1
|
Jiao B, Iversen I, Sato R, Pecenka C, Khan S, Baral R, Kruk ME, Arsenault C, Verguet S. Association between achieving adequate antenatal care and health-seeking behaviors: A study of Demographic and Health Surveys in 47 low- and middle-income countries. PLoS Med 2024; 21:e1004421. [PMID: 38968303 PMCID: PMC11226092 DOI: 10.1371/journal.pmed.1004421] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2023] [Accepted: 05/29/2024] [Indexed: 07/07/2024] Open
Abstract
BACKGROUND Antenatal care (ANC) is essential for ensuring the well-being of pregnant women and their fetuses. This study models the association between achieving adequate ANC and various health and health-seeking indicators across wealth quintiles in low- and middle-income countries (LMICs). METHODS AND FINDINGS We analyzed data from 638,265 women across 47 LMICs using available Demographic and Health Surveys from 2010 to 2022. Via multilevel logistic regression analyses adjusted for a series of confounding variables and country and wealth quintile fixed effects, we estimated the projected impact of achieving adequate ANC utilization and quality on a series of health and health care indicators: facility birth, postnatal care, childhood immunizations, and childhood stunting and wasting. Achieving adequate levels of ANC utilization and quality (defined as at least 4 visits, blood pressure monitoring, and blood and urine testing) was positively associated with health-seeking behavior across the majority of countries. The strongest association was observed for facility birth, followed by postnatal care and child immunization. The strength of the associations varied across countries and wealth quintiles, with more significant ones observed in countries with lower baseline ANC utilization levels and among the lower wealth quintiles. The associations of ANC with childhood stunting and wasting were notably less statistically significant compared to other indicators. Despite rigorous adjustments for potential confounders, a limitation to the methodology is that it is possible that unobserved variables may still impact outcomes. CONCLUSIONS Strengthening ANC is associated with improved use of other health care in LMICs. ANC could serve as a critical platform for improving health outcomes for mothers and their children, emphasizing its importance beyond direct impact on maternal and neonatal mortality.
Collapse
Affiliation(s)
- Boshen Jiao
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States of America
| | - Isabelle Iversen
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States of America
| | - Ryoko Sato
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States of America
| | | | - Sadaf Khan
- PATH, Seattle, Washington, United States of America
| | - Ranju Baral
- PATH, Seattle, Washington, United States of America
| | - Margaret E. Kruk
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States of America
| | - Catherine Arsenault
- Department of Global Health, Milken Institute School of Public Health, George Washington University, Washington, DC, United States of America
| | - Stéphane Verguet
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States of America
| |
Collapse
|
2
|
Tamir TT, Workneh BS, Mekonen EG, Zegeye AF. Coverage, spatial distribution and determinants of childhood inactivated poliovirus vaccine immunization in Ethiopia. PLoS One 2024; 19:e0301933. [PMID: 38820454 PMCID: PMC11142555 DOI: 10.1371/journal.pone.0301933] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2024] [Accepted: 03/22/2024] [Indexed: 06/02/2024] Open
Abstract
INTRODUCTION Polio eradication is a current and common strategy throughout the globe. The study of the newly introduced inactivated poliovirus vaccine provides a grasp on the current status of immunization and identifies any disparities in the implementation of the vaccine throughout Ethiopia. Thus, this study aimed to demonstrate the spatial distribution, coverage, and determinants of inactivated poliovirus vaccine immunization in Ethiopia. METHOD Spatial distribution and determinants of inactivated poliovirus vaccine immunization in Ethiopia were conducted using Ethiopian mini-demographic and health survey 2019 data. A total of 2,056 weighted children aged 12 to 35 months were included in the analysis. The association between the outcome and explanatory variables was determined by commuting the adjusted odds ratio at a 95% confidence interval. The p-value of less than 0.05 was used to declare factors as significantly associated with the inactivated poliovirus vaccine immunization. RESULT The weighted national coverage of inactivated poliovirus vaccine immunization in Ethiopia was 51.58% at a 95% confidence interval (49.42, 53.74). While the rates of inactivated poliovirus vaccine immunization were observed to be greater in Addis Ababa, Tigiray, Amahara, and Benishangul Gumuz provinces and lower in the Somali, Afar, and SNNPR provinces of Ethiopia, Antenatal care follow-up, place of delivery, place of residence, and region were significantly associated with inactivated poliovirus immunization in Ethiopia. CONCLUSION The distribution of inactivated poliovirus immunization was spatially variable across Ethiopia. Only about half of the children aged twelve to thirty-five months received the inactivated poliovirus vaccine in the country. The factors, both at the individual and community level, were significantly associated with inactivated poliovirus immunization. Therefore, policies and strategies could benefit from considering antenatal care follow-up, place of delivery, place of residence, and region while implementing inactivated poliovirus vaccine immunization.
Collapse
Affiliation(s)
- Tadesse Tarik Tamir
- Department of Pediatrics and Child Health Nursing, School of Nursing, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Belayneh Shetie Workneh
- Department of Emergency and Critical Care Nursing, School of Nursing, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Enyew Getaneh Mekonen
- Department of Surgical Nursing, School of Nursing, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Alebachew Ferede Zegeye
- Department of Medical Nursing, School of Nursing, College of Medicine and Health Sciences University of Gondar, Gondar, Ethiopia
| |
Collapse
|
3
|
Idris H, Anisah ZY. Disparity of Neonatal Care Visits by Region in Indonesia: A Secondary Data from Basic Health Research. Matern Child Health J 2024; 28:691-699. [PMID: 37955836 DOI: 10.1007/s10995-023-03841-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/27/2023] [Indexed: 11/14/2023]
Abstract
BACKGROUND Neonatal care visit is one of the efforts to reduce the neonatal mortality rate. In Indonesia, few studies have analyzed neonatal care visits by region in the last decade. The purpose of this study was to analyze factors associated with neonatal care visits by region in Indonesia. METHOD This study was a quantitative study with a cross-sectional design. It used secondary data from Riskedas (Basic Health Research). The total sample size was 64,321 female respondents of childbearing age who had babies aged 29 days to 59 months. The dependent variable was the completeness of neonatal care visits measured through at least one at the first neonatal care visit (KN 1), at least one at the second neonatal care visit (KN 2), and at least one at the third neonatal care visit (KN 3). Data were analysed using a statistical binary logistic regression test. RESULTS The respondents who had complete neonatal care visits in Indonesia was 47.9%. The region with the highest proportion was Java-Bali at 58.5%, while the region with the lowest proportion was Papua at 23.8%. Variables influencing the completeness of neonatal care visits were delivery attendant, urban residence, secondary and higher education background, parity, delivery at a healthcare facility and compete antenatal care visits. Of these variables, delivery attendant (p < 0.05) was the most significant variable in all regions. CONCLUSION This study showed that there were significant differences in complete neonatal care visits between regions in particularly between the ones in the west and east part of Indonesia. The government is expected to be able to provide equal distribution of and access to health facilities in rural and eastern Indonesia, especially neonatal services.
Collapse
Affiliation(s)
- Haerawati Idris
- Department of Health Policy and Administration, Faculty of Public Health, Sriwijaya University, Indralaya, Ogan Ilir, South Sumatera, 30662, Indonesia.
| | - Zhafirah Yanzli Anisah
- Department of Health Policy and Administration, Faculty of Public Health, Sriwijaya University, Indralaya, Ogan Ilir, South Sumatera, 30662, Indonesia
| |
Collapse
|
4
|
Ferede Zegeye A, Kassa Mekonnen C, Kindie H, Shetie Workneh B, Bihonegn Asmamaw D, Tarik Tamir T. Individual and community-level determinants of pentavalent vaccination dropouts among under-five children in the sub-Saharan African countries: A multilevel analysis of the recent demographic and health survey. Vaccine X 2024; 17:100465. [PMID: 38435980 PMCID: PMC10906395 DOI: 10.1016/j.jvacx.2024.100465] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Revised: 02/16/2024] [Accepted: 02/19/2024] [Indexed: 03/05/2024] Open
Abstract
Background Globally, each year, about 3 million deaths among children are prevented by pentavalent vaccinations. However, in developing countries, particularly in Sub-Saharan Africa, pentavalent vaccination dropout rates are not well reported. Therefore, this study aimed to assess pentavalent vaccination dropout rates and their determinants among under-five children in Sub-Saharan Africa. Methods Data from the recent Demographic and Health Surveys in 33 Sub-Saharan African countries were used for analysis. The study used a total of 358,529 under-five children. The determinants of pentavalent vaccination dropout were determined using a multilevel mixed-effects logistic regression model. Significant factors associated with pentavalent vaccination dropout were declared significant at p-values < 0.05. A model with the lowest deviance and highest logliklihood ratio was selected as the best-fit model. Results In Sub-Saharan Africa, one in five under-five children had pentavalent vaccination dropout rates. Factors such as Age (AOR = 1.61, 95 % CI: 1.51, 1.72), educational level (AOR = 1.30, 95 % CI: 1.22, 1.40), place of delivery (AOR = 1.65, 95 % CI: 1.57, 1.73), ANC visits (AOR = 1.34, 95 % CI: 1.23, 1.45), postnatal check-up (AOR = 1.19, 95 % CI: 1.14, 1.25), wealth status (AOR = 1.09, 95 % CI: 1.04, 1.15), distance to health facility (AOR = 1.08, 95 % CI: 1.03, 1.13), media exposure (AOR = 1.12, 95 % 1.15), and geographical region (AOR = 1.60, 95 % CI: 1.49, 1.72) had higher odds of pentavalent vaccination dropouts. Conclusions Pentavalent vaccination dropout rates in sub-Saharan Africa among under-five children were high. Both individual and community-level variables were determinants of pentavalent vaccination dropout rates. Government and ministry of health in Sub-Saharan Africa should give attention to those mothers of under-five children who reported distance as a big problem in accessing health facilities and to women who do not utilise antenatal and postnatal check-ups while designing policies and strategies in sub-Saharan Africa.
Collapse
Affiliation(s)
- Alebachew Ferede Zegeye
- Department of Medical Nursing, School of Nursing, College of Medicine and Health Sciences University of Gondar, Gondar, Ethiopia
| | - Chilot Kassa Mekonnen
- Department of Medical Nursing, School of Nursing, College of Medicine and Health Sciences University of Gondar, Gondar, Ethiopia
| | - Hailemichael Kindie
- Department of Medical Nursing, School of Nursing, College of Medicine and Health Sciences University of Gondar, Gondar, Ethiopia
| | - Belayneh Shetie Workneh
- Department of Emergency and Critical Care Nursing, School of Nursing, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Desale Bihonegn Asmamaw
- Department of Reproductive Health, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Tadesse Tarik Tamir
- Department of Pediatrics and Child Health Nursing, School of Nursing, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| |
Collapse
|
5
|
Chilot D, Aragaw FM, Belay DG, Asratie MH, Merid MW, Kibret AA, Teshager NW, Alem AZ. Effectiveness of eight or more antenatal contacts on health facility delivery and early postnatal care in low- and middle-income countries: a propensity score matching. Front Med (Lausanne) 2023; 10:1107008. [PMID: 37547614 PMCID: PMC10401271 DOI: 10.3389/fmed.2023.1107008] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2022] [Accepted: 06/30/2023] [Indexed: 08/08/2023] Open
Abstract
Background Despite progress in reducing maternal and child mortality, many low- and middle-income countries (LMICs) still experience an unacceptably high level of the problem. The World Health Organization (WHO) recently recommended pregnant women should have at least eight antenatal care visits (ANC8+) with a trained healthcare provider as a key strategy to promote pregnant women's health. Antenatal care is an imperative factor for subsequent maternal healthcare utilization such as health facility delivery and early postnatal care (EPNC). This study aimed to examine the net impact of ANC8+ visits on health facility delivery and EPNC in LMICs using a propensity score matching analysis. Methods We used the recent Demographic and Health Survey (DHS) datasets from 19 LMICs. Women of reproductive age (15-49 years) who had given birth within 1 year preceding the survey were included. A propensity score matching analysis was employed to assess the net impact of eight or more antenatal care visits on health facility delivery and early postnatal care. Result After matching the covariates, women who attended ANC8+ visits had a 14% (ATT = 0.14) higher chance of having their delivery at health facilities compared with women who attended less than eight ANC visits. This study further revealed that women who had ANC8+ visits were associated with a 10% (ATT = 0.10) higher probability of early PNC compared with their counterparts. Conclusion and recommendation This study confirmed that ANC8+ visits significantly increased the likelihood of health facility-based delivery and early PNC utilization in LMICs. These findings call for public health programs to focus on pregnant women attending adequate ANC visits (according to revised WHO recommendation) as our study indicates that ANC8+ visits significantly improved the chances of subsequent care.
