Does birth under-registration reduce childhood immunization? Evidence from the Dominican Republic

Receipt of seasonal malaria chemoprevention by age-ineligible children and associated factors in nine implementation states in Nigeria

BACKGROUND

As part of implementation quality standards, community distributors are expected to ensure that only age-eligible children (aged 3-59 months) receive seasonal malaria chemoprevention (SMC) medicines during monthly campaigns. There is uncertainty about the extent to which SMC medicines are administered to ineligible children. This study aimed to assess the magnitude of this occurrence, while exploring the factors associated with it across nine states where SMC was delivered in Nigeria during the 2022 round.

METHODS

This analysis was based on data from representative end-of-round SMC household surveys conducted in nine SMC-implementing states in Nigeria. Data of 3299 age-ineligible children aged > 5 years and their caregivers were extracted from the survey dataset. Prevalence of receipt of SMC medicines by ineligible children was described by child-, caregiver- and SMC-related factors. Mixed-effects multivariable logistic regression models were fitted to explore the factors associated with ineligible receipt of SMC medicines.

RESULTS

30.30% (95% CI 27.80-32.90) of ineligible children sampled received at least one dose of SMC medicines in 2022, the majority (60.60%) of whom were aged 5-6 years while the rest were aged 7-10 years. There were lower odds of an age-ineligible child receiving SMC among caregivers who had knowledge of SMC age eligibility (OR: 0.53, 95% CI 0.37-0.77, p < 0.001), compared with those who were knowledgeable of age eligibility. Higher odds of receipt of SMC were found among age-ineligible children whose caregivers had higher confidence in the protective effect of SMC against malaria (OR: 2.01, 95% CI 1.07-3.72, p = 0.030), compared with those whose caregivers were less confident. Compared with ineligible children of younger caregivers (aged < 20 years), those whose caregivers were older had lower odds of receiving SMC than those whose caregivers were younger; with lower odds among children of caregivers aged 20-39 years (OR: 0.50, 95% CI 0.30-0.82, p = 0.006).

CONCLUSIONS

This study contributes important evidence on the magnitude of the receipt of SMC medicines by age-ineligible children, while identifying individual and contextual factors associated with it. The findings provide potentially useful insights that can help inform and guide context-specific SMC implementation quality improvement efforts.

Addressing the Evidence Gap in the Economic and Social Benefits of Civil Registration and Vital Statistics Systems: A Systematic Review

Objectives: Considering the aspiration embedded in the Sustainable Development Goals to Leave No One Behind by 2030, civil registration and vital statistics systems have an essential role in providing reliable, up-to-date information to monitor the progress. Thus, the aim of this systematic review is to compile empirical evidence on the benefits of a functioning civil registration and vital statistics system.

Methods: Selected databases were systematically searched until 2019. Key experts were also contacted for relevant literature. The review process was managed with the software EPPI-Reviewer and followed standard methods for systematic reviews.

Results: A total of 18 studies were included. The findings revealed that having birth, death, and/or marriage registration, and vital statistics were associated with access to rights and protection, positive impact on economic and health outcomes, and increased access to education.

Conclusion: The present review supports the idea that systemic approaches strengthen civil registration and vital statistics systems due to the cumulative effects of vital events’ registration. Ensuring appropriate systems for civil registration will have an impact not only on the individuals but also on the generations to come.

[Factors associated with co-administration of birth dose vaccines in senegalese children]

INTRODUCTION

Co-administration of the bili&#233; de Calmette et Gu&#233;rin (BCG) and birth doses of oral polio (OPV zero) and hepatitis&#160;B (HepB BD) vaccines is strongly recommended. The objective was to determine the factors associated with this co-administration in the health district of Podor (Senegal).

METHODS

This cross-sectional study was conducted among 726&#160;children aged 12 to 23&#160;months. This was a two-stage cluster sampling. The data was collected in June&#160;2020. An electronic questionnaire was developed using the Open Data Kit Collect application. Co-administration was modeled as one dose, two doses and three doses. Ordinal logistic regression was used to search for factors likely to influence co-administration.

