nigeria.
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Affiliation(s)
- Sunday A. Adedini
- Programme in Demography and Population Studies, University of the Witwatersrand, Johannesburg, South Africa
- Department of Demography and Social Statistics, Obafemi Awolowo University, Ile-Ife, Nigeria
| | - Clifford Odimegwu
- Programme in Demography and Population Studies, University of the Witwatersrand, Johannesburg, South Africa
| | - Eunice N.S. Imasiku
- Programme in Demography and Population Studies, University of the Witwatersrand, Johannesburg, South Africa
- Department of Geography, University of Zambia, Lusaka, Zambia
| | - Dorothy N. Ononokpono
- Programme in Demography and Population Studies, University of the Witwatersrand, Johannesburg, South Africa
- Department of Sociology and Anthropology, University of Uyo, Uyo, Nigeria
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Determinants of childhood immunization uptake among socio-economically disadvantaged migrants in East China. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2013; 10:2845-56. [PMID: 23839061 PMCID: PMC3734462 DOI: 10.3390/ijerph10072845] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/14/2013] [Revised: 05/27/2013] [Accepted: 06/28/2013] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To determine the coverage of childhood immunization appropriate for age among socio-economically disadvantaged recent migrants living in East China and to identify the determinants of full immunization uptake among these migrant children. METHODS This is a cross-sectional survey of 1,426 migrant mothers with a child aged ≤ 24 months, who were interviewed with a pretested questionnaire. Various vaccines, migration history and some other social-demographic and income details were collected. Single-level logistic regression analyses were applied to identify the determinants of full immunization status. RESULTS Immunization coverage rates are lower among migrants and even lower among recent migrants. The likelihood of a child receiving full immunization rise with parents' educational level and the frequency of mother's utilization of health care. Higher household income also significantly increase the likelihood of full immunization, as dose post-natal visits by a health worker. CONCLUSIONS Recent migrant status favours low immunization uptake, particularly in the vulnerability context of alienation and livelihood insecurity. Services must be delivered with a focus on recent migrants. Investments are needed in education, socio-economic development and secure livelihoods to improve and sustain equitable health care services.
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Abebe DS, Nielsen VO, Finnvold JE. Regional inequality and vaccine uptake: a multilevel analysis of the 2007 Welfare Monitoring Survey in Malawi. BMC Public Health 2012; 12:1075. [PMID: 23237082 PMCID: PMC3543726 DOI: 10.1186/1471-2458-12-1075] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2012] [Accepted: 12/10/2012] [Indexed: 11/25/2022] Open
Abstract
Background A significant part of childhood mortality can be prevented given the existence of a well functioning health care system that can deliver vaccines to children during their first year of life. This study assesses immunization differentials between regions in Malawi, and attempts to relate regional disparities in immunization to factors on individual, household and village level. Method We used data from the 2007 Welfare Monitoring Survey which includes 18 251 children ages 10–60 months. Multilevel logistic regression models were applied for data analysis. Results Major differences in full vaccine coverage (children receiving all of the 9 recommended vaccines) were documented between the 27 official regions, called districts, of Malawi. The vaccine coverage among regions varied from 2% to 74% when all children 10 – 60 months old were included. Vaccine coverage was significantly higher for women that had their delivery attended by a midwife/nurse, or gave birth at a hospital or maternity clinic. Regions with a high percentage of deliveries attended by health personnel were also characterized by a higher coverage. Characteristics of health care utilization on the individual level could in part account for the observed regional variations in coverage. Several factors related to socio-demographic characteristics of individuals and households were significantly correlated with coverage (child’s age, illiteracy, income, water and sanitary conditions), implying a lower coverage among the most vulnerable parts of the population. However, these factors could only to a minor extent account for the regional variation in coverage. Conclusions The persistent regional inequalities suggest that the low immunization coverage in Malawi is less likely to be a result of geographical clustering of social groups with difficult level-of living conditions. Although the mean vaccine coverage in Malawi is low, some regions have succeeded in reaching a relatively high proportion of their children. The relative success of some regions implies that there is a substantial potential for political intervention to improve vaccine coverage. One important negative implication of regional inequality is the presence of clusters with under-vaccinated children, leading to an increased vulnerability during outbreaks of vaccine-preventable diseases.