Collapse
Affiliation(s)
- Dagmawi Chilot
- Department of Human Physiology, College of Medicine and Health Science, School of Medicine, University of Gondar, Gondar, Ethiopia
| | - Fantu Mamo Aragaw
- Department of Epidemiology and Biostatistics, College of Medicine and Health Science, Institute of Public Health, University of Gondar, Gondar, Ethiopia
| | - Daniel Gashaneh Belay
- Department of Epidemiology and Biostatistics, College of Medicine and Health Science, Institute of Public Health, University of Gondar, Gondar, Ethiopia
- Department of Human Anatomy, College of Medicine and Health Science, School of Medicine, University of Gondar, Gondar, Ethiopia
| | - Melaku Hunie Asratie
- Department of Women and Family Health, College of Medicine and Health Science, School of Midwifery, University of Gondar, Gondar, Ethiopia
| | - Mehari Woldemariam Merid
- Department of Epidemiology and Biostatistics, College of Medicine and Health Science, Institute of Public Health, University of Gondar, Gondar, Ethiopia
| | - Anteneh Ayelign Kibret
- Department of Human Anatomy, College of Medicine and Health Science, School of Medicine, University of Gondar, Gondar, Ethiopia
| | - Nahom Worku Teshager
- Department of Pediatrics and Child Health, College of Medicine and Health Science, School of Medicine, University of Gondar, Gondar, Ethiopia
| | - Adugnaw Zeleke Alem
- Department of Epidemiology and Biostatistics, College of Medicine and Health Science, Institute of Public Health, University of Gondar, Gondar, Ethiopia
| |
Collapse
|
6
|
Sultana N, Hossain A, Das H, Pallikadavath S, Koeryaman M, Rahman M, Chowdhury AH, Bhuiya A, Mahmood SS, Hanifi SMA. Is the maternal health voucher scheme associated with increasing routine immunization coverage? Experience from Bangladesh. Front Public Health 2023; 11:963162. [PMID: 36817885 PMCID: PMC9937056 DOI: 10.3389/fpubh.2023.963162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Accepted: 01/05/2023] [Indexed: 02/05/2023] Open
Abstract
Bangladesh initiated the Maternal Health Voucher Scheme (MHVS) in 2007 to improve maternal and child health practices and bring equity to the mainstream of health systems by reducing financial and institutional barriers. In this study, we investigated whether the MHVS has an association with immunization coverage in a rural area of Bangladesh. Between 30 October 2016 and 15 June 2017, we carried out a cross-sectional survey in two low performing areas in terms of immunization coverage- Chattogram (erstwhile Chittagong division) and Sylhet division of Bangladesh. We calculated the coverage of fully immunized children (FIC) for 1151 children aged 12-23 months of age. We compared the coverage of FIC between children whose mothers enrolled in MHVS and children whose mother did not. We analyzed immunization coverage using crude odds ratio (OR) and adjusted OR (aOR) from binary logistic regression models. The overall coverage of FIC was 86%. Ninety-three percent children whose mothers were MHVS members were fully immunized whereas the percentage was 84% for the children of mothers who were not enrolled in MHVS. Multivariate analysis also shows that FIC coverage was higher for children whose mothers enrolled in MHVS compared to those children whose mothers did not; the aOR was 2.03 (95% confidence interval 1.11-3.71). MHVS provides a window for non-targeted benefits of childhood vaccination. Providing health education to pregnant mothers during prenatal care may motivate them to immunize their children. Programmes targeted for mothers during pregnancy, childbirth and post-natal may further increase utilization of priority health services such as childhood immunization.
Collapse
Affiliation(s)
- Nazia Sultana
- Health Systems and Population Studies Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr, b), Dhaka, Bangladesh,*Correspondence: Nazia Sultana ✉
| | - Aazia Hossain
- Health Systems and Population Studies Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr, b), Dhaka, Bangladesh
| | - Hemel Das
- Health Systems and Population Studies Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr, b), Dhaka, Bangladesh
| | - Saseendran Pallikadavath
- Portsmouth-Brawijaya Centre for Global Health, Population, and Policy, University of Portsmouth, Portsmouth, United Kingdom
| | - Mira Koeryaman
- Portsmouth-Brawijaya Centre for Global Health, Population, and Policy, University of Portsmouth, Portsmouth, United Kingdom
| | - Mohammad Rahman
- Salford Business School, University of Salford, Salford, United Kingdom
| | | | - Abbas Bhuiya
- Health Systems and Population Studies Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr, b), Dhaka, Bangladesh
| | - Shehrin Shaila Mahmood
- Health Systems and Population Studies Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr, b), Dhaka, Bangladesh
| | - S. M. A. Hanifi
- Health Systems and Population Studies Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr, b), Dhaka, Bangladesh
| |
Collapse
|
7
|
Tesfa GA, Yehualashet DE, Getnet A, Bimer KB, Seboka BT. Spatial distribution of complete basic childhood vaccination and associated factors among children aged 12-23 months in Ethiopia. A spatial and multilevel analysis. PLoS One 2023; 18:e0279399. [PMID: 36608032 PMCID: PMC9821487 DOI: 10.1371/journal.pone.0279399] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Accepted: 12/07/2022] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND Complete childhood vaccination considerably aids in the reduction of morbidity and mortality from vaccine-preventable childhood diseases. Understanding the geographical disparity of complete basic childhood vaccination and Identifying associated factors is vital to designing appropriate interventions. This study aimed to assess the spatial distribution and associated factors of complete basic childhood vaccination among children aged 12-23 months in Ethiopia. METHODS A two-stage stratified sampling technique was used based on the 2019 Ethiopian mini demographic and health survey data. A total weighted sample of 1,028 children was included in the analysis. ArcGIS version 10.8 software was used to visualize the spatial distribution of complete basic childhood vaccination. The Bernoulli-based model was used to detect significant clusters of areas using SaTScan version 9.6 software. To identify associated factors, multilevel logistic regression analyses were used, and all variables with a p-value less than 0.05 were reported as statistically significant predictors. RESULTS Complete basic childhood vaccination among children aged 12-23 months had a significant variation in Ethiopia (Moran's I = 0.276, p<0.001). The spatial scan analysis identified the most likely significant primary clusters with low complete basic childhood vaccination coverage in the Somali region's Afder, Liben, Shabelle, and Nogobe zones; the Southern Nation Nationality and Peoples Region's (SNNPR) Gedeo and Sidama zones; and the Oromia region's Bale and Guji zones. The second significant cluster was found in the Afar region's zones 1, 4, and 5, as well as the northern Somali region's Siti zone. In the multivariable multilevel analysis, maternal age 20-24, 25-29, 35-39, and 40-44 years, delivery at a health facility, four or more antenatal care (ANC) visits, orthodox religion fellowship, maternal primary education, Muslim religion fellowship, living in the Afar, Somalia, and Oromia regions, and living in rural areas were all found to be significantly associated with complete basic childhood vaccination. CONCLUSION A geographically significant variation of complete basic childhood vaccination was observed. Maternal age, maternal education, religion, place of delivery, ANC visit, region, and residence were significantly associated with complete basic childhood vaccination. Developing immunization campaigns targeting areas that had low basic vaccination coverage and designing healthcare programs that can motivate facility-based delivery and ANC follow-up is recommended.
Collapse
Affiliation(s)
- Getanew Aschalew Tesfa
- School of Public Health, College of Health Science and Medicine, Dilla University, Dilla, Ethiopia
- * E-mail:
| | | | - Addisu Getnet
- Department of Midwifery, College of Health Science and Medicine, Dilla University, Dilla, Ethiopia
| | - Kirubel Biweta Bimer
- Department of Nursing, College of Health Science and Medicine, Dilla University, Dilla, Ethiopia
| | - Binyam Tariku Seboka
- School of Public Health, College of Health Science and Medicine, Dilla University, Dilla, Ethiopia
| |
Collapse
|
8
|
Akhtar S, Mohanty SK, Singh RR, Sen S. Chronic diseases and productivity loss among middle-aged and elderly in India. BMC Public Health 2022; 22:2356. [PMID: 36522623 PMCID: PMC9756765 DOI: 10.1186/s12889-022-14813-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2022] [Accepted: 12/06/2022] [Indexed: 12/23/2022] Open
Abstract
CONTEXT Chronic diseases are growing in India and largely affecting the middle-aged and elderly population; many of them are in working age. Though a large number of studies estimated the out-of-pocket payment and financial catastrophe due to this condition, there are no nationally representative studies on productivity loss due to health problems. This paper examined the pattern and prevalence of productivity loss, due to chronic diseases among middle-aged and elderly in India. METHODS We have used a total of 72,250 respondents from the first wave of Longitudinal Ageing Study in India (LASI), conducted in 2017-18. We have used two dependent variables, limiting paid work and ever stopped work due to ill health. We have estimated the age-sex adjusted prevalence of ever stopped working due to ill health and limiting paid work across MPCE quintile and socio- demographic characteristics. Propensity Score Matching (PSM) and logistic regression was used to examine the effect of chronic diseases on both these variables. FINDINGS We estimated that among middle aged adults in 45-64 years, 3,213 individuals accounting to 6.9% (95%CI:6.46-7.24) had ever-stopped work and 6,300 individuals accounting to 22.7% (95% CI: 21.49-23.95) had limiting paid work in India. The proportion of ever-stopped and limiting work due to health problem increased significantly with age and the number of chronic diseases. Limiting paid work is higher among females (25.1%), and in urban areas (24%) whereas ever-stopped is lower among female (5.7%) (95% CI:5.16-6.25 ) and in urban areas (4.9%) (95% CI: 4.20-5.69). The study also found that stroke (21.1%) and neurological or psychiatric problems (18%) were significantly associated with both ever stopped work and limiting paid work. PSM model shows that, those with chronic diseases are 4% and 11% more likely to stop and limit their work respectively. Regression model reveals that more than one chronic conditions had a consistent and significant positive impact on stopping work for over a year (increasing productivity loss) across all three models. CONCLUSION Individuals having any chronic disease has higher likelihood of ever stopped work and limiting paid work. Promoting awareness, screening and treatment at workplace is recommended to reduce adverse consequences of chronic disease in India.
Collapse
Affiliation(s)
- Shamrin Akhtar
- grid.419349.20000 0001 0613 2600International Institute for Population Sciences, Mumbai, Maharashtra 400088 India
| | - Sanjay K. Mohanty
- grid.419349.20000 0001 0613 2600Department of Population and Development, International Institute for Population Sciences, Mumbai, 400088 India
| | - Rajeev Ranjan Singh
- grid.419349.20000 0001 0613 2600International Institute for Population Sciences, Mumbai, Maharashtra 400088 India
| | - Soumendu Sen
- grid.419349.20000 0001 0613 2600International Institute for Population Sciences, Mumbai, Maharashtra 400088 India
| |
Collapse
|
9
|
Krishnamoorthy Y, Rehman T. Impact of antenatal care visits on childhood immunization: a propensity score-matched analysis using nationally representative survey. Fam Pract 2022; 39:603-609. [PMID: 34564727 DOI: 10.1093/fampra/cmab124] [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] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Evidence has suggested a relationship between antenatal care (ANC) visits and childhood immunization coverage. However, evaluating its impact using observational data suffers from the problem of selection bias. Hence, we adopted propensity score-matched (PSM) analysis for studying the impact of ANC visits on childhood immunization. METHODS Data regarding ANC visits and childhood immunization were collected from a nationally representative survey, National Family Health Survey-4 (NFHS-4). We performed PSM analysis with logit model using the psmatch2 command package in STATA to find the average treatment effect on the population (ATE), treated (ATT), and untreated (ATU). RESULTS In total, 5,430 participants were included in the analysis. Radius matching with caliper width of 0.01 was used to match the groups. The ATT values in the intervention and control groups were 0.71 and 0.47, respectively, indicating that the immunization coverage was increased by 24% because of ANC visits. The ATU values in the intervention and control groups were 0.40 and 0.65, respectively. This indicates that for the women who did not make the ANC visits, the chance of getting their children immunized would have increased by 25% if they had made four or more visits. The final ATE estimate was 0.25 among the study participants. Quality of matching was good with no significant difference in characteristics between the two groups. CONCLUSION Findings from our study imply that policymakers in India should focus on further improving the ANC coverage as it has a significant impact on improving childhood immunization coverage.
Collapse
Affiliation(s)
- Yuvaraj Krishnamoorthy
- Department of Community Medicine, ESIC Medical College & PGIMSR, K.K. Nagar, Chennai, Tamil Nadu, India
| | - Tanveer Rehman
- Department of Preventive and Social Medicine, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| |
Collapse
|
10
|
Chowdhury MAS, Chuanmin S, Sokolová M, Akbar A, Ali Z, Ali H, Alam MZ. Assessing the Empirical Linkage Among Access to Finance, Firm Quality, and Firm Performance: New Insight From Bangladeshi SMEs'. Front Psychol 2022; 13:865733. [PMID: 35572253 PMCID: PMC9093049 DOI: 10.3389/fpsyg.2022.865733] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2022] [Accepted: 03/24/2022] [Indexed: 11/18/2022] Open
Abstract
Access to finance plays a central pillar on the sustainable firm growth of developing and developed nations. This study depicts the linkage between access to external finance, firm quality, and firms’ performance as measured by labor productivity for sustainable small- and medium-sized enterprises (SMEs’) development by employing the ordinary least squares (OLS) regression and propensity score matching (PSM) techniques to alleviate the selection bias and endogeneity issue on Word bank enterprise survey (WBES) cross-sectional firm-level data of 3,196 Bangladeshi SMEs for 2007–2013 period. Empirical evidence linking access to external finance and labor productivity has been positive and significant. However, our finding explores a negative but significant relationship between exports and SME labor productivity. A further look into the results also exhibits no statistical significance in the interaction effect between firm quality and access to finance on labor productivity. Moreover, the study anticipates novel empirical support that, the disintegration effect of export sales between direct and indirect exports with labor productivity for credit-accessed firms, is also found statistically insignificant. Then, several policies are drawn from the results to gain international competitiveness, and to ensure more external finance channels for enhancing SMEs’ performance and sustainable firm growth.