RESULTS

Of the 726&#160;children, 115 (16%), 234 (32%) and 377&#160;(52%) received a single dose, two and three doses, respectively. Factors associated with co-administration were recognition by mothers or caregivers that several vaccines can be administered simultaneously (adjusted&#160;OR&#160;=&#160;1.46, p-value&#160;=&#160;0.017), availability of a health record kept at home (adjusted&#160;OR&#160;=&#160;6.88, p-value&#160;=&#160;0.006), hospitalization of the newborn after birth (adjusted&#160;OR&#160;=&#160;1.74, p-value&#160;=&#160;0.002) and receipt of advice during postnatal care (adjusted&#160;OR&#160;=&#160;1.72, p-value&#160;=&#160;0.01).

CONCLUSION

Co-administration of birth doses is an infrequent practice in Podor. Awareness and availability and proper maintenance of health information management tools would be necessary.

Deficiency in civil registration and vital statistics reporting in remote areas: the case of Sabah, Malaysia

Malaysia has a well-established civil registration system dating back to the 1960s. Birth registration is virtually complete at the national level. However, the quality of civil registration in some remote areas is doubtful, as evidenced by the abnormally low birth and death rates in several districts. This study focuses on identifying districts in Sabah, where the reporting of births seems problematic. Sabah is the least developed state in Malaysia, and it is sparsely populated, despite being the second most populous state in the country. Sabah’s civil registration lags behind the other states, to the extent that birth and death statistics were not reported for the state in the vital statistics report for the period 2000 to 2009. A 2016 study found that death registration is almost 100%, except for Sabah (88%). The plausible reasons behind the ultra-low birth rate reported in several remote districts in Sabah include misreporting of the place of occurrence as the usual residence, delayed reporting, non-coverage, ignorance of the law, inaccessibility, presence of a large number of migrants, miscommunication, and errors in data entry. The under-reporting of births may have serious consequences, such as misallocation of resources and deprivation of services to those affected. In line with the transformative promise of “leaving no one behind,” the Sustainable Development Goals urge all countries to strive to improve data quality for planning; this includes complete birth registration for creating effective development programs to reach target groups more effectively.

Birth registration in India: Are wealth inequities decreasing?

Background

This study examines the geographic variation and the magnitude of wealth inequities in birth registration in India between 2005 and 2015.

Methods

Data came from India's 2005 (n = 51,940) and 2015 (n = 250,194) Demographic Health Surveys. We estimated absolute wealth inequities at the national and state-level and specified three-level logistic regression models (children, communities, and states) to calculate the variance partitioning coefficient attributable to each level to examine the variation in birth registration at each time point.

Results

National birth registration coverage was 41.2% in 2005 and improved to 79.6% in 2015. Between 2005 and 2015, coverage among children in the poorest quintile (Q1) improved from 23.9% to 63.8% while coverage among the wealthiest children (Q5) improved from 72.4% to 92.8%. Although the absolute wealth inequity decreased from 48.6%-points to 29.1%-points, children in Q1 still had levels of coverage in 2015 that were lower than children in Q5 in 2005. Between 2005 and 2015, birth registration improved in every state and coverage was higher than 90% in 13 states. Wealth inequities decreased in 21 states and increased in 8 states. In adjusted multi-level models the proportion of total variation in birth registration attributable to states (35.7% 2005 and 29% in 2015) was larger than the variation attributable to communities (15% in 2005 and 13.7% in 2015).

Conclusion

Birth registration is essential for ensuring inclusive population counts of birth and mortality rates. Efforts to reach universal birth registration in India will require a commitment to reducing wealth inequities within states.

Decentralization of birth registration to Local Government in Tanzania: the association with completeness of birth registration and certification

BACKGROUND

In Tanzania only an estimated one-quarter of births are registered and certified. Birth registration uses a centralized system with geographic and cost barriers for families. A pilot decentralized birth registration system has been trialled in 11 of 26 regions, substantially increasing registration points, and enabling notification, registration and certification to occur in one step.

OBJECTIVE

This study compares completeness of birth registration and certification and achievement of key birth registration milestones in two districts where the birth registration system decentralized and two districts with the existing centralized system.