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Cremin S, Menton JF, Canier L, Horgan M, Fanning LJ. The prevalence and genotype of human papillomavirus on cervical samples from an Irish female population with external genital warts. Hum Vaccin Immunother 2012; 8:916-20. [PMID: 22777095 DOI: 10.4161/hv.20122] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
The aim of this study was to determine the cervical genotype profile of females who presented to an STI Clinic with external genital warts (EGW); and to determine the potential vaccine coverage prior to the uptake of the HPV vaccines. Sixty-one cervical scrapings were taken from females aged 18-35 y who had external genital warts or a history of external genital warts. The resulting 50 samples that were positive for HPV-DNA were subjected to genotype identification. Forty-six of these samples had detectable genotypes by LIPA analysis and most (78%, 36/46) had multiple low risk (LR) and high risk (HR) genotypes on the cervix. Twenty-five of these samples (54%) had more than 1 HR genotype. Of the 36 patients who had any HR genotypes, 18 (50%) were identified to have the most oncogenic HPV genotypes, namely 16 and 18. Three of these samples had both 16 and 18 on the cervix. The presence of multiple HR genotypes on the majority of cervical samples from a self-referred population of females with EGW is presented. This study is of importance since persistent HR-HPV is the necessary risk factor in the development of precancerous and cancerous lesions of the cervix. Gardisil, the quadrivalent HPV vaccine would have been useful in the prevention of 28% (13/46) of these infections.
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Affiliation(s)
- Suzanne Cremin
- STI Clinic, Infirmary, South Victoria University Hospital, Cork, Ireland.
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Itimi K, Dienye PO, Ordinioha B. Community participation and childhood immunization coverage: A comparative study of rural and urban communities of Bayelsa State, south-south Nigeria. Niger Med J 2012; 53:21-5. [PMID: 23271840 PMCID: PMC3530239 DOI: 10.4103/0300-1652.99826] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
BACKGROUND Immunization coverage rates in Nigeria have remained very poor, in spite of numerous programs and strategies, specifically designed to improve coverage. This study was to assess the possible effects of greater community participation on immunization coverage, by comparing the immunization coverage in a rural community with a functional community health committee, with an urban community, with no distinct community structure. MATERIALS AND METHODS The study was carried out in Ondewari, a rural, riverine community, in Bayelsa State; and Yenagoa, the capital of Bayelsa State, south-south Nigeria; using a cross-sectional, comparative study design. The data were collected using a structured interviewer-administered questionnaire, administered on female head of households in both communities, with under-five children; and used to collect information on the socio-demographic characteristics of the respondents, the immunization status of children in the household below the age of 2 years, and reasons for none and incomplete immunization. RESULTS A total of 288 respondents were studied in the rural community, while 270 respondents were studied in the urban center. The respondents in the urban center were significantly younger (P<0.01), better educated (P<0.001), and had fewer number of children (P<0.01). The immunization status of children in the rural community was significantly better than those in the urban community (P<0.000). Only 11.46% of the children in the rural community were not immunized, compared to 47.04% in the urban community. However, the dropout rate in the rural community was much higher; with a DPT dropout rate of 77.34%, compared to 12.39% in the urban community. Most of the reasons given in the urban community for the incomplete immunization were linked lack of motivation, and include relocation (11.34%) and the adverse rumor about childhood immunization (17.23%), while the reasons in the rural community were mostly health facility related, and included the absence of the vaccinator (20.46%) and nonavailability of vaccines (26.64%). CONCLUSION The immunization coverage in the rural community was surprisingly better than that of the urban community, which can be attributed to better mobilization and participation in the delivery of immunization services.