Collapse
Affiliation(s)
| | - Shuai Chuanmin
- School of Economics and Management, China University of Geosciences, Wuhan, China
| | - Marcela Sokolová
- Department of Management, Faculty of Informatics and Management, University of Hradec Králové, Hradec Králové, Czechia
| | - Ahsan Akbar
- Department of Management, Faculty of Informatics and Management, University of Hradec Králové, Hradec Králové, Czechia.,International Business School, Guangzhou City University of Technology, Guangzhou, China
| | - Zahid Ali
- Department of Commerce and Management, University of Malakand, Chakdara, Pakistan
| | - Hussain Ali
- School of Economics and Management, China University of Geosciences, Wuhan, China
| | - Md Zahid Alam
- School of Economics and Management, China University of Geosciences, Wuhan, China
| |
Collapse
|
11
|
Schön M, Heesemann E, Ebert C, Subramanyam M, Vollmer S, Horn S. How to ensure full vaccination? The association of institutional delivery and timely postnatal care with childhood vaccination in a cross-sectional study in rural Bihar, India. PLOS GLOBAL PUBLIC HEALTH 2022; 2:e0000411. [PMID: 36962219 PMCID: PMC10021874 DOI: 10.1371/journal.pgph.0000411] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Accepted: 04/05/2022] [Indexed: 11/19/2022]
Abstract
Incomplete and absent doses in routine childhood vaccinations are of major concern. Health systems in low- and middle-income countries (LMIC), in particular, often struggle to enable full vaccination of children, which affects their immunity against communicable diseases. Data on child vaccination cards from a cross-sectional primary survey with 1,967 households were used to assess the vaccination status. The association of timely postnatal care (PNC) and the place of delivery with any-dose (at least one dose of each vaccine) and full vaccination of children between 10-20 months in Bihar, India, was investigated. Bivariate and multivariable logistic regression models were used. The vaccines included targeted tuberculosis, hepatitis B, polio, diphtheria/pertussis/tetanus (DPT) and measles. Moreover predictors for perinatal health care uptake were analysed by multivariable logistic regression. Of the 1,011 children with card verification, 47.9% were fully vaccinated. Timely PNC was positively associated with full vaccination (adjusted odds ratio (aOR) 1.48, 95% confidence interval (CI) 1.06-2.08) and with the administration of at least one dose (any-dose) of polio vaccine (aOR 3.37 95% CI 1.79-6.36), hepatitis B/pentavalent vaccine (aOR 2.11 95% CI 1.24-3.59), and DPT/pentavalent vaccine (aOR 2.29 95% CI 1.35-3.88). Additionally, delivery in a public health care facility was positively associated with at least one dose of hepatitis B/pentavalent vaccine administration (aOR 4.86 95% CI 2.97-7.95). Predictors for timely PNC were institutional delivery (public and private) (aOR 2.7 95% CI 1.96-3.72, aOR 2.38 95% CI 1.56-3.64), at least one ANC visit (aOR 1.59 95% CI 1.18-2.15), wealth quintile (Middle aOR 1.57 95% CI 1.02-2.41, Richer aOR 1.51 95% CI 1.01-2.25, Richest aOR 2.06 95% CI 1.28-3.31) and household size (aOR 0.95 95% CI 0.92-0.99). The findings indicate a correlation between childhood vaccination and timely postnatal care. Further, delivery in a public facility correlates with the administration of at least one dose of hepatitis B vaccine and thus impedes zero-dose vaccination. Increasing uptake of timely PNC, encouraging institutional delivery, and improving vaccination services before discharge of health facilities may lead to improved vaccination rates among children.
Collapse
Affiliation(s)
- Mareike Schön
- Department of Paediatrics, University Medical Center Göttingen, Göttingen, Germany
| | | | - Cara Ebert
- RWI-Leibniz Institute for Economic Research, Essen, Germany
| | - Malavika Subramanyam
- Social Epidemiology, Indian Institute of Technology Gandhinagar, Palaj, Gandhinagar, Gujarat, India
| | - Sebastian Vollmer
- Chair of Development Economics, Center for Modern Indian Studies, University of Göttingen, Göttingen, Germany
| | - Sebastian Horn
- Department of Paediatrics, University Medical Center Göttingen, Göttingen, Germany
- Department of Paediatrics, SRH Central Hospital Suhl, Suhl, Germany
| |
Collapse
|
12
|
Francis MR, Nuorti JP, Lumme-Sandt K, Kompithra RZ, Balraj V, Kang G, Mohan VR. Vaccination coverage and the factors influencing routine childhood vaccination uptake among communities experiencing disadvantage in Vellore, southern India: a mixed-methods study. BMC Public Health 2021; 21:1807. [PMID: 34620139 PMCID: PMC8499461 DOI: 10.1186/s12889-021-11881-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Accepted: 09/21/2021] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND In 2015, the Vellore district in southern India was selected for intensified routine immunization, targeting children from communities experiencing disadvantage such as migrant, tribal, and other hard-to-reach groups. This mixed-methods study was conducted to assess routine immunization coverage and the factors influencing childhood vaccination uptake among these communities in Vellore. METHODS We conducted a cross-sectional household survey (n = 100) and six focus group discussions (n = 43) among parents of children aged 12-23 months from the known communities experiencing disadvantage in Vellore during 2017 and 2018. Multivariate logistic regression was conducted to examine associations between the parental characteristics and children's vaccination status in the household survey data; the qualitative discussions were analyzed by using the (previously published) "5As" taxonomy for the determinants of vaccine uptake. RESULTS In the household survey, the proportions of fully vaccinated children were 65% (95% CI: 53-76%) and 77% (95% CI: 58-88%) based on information from vaccination cards or parental recall and vaccination cards alone, respectively. Children whose mothers were wage earners [Adjusted prevalence odds ratio (aPOR): 0.21, 95% CI = 0.07-0.64], or salaried/small business owners [aPOR: 0.18, 95% CI = 0.04-0.73] were less likely to be fully vaccinated than children who had homemakers mothers. In the focus group discussions, parents identified difficulties in accessing routine immunization when travelling for work and showed knowledge gaps regarding the benefits and risks of vaccination, and fears surrounding certain vaccines due to negative news reports and common side-effects following childhood vaccination. CONCLUSIONS Vaccination coverage among children from the surveyed communities in Vellore was suboptimal. Our findings suggest the need to target children from Narikuravar families and conduct periodic community-based health education campaigns to improve parental awareness about and trust in childhood vaccines among the communities experiencing disadvantage in Vellore.
Collapse
Affiliation(s)
- Mark Rohit Francis
- Health Sciences Unit, Faculty of Social Sciences, Tampere University, Tampere, Finland
| | - J Pekka Nuorti
- Health Sciences Unit, Faculty of Social Sciences, Tampere University, Tampere, Finland
- Infectious Diseases and Vaccines Unit, Department of Health Protection, National Institute for Health and Welfare, Helsinki, Finland
| | - Kirsi Lumme-Sandt
- Health Sciences Unit, Faculty of Social Sciences, Tampere University, Tampere, Finland
| | - Rajeev Zachariah Kompithra
- Well Baby Immunization Clinic, Department of Pediatrics Unit - I, Christian Medical College, Vellore, Tamil Nadu, India
| | - Vinohar Balraj
- Department of Community Health, Christian Medical College, Vellore, Tamil Nadu, India
| | - Gagandeep Kang
- Division of Gastrointestinal Sciences, Christian Medical College, Vellore, Tamil Nadu, India
| | - Venkata Raghava Mohan
- Department of Community Health, Christian Medical College, Vellore, Tamil Nadu, India.
| |
Collapse
|
13
|
Wagner AL, Tefera YA, Gillespie BW, Carlson BF, Boulton ML. Vaccine coverage, timeliness and delay estimated from regional and national cross-sectional surveys in Ethiopia, 2016. Pan Afr Med J 2021; 39:205. [PMID: 34603586 PMCID: PMC8464200 DOI: 10.11604/pamj.2021.39.205.22777] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2020] [Accepted: 07/07/2021] [Indexed: 12/04/2022] Open
Abstract
Introduction measures of vaccine timing require data on vaccination dates, which may be unavailable. This study compares estimates of vaccine coverage and timing; and compares regression techniques that model these measures in the presence of incomplete data. Methods this cross-sectional study used the 2016 Ethiopian Demographic and Health Survey (DHS), and a 2016 survey from Worabe, Ethiopia. Three measures of vaccine uptake were calculated: coverage (regardless of timing), timeliness (within 1 week of recommended administration), and delay (the number of days between the recommended and actual date of vaccination). Vaccine coverage and timeliness were modeled with logistic regressions. After excluding those without dates, vaccine delay was estimated using linear regression or survival analysis. Vaccine delay was also estimated using accelerated failure time (AFT) models. Results the DHS survey included 3819 children aged 12-60 months and the Worabe survey included 484 children aged 12-23 months. In the Worabe survey, vaccine coverage for pentavalent vaccine dose 3 was 87.4%, with 8.6% receiving it within 1 week, and 71.7% within 4 weeks; the median delay was 19 days. Predictors of outcomes were similar in both the Worabe survey and Ethiopian DHS, with the largest numbers of significant associations seen in models with vaccine coverage or delays (with AFT models) as the outcomes. Conclusion estimates of coverage may miss a substantial proportion of infants who have delayed vaccination. Accelerated failure time (AFT) models are useful to estimate vaccine delay because they include information from all respondents (those with full and partial data on vaccination dates) and are agnostic about an age limit for timely vaccination.
Collapse
Affiliation(s)
- Abram Luther Wagner
- Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, Michigan, USA
| | - Yemesrach Abeje Tefera
- Department of Public Health, St. Paul´s Hospital Millennium Medical College, Addis Ababa, Ethiopia
| | - Brenda Wilson Gillespie
- Department of Biostatistics, School of Public Health, University of Michigan, Ann Arbor, Michigan, USA
| | - Bradley Frederick Carlson
- Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, Michigan, USA
| | - Matthew Lester 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
| |
Collapse
|
14
|
Worku D, Teshome D, Tiruneh C, Teshome A, Berihun G, Berhanu L, Walle Z. Antenatal care dropout and associated factors among mothers delivering in public health facilities of Dire Dawa Town, Eastern Ethiopia. BMC Pregnancy Childbirth 2021; 21:623. [PMID: 34525974 PMCID: PMC8442648 DOI: 10.1186/s12884-021-04107-7] [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] [Received: 02/11/2021] [Accepted: 09/06/2021] [Indexed: 11/19/2022] Open
Abstract
Introduction More than two-thirds of the pregnant women in Africa have at least one antenatal care contact with a health care provider. However, to achieve the full life-saving potential that antenatal care promises for women and babies, four visits providing essential evidence-based interventions – a package often called focused antenatal care are required. Hence, identifying the factors associated with dropout of maternal health care utilization would have meaningful implications. The study aimed to assess antenatal care dropout and associated factors among mothers delivering in the public health facilities of Dire Dawa town, Ethiopia. Methods Facility-based cross-sectional study was conducted from January 1 to 30, 2020. Proportionate sampling and simple random sampling techniques were used to select 230 women. Data were collected using a structured and pretested interview administered questionnaire during delivery. The data were entered into Epidata version 3.1 and analyzed using SPSS version 20. A binary logistic regression model with a 95 % confidence interval was used to analyze the results. Bivariable analysis (COR [crude odds ratio]) and multivariable analysis (AOR [adjusted odds ratio]) was used to analyze the results. From the bivariable analysis, variables with a p-value < 0.25 were entered into the multivariable logistic regression analysis. From the multivariable logistic regression analysis, variables with a significance level of p-value < 0.05 were taken as factors independently associated with ANC dropout. Result The proportion of antenatal care dropouts was 86 (37.4 %) (95 % CI: 31.3–43.9). In logistic regression analyses, those who had no past antenatal care follow up were more likely to have ANC dropout (AOR = 7.89; 95 % CI: 2.109–29.498) and those who had no professional advice were more likely to have antenatal care dropout (AOR = 4.64 95 % CI: 1.246–17.254). Conclusions This study indicates that a high number of women had antenatal care dropout. Having no past ANC follow-up and professional advice were the major factors of ANC service utilization dropout. Hence, giving more information during the ANC visit is important to reduce the dropout rate from the maternity continuum of care. Supplementary Information The online version contains supplementary material available at 10.1186/s12884-021-04107-7.