METHODS

Registration, notification, census and survey data were used to estimate birth registration completeness and quantify achievement of key registration milestones for births in 2012-16. These were compared between districts of Mbozi (decentralized in 2013) and Iringa (decentralized in 2016) and districts of Dodoma and Kibaha which remained centralized.

RESULTS

For births that occurred from 2012 to 2016, completeness of birth registration/certification (by early 2017) was higher in districts that decentralized (Iringa 60%; Mbozi 52%) than remained centralized (Kibaha 36%; Dodoma 20%). Introduction of the decentralized system saw completeness for births registered within 12 months of occurrence increase in Iringa from 1% in 2014 to 67% in 2016, and in Mbozi from 15% in 2012 to 36% in 2013 before falling and subsequently increasing to 53% in 2016. In contrast, completeness in centralized districts did not increase. Although a higher proportion of births are notified in centralized than decentralized districts, registration and certification occurs for all notified births in decentralized districts but only one-third in centralized districts.

CONCLUSIONS

Benefits of a decentralized system are more proximate registration points and the merging of notification, registration and certification steps. The findings, while demonstrating the immediate impact of the decentralized system on completeness, also show that continued efforts are necessary to sustain these improvements.

Improving the demand for birth registration: a discrete choice experiment in Ethiopia

INTRODUCTION

Birth registration remains limited in most low and middle-income countries. We investigated which characteristics of birth registration facilities might determine caregivers' decisions to register children in Ethiopia.

METHODS

We conducted a discrete choice experiment in randomly selected households in Addis Ababa and the Southern Nations, Nationalities, and People's Region. We interviewed caregivers of children 0-5 years old. We asked participants to make eight choices between pairs of hypothetical registration facilities. These facilities were characterised by six attributes selected through a literature review and consultations with local stakeholders. Levels of these attributes were assigned at random using a fractional design. We analysed the choice data using mixed logit models that account for heterogeneity in preferences across respondents. We calculated respondents' willingness to pay to access registration facilities with specific attributes. We analysed all data separately by place of residence (urban vs rural).

RESULTS

Seven hundred and five respondents made 5614 choices. They exhibited preferences for registration facilities that charged lower fees for birth certificates, that required shorter waiting time to complete procedures and that were located closer to their residence. Respondents preferred registration facilities that were open on weekends, and where they could complete procedures in a single visit. In urban areas, respondents also favoured registration facilities that remained open for extended hours on weekdays, and where the presence of only one of the parents was required for registration. There was significant heterogeneity between respondents in the utility derived from several attributes of registration facilities. Willingness to pay for access to registration facilities with particular attributes was larger in urban than rural areas.

CONCLUSION

In these regions of Ethiopia, changes to the operating schedule of registration facilities and to application procedures might help improve registration rates. Discrete choice experiments can help orient initiatives aimed at improving birth registration.

Are inequities decreasing? Birth registration for children under five in low-income and middle-income countries, 1999-2016

INTRODUCTION

Although global birth registration coverage has improved from 58% to 71% among children under five globally, inequities in birth registration coverage by wealth, urban/rural location, maternal education and access to a health facility persist. Few studies examine whether inequities in birth registration in low-income and middle-income countries have changed over time.

METHODS

We combined information on caregiver reported birth registration of 1.6 million children in 173 publicly available, nationally representative Demographic Health Surveys and Multiple Indicator Cluster Surveys across 67 low-income and middle-income countries between 1999 and 2016. For each survey, we calculated point estimates and 95% CIs for the percentage of children under 5 years without birth registration on average and stratified by sex, urban/rural location and wealth. For each sociodemographic variable, we estimated absolute measures of inequality. We then examined changes in non-registration and inequities between surveys, and annually.

RESULTS

14 out of 67 countries had achieved complete birth registration. Among the remaining 53 countries, 39 countries successfully decreased the percentage of children without birth registration. However, this reduction occurred alongside statistically significant increases in wealth inequities in 9 countries and statistically significant decreases in 10 countries. At the most recent survey, the percentage of children without birth registration was greater than 50% in 16 out of 67 countries.

CONCLUSION

Although birth registration improved on average, progress in reducing wealth inequities has been limited. Findings highlight the importance of monitoring changes in inequities to improve birth registration, to monitor Sustainable Development Goal 16.9 and to strengthen Civil Registration and Vital Statistics systems.