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Affiliation(s)
- Kalamawei Itimi
- Department of Family Medicine, Federal Medical Center, Yenagoa, Bayelsa State, Nigeria
| | - Paul O. Dienye
- Department of Family Medicine, University of Port Harcourt Teaching Hospital, Port Harcourt, Nigeria
| | - Best Ordinioha
- Department of Community Medicine, University of Port Harcourt Teaching Hospital, Port Harcourt, Nigeria
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Antai D. Gender inequities, relationship power, and childhood immunization uptake in Nigeria: a population-based cross-sectional study. Int J Infect Dis 2011; 16:e136-45. [PMID: 22197748 DOI: 10.1016/j.ijid.2011.11.004] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2011] [Revised: 11/03/2011] [Accepted: 11/10/2011] [Indexed: 10/14/2022] Open
Abstract
BACKGROUND This study aimed to simultaneously examine the association between multiple dimensions of gender inequities and full childhood immunization. METHODS A multilevel logistic regression analysis was performed on nationally representative sample data from the 2008 Nigeria Demographic and Health Survey, which included 33,385 women aged 15-49 years who had a total of 28,647 live-born children; 24,910 of these children were included in this study. RESULTS A total of 4283 (17%) children had received full immunization. Children of women whose spouse did not contribute to household earnings had a higher likelihood of receiving full childhood immunization (odds ratio (OR) 1.96, 95% confidence interval (95% CI) 1.02-3.77), and children of women who lacked decision-making autonomy had a lower likelihood of receiving full childhood immunization (OR 0.74, 95% CI 0.60-0.91). The likelihood of receiving full childhood immunization was higher among female children (OR 1.28, 95% CI 1.06-1.54), Yoruba children (OR 2.45, 95% CI 1.19-4.26), and children resident in communities with low illiteracy (OR 1.82, 95% CI 1.06-3.12), but lower for children of birth order 5 or above (OR 0.64, 95% CI 0.45-0.96), children of women aged ≤ 24 years (OR 0.66, 95% CI 0.50-0.87) and 25-34 years (OR 0.79, 95% CI 0.63-0.99), children of women with no education (OR 0.33, 95% CI 0.21-0.54) and primary education (OR 0.66, 95% CI 0.45-0.97), as well as children of women resident in communities with high unemployment (OR 0.34, 95% CI 0.20-0.57). CONCLUSIONS The woman being the sole provider for her family (i.e., having a spouse who did not contribute to household earnings) was associated with a higher likelihood of fully immunizing the child, and the woman lacking decision-making autonomy was associated with a lower likelihood of fully immunizing the child. These findings draw attention to the need for interventions aimed at promoting women's employment and earning possibilities, whilst changing gender-discriminatory attitudes within relationships, communities, and society in general.
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Affiliation(s)
- Diddy Antai
- Department of Public Health, Division of Social Medicine, Karolinska Institutet, 171 76 Stockholm, Sweden.
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Kusuma YS, Kumari R, Pandav CS, Gupta SK. Migration and immunization: determinants of childhood immunization uptake among socioeconomically disadvantaged migrants in Delhi, India. Trop Med Int Health 2011; 15:1326-32. [PMID: 20955496 DOI: 10.1111/j.1365-3156.2010.02628.x] [Citation(s) in RCA: 75] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To determine the coverage of childhood immunization appropriate for age among socioeconomically disadvantaged rural-urban migrants living in Delhi and to identify the determinants of full immunization uptake among these migrant children. METHODS This is a cross-sectional survey of 746 rural-urban migrant mothers with a child aged up to 2 years, who were interviewed with a pretested questionnaire. Data pertaining to the reception of various vaccines, migration history and some other social, demographic and income details were collected. Multiple logistic regression analyses were performed to identify the determinants of full immunization status. RESULTS Immunization coverage rates were lower among migrants than the general population of Delhi and even lower among recent migrants. The likelihood of a child receiving full immunization rose with age of the mother, her educational attainment and the frequency of her use of health care. The head of household having a secured salaried job also significantly increased the likelihood of full immunization, as did post-natal visits by a health worker. CONCLUSION Migrant status favours low immunization uptake particularly in the vulnerability context of alienation and livelihood insecurity. Services must be delivered with a focus on recent migrants; investments are needed in education, socio-economic development and secure livelihoods to improve and sustain equitable health care services.
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Affiliation(s)
- Yadlapalli S Kusuma
- Centre for Community Medicine, All India Institute of Medical Sciences, New Delhi, India.
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