Collapse
Affiliation(s)
- Dereje Worku
- Department of Gynecology and Obstetrics, College of Medicine and Health Sciences, Wachamo University, Hossana, Ethiopia
| | - Daniel Teshome
- Department of Anatomy, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia.
| | - Chalachew Tiruneh
- Department of Anatomy, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
| | - Alemtsehay Teshome
- Department of Gynecology and Obstetrics, College of Medicine and Health Sciences, Wachamo University, Hossana, Ethiopia
| | - Gete Berihun
- Department of Environmental Health, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
| | - Leykun Berhanu
- Department of Environmental Health, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
| | - Zebader Walle
- Department of Public Health, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
| |
Collapse
|
15
|
Associated Factors for Dropout of First Vs Third Doses of Diphtheria Tetanus Pertussis (DPT) Vaccination in Nepal. Adv Prev Med 2021; 2021:1319090. [PMID: 33959398 PMCID: PMC8075685 DOI: 10.1155/2021/1319090] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Revised: 02/13/2021] [Accepted: 04/05/2021] [Indexed: 11/17/2022] Open
Abstract
Background Immunization acts as a key intervention to reduce under-five mortality and morbidity. Despite global progress on vaccination, difficulties in the utilization of this service in developing countries have been observed. According to Nepal Demographic and Health Survey (NDHS) 2016, only 78% of children received a complete dose of vaccine among which the first-dose receiver of DPT is 98%, whereas only 83% received a third dose. This study aims to explore the influencing factors of DPT vaccination dropout in Nepal. Methods The explorative study was done through secondary data analysis of NDHS 2016. The KR file was used for the analysis of information for 2883 children. Factors influencing dropout of DPT vaccination were explored against the independent variables such as external environment, predisposing factors, and enabling resources. All the analyses were weighted before the analysis. The descriptive, bivariate, and multivariate analyses were performed. The variables showing collinearity have been removed in the final model. Results A higher dropout was reported in Terai (18.9%) and province 2 (22.0%), among uneducated mothers (18.1%) and uneducated fathers (19.4%), less than once a week internet users (22.2%), the nonradio listener (17.4%), who had <4 ANC visits (22.7%), home delivery (19.2%), no advised SBA (19.1%), long distance to health facility (17.9%), no iron supplementation in pregnancy (24.3%), and PNC by TBA/others (21.1%). All these tested relationships were found statistically significant (P value <0.05). The aOR for dropout was found to be 7.94 (4.07–15.51) for mothers with less than 4 or no ANC visit, long distance to health facility 4.68 (1.98–10.67), province 2 3.53 (1.13–11.03), and mother without formal employment 2.33 (1.52–3.55). Conclusion Factors related to health services, distance, provinces, and socioeconomic status of the family were influencers for vaccine dropout. Targeted intervention towards disadvantaged regions, counseling the mother during ANC, improving the education status of parents, access to the health facility, and use of mass media for advocacy are hereby recommended.
Collapse
|
16
|
Budu E, Seidu AA, Agbaglo E, Armah-Ansah EK, Dickson KS, Hormenu T, Hagan JE, Adu C, Ahinkorah BO. Maternal healthcare utilization and full immunization coverage among 12-23 months children in Benin: a cross sectional study using population-based data. ACTA ACUST UNITED AC 2021; 79:34. [PMID: 33726859 PMCID: PMC7962345 DOI: 10.1186/s13690-021-00554-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Accepted: 03/01/2021] [Indexed: 01/24/2023]
Abstract
Background Maternal and child health are important issues for global health policy, and the past three decades have seen a significant progress in maternal and child healthcare worldwide. Immunization is a critical, efficient, and cost-effective public health intervention for newborns. However, studies on these health-promoting indicators in low-income and middle-income countries, especially in sub-Sahara Africa are sparse. We investigated the association between maternal healthcare utilization and complete vaccination in the Republic of Benin. Methods We analysed data from the 2018 Benin Demographic and Health Survey (BDHS). Specifically, the children’s recode file was used for the study. The outcome variable used was complete vaccination. Number of antenatal care visits, assistance during delivery, and postnatal check-up visits were the key explanatory variables. Bivariate and multilevel logistic regression analyses were carried out. The results were presented as unadjusted odds ratios (uOR) and adjusted odds ratios (aOR), with their corresponding 95% confidence intervals (CIs) signifying their level of precision. Statistical significance was declared at p < 0.05. Results The prevalence of full immunization coverage in Benin was 85.4%. The likelihood of full immunization was lower among children whose mothers had no antenatal care visits, compared to those whose mothers had 1–3 visits [aOR = 0.11, 95% CI: 0.08–0.15], those who got assistance from Traditional Birth Attendants/other during delivery, compared to those who had assistance from Skilled Birth Attendants/health professionals [aOR = 0.55, 95% CI: 0.40–0.77], and mothers who had no postnatal care check-up visit, compared to those who had postnatal care check-up < 24 h after delivery [aOR = 0.49, 95% CI: 0.36–0.67]. With the covariates, religion, partner’s level of education, parity, wealth quintile, and place of residence also showed significant associations with full immunization. Conclusion The study has demonstrated strong association between full immunization and antenatal care, skilled attendance at birth, and postnatal care check-up visit. We found that full immunization decreases among women with no antenatal care visits, those who receive assistance from Traditional Birth Attendants during delivery, and those who do not go for postnatal care visits. To help achieve full immunization, it is prudent that the government of Benin collaborates with international organisations such as WHO and UNICEF to provide education to pregnant women on the importance of immunization after delivery. Such education can be embedded in the antenatal care, delivery and postnatal care services offered to pregnant women during pregnancy, delivery, and after delivery. Supplementary Information The online version contains supplementary material available at 10.1186/s13690-021-00554-y.
Collapse
Affiliation(s)
- Eugene Budu
- Department of Population and Health, College of Humanities and Legal Studies, University of Cape Coast, Cape Coast, Ghana
| | - Abdul-Aziz Seidu
- Department of Population and Health, College of Humanities and Legal Studies, University of Cape Coast, Cape Coast, Ghana. .,College of Public Health, Medical and Veterinary Sciences, James Cook University, Townsville, Queensland, Australia.
| | - Ebenezer Agbaglo
- Department of English, University of Cape Coast, Cape Coast, Ghana
| | - Ebenezer Kwesi Armah-Ansah
- Department of Population and Health, College of Humanities and Legal Studies, University of Cape Coast, Cape Coast, Ghana
| | - Kwamena Sekyi Dickson
- Department of Population and Health, College of Humanities and Legal Studies, University of Cape Coast, Cape Coast, Ghana
| | - Thomas Hormenu
- Department of Health, Physical Education, and Recreation, University of Cape Coast, Cape Coast, Ghana
| | - John Elvis Hagan
- Department of Health, Physical Education, and Recreation, University of Cape Coast, Cape Coast, Ghana.,Neurocognition and Action-Biomechanics-Research Group, Faculty of Psychology and Sport Sciences, Bielefeld University, Bielefeld, Germany
| | - Collins Adu
- Department of Health Promotion and Disability Studies, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Bright Opoku Ahinkorah
- School of Public Health, Faculty of Health, University of Technology Sydney, Sydney, NSW, Australia
| |
Collapse
|
17
|
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.
Collapse
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.
| |
Collapse
|
18
|
Oduse S, Zewotir T, North D. The impact of antenatal care on under-five mortality in Ethiopia: a difference-in-differences analysis. BMC Pregnancy Childbirth 2021; 21:44. [PMID: 33423662 PMCID: PMC7798199 DOI: 10.1186/s12884-020-03531-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Accepted: 12/26/2020] [Indexed: 12/01/2022] Open
Abstract
Background Sub-Saharan Africa, as opposed to other regions, has the highest under-five mortality rates yet makes the least improvement in reducing under-five mortality. Despite the decline, Ethiopia is among the top ten countries contributing the most to global under-five mortalities. This article examines the impact of the number of antenatal care and the timing of first antenatal care on child health outcomes. We specifically investigated if the utilization of antenatal care services positively affects the reduction of under-five mortality. Methods We employ a difference-in-differences design with propensity score matching to identify direct causal effects of antenatal care on under-five mortality based on the Ethiopian Demographic Health Survey data of 2011 and 2016. Our sample includes 22 295 women between the ages of 14–49 who had antenatal care visits at different times before delivery. Results The study revealed 1 481 cases of reported under-five mortality. 99.0% of that under-five mortality cases are women who had less than eight antenatal care visits, while only 1% of that is by women who had eight or more antenatal care visits. Antenatal care visit decreases the likelihood of under-five mortality in Ethiopia by 45.2% (CI = 19.2–71.3%, P-value < 0.001) while the timing of first antenatal care within the first trimester decreases the likelihood of under-five mortality by 10% (CI = 5.7–15.6%, P-value < 0.001). Conclusions To achieve a significant reduction in the under-five mortality rate, Intervention programs that encourages more antenatal care visits should be considered. This will improve child survival and help in attaining Sustainable Development Goal targets.
Collapse
Affiliation(s)
- Samuel Oduse
- School of Mathematics, Statistics and Computer Science, University of KwaZulu-Natal, 4001, Durban, South Africa.
| | - Temesgen Zewotir
- School of Mathematics, Statistics and Computer Science, University of KwaZulu-Natal, 4001, Durban, South Africa
| | - Delia North
- School of Mathematics, Statistics and Computer Science, University of KwaZulu-Natal, 4001, Durban, South Africa
| |
Collapse
|
19
|
Dhawan D, Pinnamaneni R, Bekalu M, Viswanath K. Association between different types of mass media and antenatal care visits in India: a cross-sectional study from the National Family Health Survey (2015-2016). BMJ Open 2020; 10:e042839. [PMID: 33323449 PMCID: PMC7745528 DOI: 10.1136/bmjopen-2020-042839] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Revised: 11/17/2020] [Accepted: 11/30/2020] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVE To generate evidence for the association between different types of mass media and antenatal care (ANC) visits in India. DESIGN A cross-sectional study design, analysing data from India's National Family Health Survey 4 (NFHS-4), 2015-2016. SETTING Rural and urban India. PARTICIPANTS From NFHS-4, women who had given birth in the last 5 years before survey administration were included in this study. Women with missing information about their number of ANC visits and their caste were excluded, leaving 187 894 women in the final analytical sample. PRIMARY OUTCOME MEASURES Logistic regression analysis was conducted to determine the association of ANC utilisation with mass media exposure. RESULTS Overall, our study showed that high exposure to all four types of mass media was positively associated with making at least eight ANC visits. In rural India, women who had high exposure to newspaper/magazine (adjusted OR (aOR), 1.43; 95% CI, 1.31 to 1.57), radio (aOR, 1.22; 95% CI, 1.09 to 1.37), television (aOR, 2.07; 95% CI, 1.94 to 2.2) and movies (aOR, 1.33; 95% CI, 1.2 to 1.47) were more likely to make at least eight ANC visits. In urban India, women who had high exposure to newspaper/magazine (aOR, 1.12; 95% CI, 1.02 to 1.24), radio (aOR, 1.37; 95% CI, 1.13 to 1.65), television (aOR, 1.39; 95% CI, 1.24 to 1.55) and movies (aOR, 1.23; 95% CI, 1.09 to 1.38) were more likely to make at least eight ANC visits. CONCLUSIONS Our findings emphasise the need for increased awareness about adequate ANC visits in India, to improve maternal, neonatal and child health outcomes. Our study highlights that television penetration is broader than other forms of media and has the potential to create awareness about health in both urban and rural populations. These findings can inform ANC-related health awareness campaigns in the country to allocate resources to appropriate media sources to encourage healthy behaviours.
Collapse
Affiliation(s)
- Dhriti Dhawan
- Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - Ramya Pinnamaneni
- Social and Behavioral Sciences, Harvard T.H Chan School of Public Health, Boston, Massachusetts, USA
| | - Mesfin Bekalu
- Social and Behavioral Sciences, Harvard T.H Chan School of Public Health, Boston, Massachusetts, USA
| | - Kasisomayajula Viswanath
- Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
- Social and Behavioral Sciences, Harvard T.H Chan School of Public Health, Boston, Massachusetts, USA
| |
Collapse
|
20
|
Nour TY, Farah AM, Ali OM, Osman MO, Aden MA, Abate KH. Predictors of immunization coverage among 12-23 month old children in Ethiopia: systematic review and meta-analysis. BMC Public Health 2020; 20:1803. [PMID: 33243208 PMCID: PMC7689978 DOI: 10.1186/s12889-020-09890-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Accepted: 11/15/2020] [Indexed: 12/26/2022] Open
Abstract
Background Immunization is one of modern medicine’s greatest achievements in the last three decades. Annually it can prevent nearly 2 to 3 million deaths. Understanding the determinants of effective immunization coverage is a critical undertaking. Accordingly, we set out to check the best available evidence of outstanding predictors of immunization coverage among children aged 12–23 months in Ethiopia. Method Electronic databases including PubMed, Google Scholar, HINARI, and SCOPUS, Web of Science, African Journals Online, Ethiopian Medical Journals were searched. The search process, study selection, critical appraisal, and data extraction were done independently by two reviewers using Joanna Briggs Institute Meta-analysis for Review Instrument (JBI-MAStARI). The difference between reviewers was resolved with a third person. The risk of bias was assessed by the Newcastle Ottawa Tool for observational studies. Data were extracted using the Microsoft Excel checklist and exported to STATA 13. Heterogeneity was assessed using I2, Funnel plot and Egger’s test was used to check for publication bias. Results We identified 26 studies with 15,042 children with mothers/caretakers to assess factors associated with immunization coverage and significant factors were: maternal formal education, (OR = 2.45; 95% CI: 1.62–3.72), paternal formal education, (OR = 1.01; 95% CI: 0.27–3.77), residence, (OR = 2.11; 95% CI: 1.00–4.45), birth at health facility (OR = 1.86; 95% CI: 0.99–3.49), family size less than four, (OR = 1.81; 95% CI: 1.16–2.84), knowledge on age of immunization to be completed (OR = 6.18;95% CI: 3.07–12.43), knowledge on immunization schedule (OR = 2.49; 95% CI: 1.35–4.59), time to travel to health faculties, (OR = 1.74; 95% CI: 0.62–4.89), antennal care, (OR = 3.11; 95% CI: 1.64–5.88), and tetanus toxoid vaccination, (OR = 4.82; 95% CI: 2.99–7.75). Conclusion Our findings showed that literacy, residence, awareness, family size, maternal health services use, and proximity of the health facilities were factors associated with full immunization. This implies that there is a need for primary health service expansion and health education to “hard to reach areas” to improve immunization coverage for children aged 12–23 months.