A Case Study in Personal Identification and Social Determinants of Health: Unregistered Births among Indigenous People in Northern Ontario

Under international law, birth registration is considered a human right because it determines access to important legal protections as well as essential services and social supports across the lifespan. Difficulties related to birth registration and the acquisition of personal identification (PID) are largely regarded as problems specific to low-income countries. For Indigenous people in northern and rural Canada, however, lack of PID, like birth certificates, is a common problem that is rooted in the geography of the region as well as historical and contemporary settler colonial policies. This communication elucidates the complicated terrain of unregistered births for those people living in northern Ontario in order to generate discussion about how the social determinants of health for Indigenous people in Canada are affected by PID. Drawing on intake surveys, qualitative interviews and participant observation field notes, we use the case study of “Susan” as an entry point to share insights into the “intergenerational problem” of unregistered births in the region. Susan’s case speaks to how unregistered births and lack of PID disproportionately impacts the health and well-being of Indigenous people and communities in northern Ontario. The implications and the need for further research on this problem in Canada are discussed.

How useful are registered birth statistics for health and social policy? A global systematic assessment of the availability and quality of birth registration data

Background

The registration and certification of births has a wide array of individual and societal benefits. While near-universal in some parts of the world, birth registration is less common in many low- and middle-income countries, and the quality of vital statistics vary. We assembled publicly available birth registration records for as many countries as possible into a novel global birth registration database, and we present a systematic assessment of available data.

Methods

We obtained 4918 country-years of data from 145 countries covering the period 1948–2015. We compared these to existing estimates of total births to assess completeness of public data and adapted existing methods to evaluate the quality and timeliness of the data.

Results

Since 1980, approximately one billion births were registered and shared in public databases. Compared to estimates of fertility, this represents only 40.0% of total births in the peak year, 2011. Approximately 74 million births (53.1%) per year occur in countries whose systems do not systematically register them and release the aggregate records. Considering data quality, timeliness, and completeness in country-years where data are available, only about 12 million births per year (8.6%) occur in countries with high-performing registration systems.

Conclusions

This analysis highlights the gaps in available data. Our objective and low-cost approach to assessing the performance of birth registration systems can be helpful to monitor country progress, and to help national and international policymakers set targets for strengthening birth registration systems.

Electronic supplementary material

The online version of this article (10.1186/s12963-018-0180-6) contains supplementary material, which is available to authorized users.

Associations between birth registration and early child growth and development: evidence from 31 low- and middle-income countries

Background

Lack of legal identification documents can impose major challenges for children in low- and middle-income countries (LMICs). The aim of this study was to investigate the association between not having a birth certificate and young children’s physical growth and developmental outcomes in LMICs.

Methods

We combined nationally representative data from the Multiple Indicator Cluster Surveys in 31 LMICs. For our measure of birth registration, primary caregivers reported on whether the child had a birth certificate. Early child outcome measures focused on height-for-age z-scores (HAZ), weight-for-age z-scores (WAZ), weight-for-height z-scores (WHZ), and standardized scores of the Early Childhood Development Index (ECDI) for a subsample of children aged 36–59 months. We used linear regression models with country fixed effects to estimate the relationship between birth registration and child outcomes. In fully adjusted models, we controlled for a variety of child, caregiver, household, and access to child services covariates, including cluster-level fixed effects.

Results

In the total sample, 34.7% of children aged 0–59 months did not possess a birth certificate. After controlling for covariates, not owning a birth certificate was associated with lower HAZ (β = − 0.18; 95% CI: -0.23, − 0.14), WAZ (β = − 0.10, 95% CI: -0.13, − 0.07), and ECDI z-scores (β = − 0.10; 95% CI: -0.13, − 0.07) among children aged 36–59 months.

Conclusion

Our findings document links between birth registration and children’s early growth and development outcomes. Efforts to increase birth registration may be promising for promoting early childhood development in LMICs.

Electronic supplementary material

The online version of this article (10.1186/s12889-018-5598-z) contains supplementary material, which is available to authorized users.