Collapse
Affiliation(s)
- Tahir Yousuf Nour
- Department of public health, College of Medicine and Health Sciences, Jigjiga University, P.O. BOX 1020, Jigjiga, Ethiopia.
| | - Alinoor Mohamed Farah
- Department of public health, College of Medicine and Health Sciences, Jigjiga University, P.O. BOX 1020, Jigjiga, Ethiopia
| | - Omer Moelin Ali
- Department of public health, College of Medicine and Health Sciences, Jigjiga University, P.O. BOX 1020, Jigjiga, Ethiopia
| | - Mohamed Omar Osman
- Department of public health, College of Medicine and Health Sciences, Jigjiga University, P.O. BOX 1020, Jigjiga, Ethiopia
| | - Mowlid Akil Aden
- Department of public health, College of Medicine and Health Sciences, Jigjiga University, P.O. BOX 1020, Jigjiga, Ethiopia
| | | |
Collapse
|
21
|
The Magnitude and Determinants of Missed Opportunities for Childhood Vaccination in South Africa. Vaccines (Basel) 2020; 8:vaccines8040705. [PMID: 33255767 PMCID: PMC7712226 DOI: 10.3390/vaccines8040705] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Revised: 11/09/2020] [Accepted: 11/09/2020] [Indexed: 11/17/2022] Open
Abstract
Missed opportunities for vaccination (MOV) may be among the factors responsible for suboptimal vaccination coverage in South Africa. However, the magnitude and determinants of MOV in the country are not known. Thus, this study seeks to assess the prevalence and determinants of MOV in the country. South Africa is sub-divided into nine administrative provinces. We used nationally representative data from the 2016 South African Demographic and Health Survey. We considered MOV to have occurred if a child aged 12–23 months old had not taken all scheduled basic vaccine doses despite having any of the following contacts with health services: delivery in a health facility; postnatal clinic visit; receipt of vitamin A; and any child-related treatment at a health facility. Multilevel logistic regression was used to determine factors associated with MOV. The national prevalence of MOV among children aged 12–23 months was 40.1%. Children whose mothers attended facility-based antenatal care were considerably less likely to experience MOV than those whose mothers did not attend antenatal care: odds ratio (OR) 0.41, 95% confidence interval (CI) 0.19 to 0.88. Conversely, the independent predictor of an increased MOV among children was residence in either the Gauteng province (OR 2.97, 95% CI 1.29 to 6.81) or Mpumalanga province (OR 2.32, 95%CI 1.04 to 5.18); compared to residence in the Free State province. Our findings suggest a high burden of MOV among children in South Africa and that MOV may be associated with individual and contextual factors. The findings also underscore the need for further exploration of the contextual factors contributing to MOV in South Africa.
Collapse
|
22
|
Desalew A, Semahegn A, Birhanu S, Tesfaye G. Incomplete Vaccination and Its Predictors among Children in Ethiopia: A Systematic Review and Meta-Analysis. Glob Pediatr Health 2020; 7:2333794X20968681. [PMID: 33241080 PMCID: PMC7675896 DOI: 10.1177/2333794x20968681] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Revised: 09/13/2020] [Accepted: 09/30/2020] [Indexed: 12/16/2022] Open
Abstract
Background. Vaccination is an effective public health intervention that has contributed to a substantial reduction in the burden of vaccine-preventable diseases. Abridged evidence on incomplete vaccination is not well established in Ethiopia. Therefore, this meta-analysis aimed to estimate the pooled prevalence of incomplete vaccination and its predictors among children aged 12 to 23 months. Methods. Primary studies conducted in Ethiopia were searched. The methodological quality of the included studies was assessed using the Joanna Briggs Institute (JBI) checklist. The analysis was conducted using STATA 14 and RevMan. The presence of statistical heterogeneity was checked using the Cochran Q test, and its level was quantified using I2 statistics. Pooled prevalence and odds ratio (OR) were computed at a 95% confidence interval (CI). Results. The pooled prevalence of incomplete vaccination was 30% (95% CI: 25-35). Maternal illiteracy (OR = 1.96; 95% CI: 1.40, 2.74) and home delivery (OR = 2.78; 95% CI: 2.28, 3.38) were associated factors that increased incomplete vaccination. However, maternal autonomy (OR = 0.54; 95% CI: 0.33, 0.89), maternal knowledge (OR = 0.31; 95% CI: 0.20, 0.47), husband employment (OR = 0.49; 95% CI: 0.35, 0.67), urban residence (OR = 0.61; 95% CI: 0.43, 0.86), ANC visits (OR = 0.30; 95% CI: 0.23, 0.39), postnatal care (OR = 0.39; 95% CI: 0.30, 0.52), and tetanus toxoid vaccine (3+) (OR = 0.42; 95% CI: 0.26, 0.69) were factors that reduced incomplete vaccination. Conclusion. In Ethiopia, 3 out of 10 children have incomplete vaccination. Policies should focus on strengthening and improving women’s education, maternal health knowledge, empowering women, and the utilization of prenatal care can overcome some of the barriers.
Collapse
Affiliation(s)
- Assefa Desalew
- College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Agumasie Semahegn
- College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Simon Birhanu
- College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| | - Gezahegn Tesfaye
- College of Health and Medical Sciences, Haramaya University, Harar, Ethiopia
| |
Collapse
|
23
|
Continuum of maternal health care services and its impact on child immunization in India: an application of the propensity score matching approach. J Biosoc Sci 2020; 53:643-662. [PMID: 32830633 DOI: 10.1017/s0021932020000450] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Continuum of care throughout pregnancy, delivery and post-delivery has proved to be a critical health intervention for improving the health of mothers and their newborn children. Using data from the fourth wave of the National Family Health Survey (NFHS-4) conducted in 2015-16, this study examined the correlates of utilization of maternal health care services and child immunization following the continuum of care approach in India. The study also assessed whether the continuity in utilizing maternal health care services affects the immunization of children. A total of 33,422 survey women aged 15-49 were included in the analysis of maternal health care indicators, and 8246 children aged 12-23 months for the analysis of child immunization. The results indicated that about 19% of the women had completed the maternal health continuum, i.e. received full antenatal care, had an institutional delivery and received postnatal care. Women with a higher level of education and of higher economic status were more likely to have complete continuum of care. Continuity of maternal health care was found to be associated with an increase in the immunization level of children. It was observed that 76% of the children whose mothers had complete continuum of care were fully immunized. Furthermore, the results from propensity score matching revealed that if mothers received continuum of care, the chance of their child being fully immunized increased by 17 percentage points. The results suggest that promotion of the continuum of maternal health care approach could help reduce not only the burden of maternal deaths in India, but also that of child deaths by increasing the immunization level of children.
Collapse
|
24
|
Aalemi AK, Shahpar K, Mubarak MY. Factors influencing vaccination coverage among children age 12-23 months in Afghanistan: Analysis of the 2015 Demographic and Health Survey. PLoS One 2020; 15:e0236955. [PMID: 32764770 PMCID: PMC7413477 DOI: 10.1371/journal.pone.0236955] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2020] [Accepted: 07/16/2020] [Indexed: 11/19/2022] Open
Abstract
Background Childhood vaccination plays a key role in reducing morbidity and mortality from vaccine-preventable diseases. Numerous studies have assessed the influence of demographic and socioeconomic factors on child immunization around the world. There are few such studies in Afghanistan, however. Therefore, this study aimed to identify factors influencing vaccination status among children age 12–23 months in Afghanistan. Materials and methods Nationally representative data from the 2015 Afghanistan Demographic and Health Survey were used for this study. A sample of 5,708 children age 12–23 months with a vaccine card and immunization history was analyzed. Multinomial logistic regression was used to identify significant relationships between cofactors and vaccination status. Results In the study, 51% the subjects were boys, 48% were born at home, and 76% were residents of rural areas. Background characteristics positively associated with vaccination status included delivery in a health facility (RRR = 2.5, 95% CI = 1.9–3.3), maternal age of 30–39 years (RRR = 2.2, 95% CI = 1.2–4.1), attending at least four visits for antenatal care (RRR = 2.7, 95% CI = 1.7–4.5), health facility visit in the past 12 months (RRR = 1.9, 95% CI = 1.4–2.5), paternal professional occupation (RRR = 4.9, 95% CI = 2.0–12.3), family with richer wealth index (RRR = 2.4, 95% CI = 1.4–4.1), and living in the northeast region (RRR = 2.2, 95% CI = 1.2–3.9)were positively associated with vaccination status. Living in the southern region (RRR = 0.3, 95% CI = 0.2–0.5) was negatively associated with vaccination status. Conclusion This study identified maternal age, ANC visits, place of delivery, health facility visits in past 12 months, paternal occupation, wealth quintile, and geographic region as the factors influencing child’s vaccination status in Afghanistan.
Collapse
Affiliation(s)
- Ahmad Khalid Aalemi
- Department of Epidemiology, Kabul University of Medical Sciences, Kabul, Afghanistan
- Department of Dermatology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- * E-mail:
| | - Karimullah Shahpar
- Department of Infectious Disease, Kabul University of Medical Sciences, Kabul, Afghanistan
| | | |
Collapse
|
25
|
Ndwandwe D, Nnaji CA, Mashunye T, Uthman OA, Wiysonge CS. Incomplete vaccination and associated factors among children aged 12-23 months in South Africa: an analysis of the South African demographic and health survey 2016. Hum Vaccin Immunother 2020; 17:247-254. [PMID: 32703070 PMCID: PMC7872074 DOI: 10.1080/21645515.2020.1791509] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Background Socioeconomic and health inequalities remain a huge problem in post-apartheid South Africa. Despite substantial efforts at ensuring universal access to vaccines, many children remain under-vaccinated in the country. This study aimed to assess the prevalence and factors associated with incomplete vaccination in the first year of life, among children aged 12–23 months in South Africa. Methods The study is a secondary analysis of the 2016 South African Demographic and Health Survey. A multivariable logistic regression model was applied to the data on 708 children aged 12–23 months. The study outcome, vaccination completeness, was assessed using a composite assessment of nine doses of four vaccines; Bacillus Calmette–Guérin (BCG) (one dose), Polio (four doses), diphtheria-tetanus-pertussis containing vaccines (DTP) (three doses) and measles-containing vaccines (MCV) (one dose). Children who received all the nine doses were categorized as completely vaccinated. Independent variables included child, maternal, and demographic characteristics. Variables were included in the model based on literature findings. Bivariate analyses were used to examine the crude association between each independent variable and incomplete vaccination, while the multivariable logistic regression model was used to examine the adjusted association after controlling for other variables. Measures of association were presented as odds ratios (OR) with their 95% confidence intervals (CI). Results About two-fifths (40.8%) of the children were incompletely vaccinated. The prevalence of incomplete vaccination was significantly high among children whose mothers did not receive antenatal care (ANC) during pregnancy (57.5%), and children living in Gauteng Province (52.2%). From the bivariate analyses, the odds of being incompletely vaccinated were three times higher in children whose mothers did not attend ANC compared with children whose mothers attended ANC (crude OR = 2.93; 95% CI 1.42–6.03). The odds were about three times higher in children living in Mpumalanga province (OR = 2.58; 95% CI 1.27–5.25) and in those living in Gauteng province (OR = 2.76; 95% CI 1.30–5.91), compared with those living in Free State province. Conversely, the odds were 32% lower in children from rich households, compared with those from poor households (OR = 0.68; 95% CI 0.47–0.98). In the adjusted model, the higher odds of incomplete vaccination in children whose mothers did not attend ANC were maintained in both magnitude and direction (adjusted OR [aOR] = 2.87; 95% CI 1.31–6.25). Similarly, compared with children living in Free State province, the higher odds of a child being incompletely vaccinated in Mpumalanga (aOR = 2.30; 95% CI 1.03–5.14) and in Gauteng (aOR = 3.10; 95% CI 1.35–7.15) provinces were maintained in both magnitude and direction. Conclusions There is a substantial burden of incomplete childhood vaccination in South Africa. Maternal ANC attendance during pregnancy and area of residence significantly influences this burden. Interventions that promote broader health service utilization, such as ANC attendance, can help improve the awareness and uptake of routine childhood vaccination. It is also imperative to take into consideration the provincial disparities in childhood vaccination completeness, in planning and implementing interventions to improve vaccination coverage in the country.
Collapse
Affiliation(s)
- Duduzile Ndwandwe
- Cochrane South Africa, South African Medical Research Council , Cape Town, South Africa
| | - Chukwudi A Nnaji
- Cochrane South Africa, South African Medical Research Council , Cape Town, South Africa.,School of Public Health and Family Medicine, University of Cape Town , Cape Town, South Africa
| | - Thandiwe Mashunye
- Cochrane South Africa, South African Medical Research Council , Cape Town, South Africa.,School of Public Health and Family Medicine, University of Cape Town , Cape Town, South Africa
| | - Olalekan A Uthman
- Warwick-Centre for Applied Health Research and Delivery (WCAHRD), University of Warwick Medical School , Coventry, UK.,Centre for Evidence-based Health Care, Division of Epidemiology and Biostatistics, Stellenbosch University , Cape Town, South Africa
| | - Charles S Wiysonge
- Cochrane South Africa, South African Medical Research Council , Cape Town, South Africa.,School of Public Health and Family Medicine, University of Cape Town , Cape Town, South Africa.,Centre for Evidence-based Health Care, Division of Epidemiology and Biostatistics, Stellenbosch University , Cape Town, South Africa
| |
Collapse
|
26
|
Sen S, Chatterjee S, Khan PK, Mohanty SK. Unintended effects of Janani Suraksha Yojana on maternal care in India. SSM Popul Health 2020; 11:100619. [PMID: 32642548 PMCID: PMC7334609 DOI: 10.1016/j.ssmph.2020.100619] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2020] [Revised: 05/31/2020] [Accepted: 06/21/2020] [Indexed: 12/15/2022] Open
Abstract
Background The Janani Suraksha Yojana (JSY) is the largest ever conditional cash transfer programme worldwide. It primarily aimed to reduce the maternal and child mortality by increasing the facility based delivery in India. Besides, the JSY has resulted in reduction of out-of-pocket expenditure for delivery care and increased antenatal care. Though studies have examined the direct outcome of JSY, limited studies have attempted to understand the unintended effects (indirect) of the programme. The aim of this study is to examine the effect of JSY on contraceptive use, initiation of breast feeding and postnatal check-up in India. Data & Methods Data from the National Family Health Survey 4, 2015-16 was used in the analyses. A total of 148,746 institutional births in five years preceding the survey were analysed and the analyses were carried out for Low Performing States (LPS) and High Performing States (HPS). Descriptive statistics and the propensity score matching were used to understand the unintended effects of JSY. Results In India, the use of contraception, early initiation of breastfeeding and postnatal check up was consistently higher among JSY beneficiaries compared to non-JSY beneficiaries. Among JSY beneficiaries, about 45% of the mothers breastfed their child within one hour compared to 42% of the JSY non-beneficiaries. The pattern was almost similar for postnatal check-up. The variations in contraceptive use, breastfeeding practice and postnatal check-up among JSY beneficiaries were higher in LPS states compared to HPS. For instance, in LPS, among JSY beneficiaries, about 58% mothers breastfed their child within one hour of delivery compared to 46% in HPS. Controlling for socio-economic covariates, the JSY beneficiaries in LPS were 12% more likely to use contraception, 8% were more likely to initiate the breast feeding within one hour of child delivery and 6% were more likely to get their postnatal check-up than their counterparts in HPS. Discussion The unintended effects of JSY were strong and significant in the low performing states. The coverage of JSY should be further extended and the programme needs to be continued.
Collapse
Affiliation(s)
- Soumendu Sen
- International Institute for Population Sciences, Govandi Station Road, Deonar, Mumbai, 400088, India
| | - Sayantani Chatterjee
- International Institute for Population Sciences, Govandi Station Road, Deonar, Mumbai, 400088, India
| | - Pijush Kanti Khan
- International Institute for Population Sciences, Govandi Station Road, Deonar, Mumbai, 400088, India
| | - Sanjay K Mohanty
- International Institute for Population Sciences, Govandi Station Road, Deonar, Mumbai, 400088, India
| |
Collapse
|
27
|
Lee H, Oh J, Kim R, Subramanian S. Long-term trend in socioeconomic inequalities and geographic variation in the utilization of antenatal care service in India between 1998 and 2015. Health Serv Res 2020; 55:419-431. [PMID: 32133652 PMCID: PMC7240766 DOI: 10.1111/1475-6773.13277] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE To investigate the temporal trend of socioeconomic and rural-urban disparities and geographical variation in the utilization of antenatal care (ANC) services in India before and throughout the Millennium Development Goals era. DATA SOURCES/STUDY SETTING For this temporal analysis, secondary data from the Indian National Family Health Surveys between 1998 and 2015 (Waves 2, 3, and 4) were used. STUDY DESIGN We analyzed the trend in inequality for at least one and four ANC visits to a health care professional (ANC1+ and ANC4+, respectively) by education, wealth, and residence type. Multilevel logistic regression models were used to assess the temporal trend and the relative contribution of communities and states to the overall variation in ANC1+ and ANC4+. DATA COLLECTION/EXTRACTION METHODS Data on utilization of ANC services for the last birth of women aged 15-49 years during the three or five years preceding the survey (depending on the survey year) were used. PRINCIPAL FINDINGS Educational and wealth inequality in ANC1+ and ANC4+ worsened between 1998 and 2005 and improved between 2005 and 2015 (for ANC4+, OR [95% CI] = 0.22 [0.19-0.25] in Wave 2; OR [95% CI] = 0.19 [0.17-0.22] in Wave 3; and OR [95% CI] = 0.38 [0.36-0.40] in Wave 4 for the poorest). Rural-urban inequality showed a consistent decline (for ANC4+, OR [95% CI] = 0.59 [0.54-0.64] in Wave 2; OR [95% CI] = 0.63 [0.59-0.68] in Wave 3; and OR [95% CI] = 0.82 [0.79-0.85] in Wave 4 for rural area). The relative contribution of the community to the total geographic variation in the utilization of ANC services increased more than four times during the study period. CONCLUSIONS The use of ANC services remains disproportionately lower among women with low socioeconomic status. Efforts to directly target these women are necessary to tackle inequality in ANC utilization in India.
Collapse
Affiliation(s)
- Hwa‐Young Lee
- Takemi Program in International HealthDepartment of Global Health and PopulationHarvard T.H. Chan School of Public HealthBostonMassachusetts
- JW LEE Center for Global MedicineSeoul National University College of MedicineSeoulKorea
| | - Juhwan Oh
- JW LEE Center for Global MedicineSeoul National University College of MedicineSeoulKorea
- Department of MedicineSeoul National University College of MedicineSeoulKorea
- Department of Social and Behavioral SciencesHarvard T.H. Chan School of Public HealthBostonMassachusetts
| | - Rockli Kim
- Division of Health Policy and ManagementCollege of Health SciencesKorea UniversitySeoulKorea
- Department of Public Health SciencesGraduate SchoolKorea UniversitySeoulKorea
- Harvard Center for Population & Development StudiesCambridgeMassachusetts
| | - S.V. Subramanian
- Department of Social and Behavioral SciencesHarvard T.H. Chan School of Public HealthBostonMassachusetts
- Harvard Center for Population & Development StudiesCambridgeMassachusetts
| |
Collapse
|
28
|
Women’s Autonomy Decision Making Power on Postpartum Modern Contraceptive Use and Associated Factors in North West Ethiopia. ADVANCES IN PUBLIC HEALTH 2019. [DOI: 10.1155/2019/1861570] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background. Most postpartum women (95%) do not want pregnancy within 24 months after birth, however, 70% of them do not use modern contraceptives. In Ethiopia postpartum modern contraceptive use is low. Evidences show that women’s autonomy within the household is the most important thing in modern contraceptive use. Yet, there is dearth of information in Ethiopian context. Therefore, this study was aimed to assess women’s autonomy on modern contraceptive use and its associated factors among women who attended their children immunization service. Methods. Facility-based cross-sectional study was carried out from May 5 to Jone15, 2017 in sekota town and its surroundings among 415 women who attended immunization service for their children. Participants were selected by using a systematic sampling technique. The data were collected through face-to-face interviews using pre-tested structured questionnaires. The data were entered into epi.info version7 and analyzed using SPSS version 23. Both descriptive and logistic regression analyses were performed. A P-value less than or equal to 0.05 at 95% confidence interval was set to test statistical significance. Result. The proportion of women’s decision making power on postpartum modern contraceptive use was 77.3%. Being counseled on postpartum family planning (2.29, 95% CI: 1.27, 5.71), discussed on postpartum family planning with their husbands (AOR = 14.62, 95% CI: 6.52, 32.75), and had the index child within one year after previous birth (AOR = 7.98, 95% CI: 2.52, 30.65) were found positively associated with women’s autonomous decision making power on postpartum modern contraceptive use. In addition, those women who knew that pregnancy could happen during the postpartum period (AOR = 6.53, 95% CI: 3.2, 14.12) were more autonomous in decision to use postpartum contraception. Conclusion. The proportion of women’s autonomous decision making power on postpartum modern contraceptive use was low. Those women who were counseled on postpartum family planning, discussed with partners, and those who knew that pregnancy could happen during the postpartum period had higher odds of autonomous decision making power. Therefore, strengthening counseling, educating on postpartum family planning, and encouraging women to discuss postpartum family planning with their husbands may improve women’s power.
Collapse
|
29
|
Ntenda PAM. Factors associated with non- and under-vaccination among children aged 12-23 months in Malawi. A multinomial analysis of the population-based sample. Pediatr Neonatol 2019; 60:623-633. [PMID: 31040068 DOI: 10.1016/j.pedneo.2019.03.005] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2018] [Revised: 11/15/2018] [Accepted: 03/14/2019] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND Non- and under-vaccination among children in Malawi have received little attention. Between 2010 and 2016, the proportion of children who received full immunization before their first birthday dropped from 81% to 76% in Malawi. This signifies that a certain fraction of children are either non-vaccinated or under-vaccinated. Thus, the present study attempted to examine the predictors of non- and under-vaccination among children aged 12-23 months in Malawi. METHODS Cross-sectional data obtained from the Malawi Demographic and Health Survey 2015-16 were utilized. The percentage of children aged 12-23 months who were non-vaccinated, under-vaccinated, or fully vaccinated with 1 dose of Bacillus Calmette-Guérin, 3 doses of oral polio vaccine, 3 doses of pentavalent, 2 doses of rotavirus vaccine, 3 doses of pneumococcal vaccine and 1 dose of measles-containing vaccine were calculated. The odds of being non-vaccinated and under-vaccinated compared to full vaccination relative to various sociodemographic factors were assessed using a multivariable multinomial logistic regression with logit link function which accounted for survey design. RESULTS Of 3111 children aged 12-23 months, 72% were fully vaccinated, 26% were under-vaccinated, and about 2% were non-vaccinated. The multinomial logistic regression showed that children from the poorest households, and children who did not have postnatal care within two months had increased odds of being under-vaccinated. On the other hand, children who had no health card or whose card was lost had increased odds of being both non- and under-vaccinated. Additionally, children from the northern region and who resided in households with either none or one under-five child had reduced odds of being non-vaccinated and under-vaccinated, respectively. CONCLUSIONS Women from the poorest households and those who are not attending PNC should be targeted when designing interventions that aim at improving childhood vaccination in order to reduce the barriers they face in accessing vaccination services.
Collapse
Affiliation(s)
- Peter Austin Morton Ntenda
- School of Public Health, Taipei Medical University, College of Public Health, No. 250, Wu-Hsing St, Taipei City 11031, Taiwan.
| |
Collapse
|
30
|
Ntenda PAM, Nkoka O, Nana AW, Majoni P, Mhone TG, Tizifa T, Mwenyenkulu ET, Kazambwe JF, Putthanachote N, Motsa MPS. Factors associated with completion of childhood immunization in Malawi: a multilevel analysis of the 2015-16 Malawi demographic and health survey. Trans R Soc Trop Med Hyg 2019; 113:534-544. [PMID: 31034078 DOI: 10.1093/trstmh/trz029] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2018] [Revised: 03/15/2019] [Accepted: 04/02/2019] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Between 2010 and 2015, the percentage of children 12-23 months of age who received full immunization in Malawi decreased from 81% to 76%, prompting us to investigate the factors associated with completion of childhood immunization in Malawi. METHODS Using data from the 2015-16 Malawi Demographic and Health Survey, generalized linear mixed models were applied on 3145 children 12-23 months of age nested within 850 communities. Complete immunization was defined as the child having received a Bacillus Calmette-Guerin, three doses of pentavalent vaccine, four doses of oral polio vaccine, three doses of pneumococcal vaccine, two doses of rotavirus vaccine and one dose of measles vaccine before their first birthday. RESULTS Adjusted multilevel regression showed that children born to mothers with either none or one antenatal care visit (adjusted odds ratio [aOR] 0.56 [95% confidence interval {CI} 0.32 to 0.93]) and whose mothers had no card or no longer had a vaccination card (aOR 0.06 [95% CI 0.04 to 0.07]) were less likely to receive complete immunization. In addition, children from the poorest households (aOR 0.60 [95% CI 0.40 to 0.92]) and who resided in communities with a medium (aOR 0.73 [95% CI 0.53 to 0.98]) or high percentage (aOR 0.73 [95% CI 0.53 to 0.99]) of households that perceived the distance to the nearest health facility as a big problem had reduced odds of achieving complete immunization. Furthermore, the findings showed evidence of clustering effects of childhood complete immunization at the community level. CONCLUSIONS Our findings show that a series of sociodemographic, health and contextual factors are associated with the completion of childhood vaccination. Therefore interventions that aim at increasing the completion of childhood immunization in Malawi should not only address individual needs, but should also consider contextual factors and the communities addressed in this study.
Collapse
Affiliation(s)
- Peter Austin Morton Ntenda
- School of Public Health, College of Public Health, Taipei Medical University, No. 250, Wuhsing St, Taipei City 110, Taiwan
| | - Owen Nkoka
- School of Public Health, College of Public Health, Taipei Medical University, No. 250, Wuhsing St, Taipei City 110, Taiwan
| | | | - Precious Majoni
- Department of Computer Science, Chancellor College, University of Malawi, Zomba, Malawi
| | - Thomas Gabriel Mhone
- Medical Laboratory Science and Biotechnology, College of Health Sciences, Kaohsiung Medical University, No. 100, Shiquan 1st Road, Sanmin District, Kaohsiung City, Taiwan
| | - Tinashe Tizifa
- Training and Research Unit of Excellence (TRUE), School of Public Health and Family Medicine, College of Medicine, University of Malawi, Private Bag 360, Chichiri, Blantyre 3, Malawi
| | - Edward Tisungane Mwenyenkulu
- School of International Education, Southern Medical University, No. 1023, South Shatai Road, Guangzhou, Guangdong, People's Republic of China
| | - Jane Flora Kazambwe
- NBS, House Corner Chipembere Highway & Johnstone Roads Ginnery Corner Blantyre, Chichiri, Blantyre, Malawi
| | - Nuntiput Putthanachote
- Roi Et Hospital, 111 Ronnachaicharnyut Soi 13, Tambon Nai Mueang, Amphoe Mueang Roi Et, Roi Et Province, Thailand
| | | |
Collapse
|
31
|
Kumar G, Choudhary TS, Srivastava A, Upadhyay RP, Taneja S, Bahl R, Martines J, Bhan MK, Bhandari N, Mazumder S. Utilisation, equity and determinants of full antenatal care in India: analysis from the National Family Health Survey 4. BMC Pregnancy Childbirth 2019; 19:327. [PMID: 31488080 PMCID: PMC6727513 DOI: 10.1186/s12884-019-2473-6] [Citation(s) in RCA: 63] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2019] [Accepted: 08/23/2019] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVES We examined the utilisation, equity and determinants of full antenatal care (ANC), defined as 4 or more antenatal visits, at least one tetanus toxoid (TT) injection and consumption of iron folic acid (IFA) for a minimum of 100 days, in India. METHODS We analysed a sample of 190,898 women from India's National Family Health Survey 4. Concentration curves and concentration index were used to assess equity in full ANC utilisation. Multivariable logistic regression model was used to examine the factors associated with full ANC utilisation. RESULTS In India, 21% of pregnant women utilised full ANC, ranging from 2.3-65.9% across states. Overall, 51.6% had 4 or more ANC visits, 30.8% consumed IFA for atleast 100 days, and 91.1% had one or more doses of tetanus toxoid. Full ANC utilisation was inequitable across place of residence, caste and maternal education. Registration of pregnancy, utilisation of government's Integrated Child Development Services (ICDS) and health insurance coverage were associated with higher odds of full ANC utilisation. Lower maternal education, lower wealth quintile(s), lack of father's participation during antenatal visits, higher birth order, teenage and unintended pregnancy were associated with lower odds of full ANC utilisation. CONCLUSIONS Full ANC utilisation in India was inadequate and inequitable. Although half of the women did not receive the minimum recommended ANC visits, the utilisation of TT immunisation was almost universal. The positive association of full ANC with ICDS utilisation and child's father involvement may be leveraged for increasing the uptake of full ANC. Strategies to address the socio-demographic factors associated with low and inequitable utilisation of full ANC are imperative for strengthening India's maternal health program.
Collapse
Affiliation(s)
- Gunjan Kumar
- Knowledge Integration and Translational Platform (KnIT) at the Centre for Health Research and Development, Society for Applied Studies, 45, Kalu Sarai, New Delhi, 110016, India
| | - Tarun Shankar Choudhary
- Knowledge Integration and Translational Platform (KnIT) at the Centre for Health Research and Development, Society for Applied Studies, 45, Kalu Sarai, New Delhi, 110016, India
| | - Akanksha Srivastava
- Knowledge Integration and Translational Platform (KnIT) at the Centre for Health Research and Development, Society for Applied Studies, 45, Kalu Sarai, New Delhi, 110016, India
| | - Ravi Prakash Upadhyay
- Knowledge Integration and Translational Platform (KnIT) at the Centre for Health Research and Development, Society for Applied Studies, 45, Kalu Sarai, New Delhi, 110016, India
| | - Sunita Taneja
- Knowledge Integration and Translational Platform (KnIT) at the Centre for Health Research and Development, Society for Applied Studies, 45, Kalu Sarai, New Delhi, 110016, India
| | - Rajiv Bahl
- Department of Maternal, New-born, Child and Adolescent Health, World Health Organisation, Geneva, Switzerland
| | - Jose Martines
- Centre for Intervention Science in Maternal and Child Health, Centre for International Health, University of Bergen, Bergen, Norway
| | - Maharaj Kishan Bhan
- Indian Institute of Technology, New Delhi, India.,Knowledge Integration and Translational Platform (KnIT), Biotechnology Industry Research Assistance Council (BIRAC), New Delhi, India
| | - Nita Bhandari
- Knowledge Integration and Translational Platform (KnIT) at the Centre for Health Research and Development, Society for Applied Studies, 45, Kalu Sarai, New Delhi, 110016, India
| | - Sarmila Mazumder
- Knowledge Integration and Translational Platform (KnIT) at the Centre for Health Research and Development, Society for Applied Studies, 45, Kalu Sarai, New Delhi, 110016, India.
| |
Collapse
|
32
|
Ntenda PAM, Mwenyenkulu ET, Putthanachote N, Nkoka O, Mhone TG, Motsa MPS, Tizifa T. Predictors of uptake of newly introduced vaccines in Malawi - monovalent human rotavirus and pneumococcal conjugate vaccines: Evidence from the 2015-16 Malawi demographic and health survey. J Trop Pediatr 2019; 65:287-296. [PMID: 30085260 DOI: 10.1093/tropej/fmy050] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVES The purpose of this study was to examine the uptake and predictors of monovalent human rotavirus and pneumococcal conjugate vaccines among children of age 12-35 months in Malawi. METHODS This study used cross-sectional data obtained from the 2015-16 Malawi Demographic and Health Survey. Multivariate logistic regression was used to identify the factors related to uptake of pneumococcal and rotavirus vaccination. RESULTS The uptake of rotavirus and pneumococcal vaccines was 90.96% and 88.84%, respectively. The multivariate logistic results showed that children whose mothers had no formal education, who did not attend postnatal care for the baby within 2 months and had no vaccination card or had lost it were less likely to achieve vaccination uptake. Furthermore, children from northern region had increased odds of achieving vaccination uptake. CONCLUSIONS Strategies aimed at increasing further uptake of rotavirus and pneumococcal vaccines should target uneducation women to improve health knowledge on vaccination.
Collapse
Affiliation(s)
| | - Edward Tisungane Mwenyenkulu
- School of International Education, Southern Medical University, No. 1023, South Shatai Road, Baiyun, Guangzhou, Guangdong, P.R. China
| | - Nuntiput Putthanachote
- Roi Et Hospital, 111 Ronnachaicharnyut Soi 13, Tambon Nai Mueang, Amphoe Mueang Roi Et, Roi Et Province, Thailand
| | - Owen Nkoka
- School of Public Health, Taipei Medical University, No. 250, Wu-Hsing St, Taipei City, Taiwan
| | - Thomas Gabriel Mhone
- Medical Laboratory Science and Biotechnology College of Health Sciences, Kaohsiung Medical University, No. 100, Shiquan 1st Road, Kaohsiung City, Sanmin District, Taiwan
| | | | - Tinashe Tizifa
- Training and Research Unit of Excellence (TRUE), Public Health Department, College of Medicine, University of Malawi, Private Bag 360, Chichiri, Blantyre, Malawi
| |
Collapse
|
33
|
Ryan BL, Krishnan RJ, Terry A, Thind A. Do four or more antenatal care visits increase skilled birth attendant use and institutional delivery in Bangladesh? A propensity-score matched analysis. BMC Public Health 2019; 19:583. [PMID: 31096959 PMCID: PMC6521440 DOI: 10.1186/s12889-019-6945-4] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2018] [Accepted: 05/07/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND With Bangladesh's adoption of the third Sustainable Development Goal to reduce maternal mortality, the impetus for Bangladesh to continue to improve uptake of maternal healthcare is strong. METHODS Using a propensity-score matched analysis, the present study utilized data from the 2014 Bangladesh Demographic Health survey to examine the impact of four or more antenatal care visits on skilled birth attendant use and institutional delivery. RESULTS The results revealed a significant and positive impact of four or more antenatal care visits on skilled birth attendant use and institutional delivery after matching treated and untreated mothers on included socio-demographic characteristics. CONCLUSIONS Implementation of policies to provide at least four antenatal care visits may serve as an effective strategy to increase SBA use and institutional delivery in Bangladesh, which could contribute to the reduction of maternal mortality.
Collapse
Affiliation(s)
- Bridget L Ryan
- Department of Epidemiology and Biostatistics, Western University, 1151 Richmond Street, London, ON, Canada.,Department of Family Medicine, Western University, London, ON, Canada
| | - Rohin J Krishnan
- Department of Epidemiology and Biostatistics, Western University, 1151 Richmond Street, London, ON, Canada.,Department of Family Medicine, Western University, London, ON, Canada
| | - Amanda Terry
- Department of Epidemiology and Biostatistics, Western University, 1151 Richmond Street, London, ON, Canada.,Department of Family Medicine, Western University, London, ON, Canada.,Schulich Interfaculty Program in Public Health, Western University, London, ON, Canada
| | - Amardeep Thind
- Department of Epidemiology and Biostatistics, Western University, 1151 Richmond Street, London, ON, Canada. .,Department of Family Medicine, Western University, London, ON, Canada. .,Schulich Interfaculty Program in Public Health, Western University, London, ON, Canada.
| |
Collapse
|
34
|
Francis MR, Nuorti JP, Kompithra RZ, Larson H, Balraj V, Kang G, Mohan VR. Vaccination coverage and factors associated with routine childhood vaccination uptake in rural Vellore, southern India, 2017. Vaccine 2019; 37:3078-3087. [PMID: 31040085 DOI: 10.1016/j.vaccine.2019.04.058] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2018] [Revised: 03/18/2019] [Accepted: 04/19/2019] [Indexed: 11/29/2022]
Abstract
BACKGROUND Vellore district in southern India was selected for intensified immunization efforts through India's Mission Indradhanush campaign based on 74% coverage in the National Family Health Survey in 2015. As rural households rely almost entirely on the Universal Immunization Program (UIP), we assessed routine immunization coverage and factors associated with vaccination status of children in rural Vellore. METHODS We conducted a cross-sectional household survey among parents or primary caretakers of children aged 12-23 months during August-September 2017 using two-stage, EPI cluster sampling. We verified vaccination histories from vaccination cards and collected data on sociodemographic and non-socio-demographic characteristics by using mobile data capture. Associations with vaccination status were examined with univariate and multivariate logistic regression models. RESULTS A total of 643 children were included. Coverage of BCG, third dose pentavalent/DPT, measles/MR vaccines and full vaccination (BCG, three doses of polio and pentavalent/DPT and measles/MR vaccines) among children with vaccination cards (n = 606) was 94%, 96%, 93% and 84%, respectively. Of children with vaccination cards, 70.8% had received all recommended doses according to the UIP schedule. No socio-demographic differences were identified, but parents' familiarity with the schedule (Adjusted Prevalence Odds Ratio (aPOR): 2.06, 95%CI = 1.26-3.38) and receiving information on recommended vaccinations during antenatal visits (aPOR: 2.16, 95% CI = 1.13-4.12) were significantly associated with full vaccination status of the children. CONCLUSIONS We found higher UIP antigen coverage and proportion of fully vaccinated children than previously reported from rural Vellore. However, adherence to the recommended schedule was still not optimal. Our study highlights the potential of improving parental awareness of vaccination schedule and targeting health education interventions at pregnant women during antenatal visits to sustain and improve routine immunization coverage.
Collapse
Affiliation(s)
- Mark Rohit Francis
- Health Sciences Unit, Faculty of Social Sciences, Tampere University, Finland
| | - J Pekka Nuorti
- Health Sciences Unit, Faculty of Social Sciences, Tampere University, Finland; Infectious Diseases and Vaccines, Department of Health Protection, National Institute for Health and Welfare, Helsinki, Finland
| | - Rajeev Zachariah Kompithra
- Well Baby Immunization Clinic, Department of Pediatrics Unit - I, Christian Medical College, Vellore, Tamil Nadu, India
| | - Heidi Larson
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | | | - Gagandeep Kang
- Division of Gastrointestinal Sciences, Christian Medical College, Vellore, Tamil Nadu, India
| | - Venkata Raghava Mohan
- Department of Community Health, Christian Medical College, Vellore, Tamil Nadu, India.
| |
Collapse
|
35
|
Shenton LM, Wagner AL, Bettampadi D, Masters NB, Carlson BF, Boulton ML. Factors Associated with Vaccination Status of Children Aged 12-48 Months in India, 2012-2013. Matern Child Health J 2019; 22:419-428. [PMID: 29285631 DOI: 10.1007/s10995-017-2409-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Objectives India has more unvaccinated children than any other country despite provision of free vaccines through the government's Universal Immunization Program. In this study, we calculated the proportion of children aged 12-48 months who were fully vaccinated, under-vaccinated, or who had not received any vaccines. Childhood, household, and sociocultural factors associated with under-vaccination and non-vaccination were evaluated. Methods Using data from India's 4th District-level Health and Facility Survey, 2012-2013 (DLHS-4) and the 2012-2013 Annual Health Survey (AHS), we calculated the proportion of children who were non-vaccinated, under-vaccinated, or fully vaccinated with 1 dose of Bacillus Calmette-Guérin, 3 doses of oral polio vaccine, 3 doses of diphtheria-pertussis-tetanus, and 1 dose of measles-containing vaccine. The odds of full vaccination compared to non-vaccination and under-vaccination relative to various factors was assessed using a multivariable, multinomial logistic regression which accounted for survey design. Results Of 1,929,580 children aged 12-48 months, 59% were fully vaccinated, 34% were under-vaccinated, and 7% were non-vaccinated. Compared to children born in government institutions, children delivered in non-institutional settings with a skilled birth attendant present had higher odds of non-vaccination (OR 1.66) and those without a skilled attendant present had still greater odds of non-vaccination (OR 2.39) and under-vaccination (OR 1.11). Conclusions for Practice India's vaccination rates among children aged 12-48 months remains unacceptably low. The Indian government should encourage institutional delivery or birthing with a skilled attendant to ensure women receive adequate health education through antenatal care that includes the importance of childhood vaccination.
Collapse
Affiliation(s)
- Luke M Shenton
- Department of Epidemiology, School of Public Health, University of Michigan, 1415 Washington Heights, Ann Arbor, MI, 48109, USA.
| | - Abram L Wagner
- Department of Epidemiology, School of Public Health, University of Michigan, 1415 Washington Heights, Ann Arbor, MI, 48109, USA
| | - Deepti Bettampadi
- Department of Epidemiology, School of Public Health, University of Michigan, 1415 Washington Heights, Ann Arbor, MI, 48109, USA
| | - Nina B Masters
- Department of Epidemiology, School of Public Health, University of Michigan, 1415 Washington Heights, Ann Arbor, MI, 48109, USA
| | - Bradley F Carlson
- Department of Epidemiology, School of Public Health, University of Michigan, 1415 Washington Heights, Ann Arbor, MI, 48109, USA
| | - Matthew L Boulton
- Department of Epidemiology, School of Public Health, University of Michigan, 1415 Washington Heights, Ann Arbor, MI, 48109, USA
- Division of Infectious Disease, Department of Internal Medicine, University of Michigan Medical School, 1500 East Medical Center Drive, Ann Arbor, MI, 48109, USA
| |
Collapse
|
36
|
McNellan CR, Dansereau E, Wallace MCG, Colombara DV, Palmisano EB, Johanns CK, Schaefer A, Ríos-Zertuche D, Zúñiga-Brenes P, Hernandez B, Iriarte E, Mokdad AH. Antenatal care as a means to increase participation in the continuum of maternal and child healthcare: an analysis of the poorest regions of four Mesoamérican countries. BMC Pregnancy Childbirth 2019; 19:66. [PMID: 30755183 PMCID: PMC6371485 DOI: 10.1186/s12884-019-2207-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2017] [Accepted: 01/28/2019] [Indexed: 11/22/2022] Open
Abstract
Background Antenatal care (ANC) is a means to identify high-risk pregnancies and educate women so that they might experience a healthier delivery and outcome. There is a lack of evidence about whether receipt of ANC is an effective strategy for keeping women in the system so they partake in other maternal and child interventions, particularly for poor women. The present analysis examines whether ANC uptake is associated with other maternal and child health behaviors in poor mothers in Guatemala, Honduras, Nicaragua, and Mexico (Chiapas). Methods We conducted a cross-sectional survey of women regarding their uptake of ANC for their most recent delivery in the last two years and their uptake of selected services and healthy behaviors along a continuity of maternal and child healthcare. We conducted logistic regressions on a sample of 4844 births, controlling for demographic, household, and maternal characteristics to understand the relationship between uptake of ANC and later participation in the continuum of care. Results Uptake of four ANC visits varied by country from 17.0% uptake in Guatemala to 81.4% in Nicaragua. In all countries but Nicaragua, ANC was significantly associated with in-facility delivery (IFD) (Guatemala odds ratio [OR] = 5.28 [95% confidence interval [CI] 3.62–7.69]; Mexico OR = 5.00 [95% CI: 3.41–7.32]; Honduras OR = 2.60 [95% CI: 1.42–4.78]) and postnatal care (Guatemala OR = 4.82 [95% CI: 3.21–7.23]; Mexico OR = 4.02 [95% CI: 2.77–5.82]; Honduras OR = 2.14 [95% CI: 1.26–3.64]), but did not appear to have any positive relationship with exclusive breastfeeding habits or family planning methods, which may be more strongly determined by cultural influences. Conclusions Our results demonstrate that uptake of the WHO-recommended four ANC visits has limited effectiveness on uptake of services in some poor populations in Mesoamérica. Our study highlights the need for continued and varied efforts in these populations to increase both the uptake and the effectiveness of ANC in encouraging positive and lasting effects on women’s uptake of health care services.
Collapse
Affiliation(s)
- Claire R McNellan
- Institute for Health Metrics and Evaluation, 2301 5th Ave, Suite, Seattle, WA, 600, USA.
| | - Emily Dansereau
- Institute for Health Metrics and Evaluation, 2301 5th Ave, Suite, Seattle, WA, 600, USA
| | - Marielle C G Wallace
- Institute for Health Metrics and Evaluation, 2301 5th Ave, Suite, Seattle, WA, 600, USA
| | - Danny V Colombara
- Institute for Health Metrics and Evaluation, 2301 5th Ave, Suite, Seattle, WA, 600, USA
| | - Erin B Palmisano
- Institute for Health Metrics and Evaluation, 2301 5th Ave, Suite, Seattle, WA, 600, USA
| | - Casey K Johanns
- Institute for Health Metrics and Evaluation, 2301 5th Ave, Suite, Seattle, WA, 600, USA
| | - Alexandra Schaefer
- Institute for Health Metrics and Evaluation, 2301 5th Ave, Suite, Seattle, WA, 600, USA
| | - Diego Ríos-Zertuche
- Salud Mesoamérica Initiative/Inter-American Development Bank, Calle 50, Edificio Tower Financial Center (Towerbank), Piso 23, Panamá city, Panamá
| | - Paola Zúñiga-Brenes
- Salud Mesoamérica Initiative/Inter-American Development Bank, Calle 50, Edificio Tower Financial Center (Towerbank), Piso 23, Panamá city, Panamá
| | - Bernardo Hernandez
- Institute for Health Metrics and Evaluation, 2301 5th Ave, Suite, Seattle, WA, 600, USA.,University of Washington Department of Health Metrics Sciences and Department of Global Health, 1510 San Juan Rd, Seattle, WA, 98195, USA
| | - Emma Iriarte
- Salud Mesoamérica Initiative/Inter-American Development Bank, Calle 50, Edificio Tower Financial Center (Towerbank), Piso 23, Panamá city, Panamá
| | - Ali H Mokdad
- Institute for Health Metrics and Evaluation, 2301 5th Ave, Suite, Seattle, WA, 600, USA
| |
Collapse
|
37
|
Noh JW, Kim YM, Akram N, Yoo KB, Park J, Cheon J, Kwon YD, Stekelenburg J. Factors affecting complete and timely childhood immunization coverage in Sindh, Pakistan; A secondary analysis of cross-sectional survey data. PLoS One 2018; 13:e0206766. [PMID: 30379947 PMCID: PMC6209382 DOI: 10.1371/journal.pone.0206766] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2018] [Accepted: 10/18/2018] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Pakistan has a high burden of newborn mortality, which would be significantly preventable through appropriate routine immunization. The purpose of this study was to measure the basic timely childhood immunization coverage and to identify determinants of factors influencing childhood immunization coverage in Sindh, Pakistan. METHODS Data from Maternal and Child Health Program Indicator Survey 2013-2014 which was conducted in Sindh province of Pakistan was used. Outcome measure was full coverage of the basic immunization schedule from child's vaccination card. The association of receiving basic immunization with demographic factors, socioeconomic status, mother and child health information sources, and perinatal care factors were tested by binary logistic regression. RESULTS Among 2,253 children, 1,156 (51.3%) received age-based full basic immunization. The basic immunization rates were 69.1% for under five weeks old, 38.3% for six to nine weeks, 18.8% for 10-13 weeks, 44.0% for 14 weeks-eight months, 60.4% for nine to 11 months, and 59.1% for over one year. Child's age, number of living children, parents' education level, wealth, the source of mother and child health information, number of antenatal care, and assistance during delivery were associated with completing basic immunization. CONCLUSIONS The overall full basic immunization coverage in Pakistan was still low. Policy makers should identify children at risk of low immunization coverage and obstacles of receiving antenatal care, implement educational interventions targeting on less educated parents, and conduct mass immunization campaigns for timely and complete immunization.
Collapse
Affiliation(s)
- Jin-Won Noh
- Department of Healthcare Management, Eulji University, Seongnam, Korea
- Global Health Unit, Department of Health Sciences, University Medical Centre Groningen, University of Groningen, Groningen, the Netherlands
| | - Young-mi Kim
- Jhpiego, Johns Hopkins University, Baltimore, Maryland, United States of America
| | - Nabeel Akram
- Jhpiego, Johns Hopkins University, Baltimore, Maryland, United States of America
| | - Ki-Bong Yoo
- Department of Health Administration, College of Health Sciences, Yonsei University, Wonju, Korea
| | - Jumin Park
- National Institutes of Health Clinical Center, Bethesda, Maryland, United States of America
| | - Jooyoung Cheon
- Department of Nursing Science, Sungshin University, Seoul, Korea
| | - Young Dae Kwon
- Department of Humanities and Social Medicine, College of Medicine and Catholic Institute for Healthcare Management, The Catholic University of Korea, Seoul, Korea
- * E-mail:
| | - Jelle Stekelenburg
- Global Health Unit, Department of Health Sciences, University Medical Centre Groningen, University of Groningen, Groningen, the Netherlands
- Department of Obstetrics and Gynecology, Medical Centre Leeuwarden, Leeuwarden, the Netherlands
| |
Collapse
|
38
|
Acharya P, Kismul H, Mapatano MA, Hatløy A. Individual- and community-level determinants of child immunization in the Democratic Republic of Congo: A multilevel analysis. PLoS One 2018; 13:e0202742. [PMID: 30138459 PMCID: PMC6107214 DOI: 10.1371/journal.pone.0202742] [Citation(s) in RCA: 50] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2017] [Accepted: 08/08/2018] [Indexed: 11/19/2022] Open
Abstract
Understanding modifiable determinants of full immunization of children provide a valuable contribution to immunization programs and help reduce disease, disability, and death. This study is aimed to assess the individual and community-level determinants of full immunization coverage among children in the Democratic Republic of Congo. This study used data from the Demographic and Health Survey 2013–14 from the Democratic Republic of Congo. Data regarding total 3,366 children between 12 and 23 months of age were used in this study. Children who were immunized with one dose of BCG, three doses of polio, three doses of DPT, and a dose of measles vaccine was considered fully immunized. Descriptive statistics were calculated for the prevalence and distribution of full immunization coverage. Two-level multilevel logistic regression analysis, with individual-level (level 1) characteristics nested within community-level (level 2) characteristics, was used to assess the individual- and community-level determinants of full immunization coverage. This study found that about 45.3% [95%CI: 42.02, 48.52] of children aged 12–23 months were fully immunized in the DRC. The results confirmed immunization coverage varied and ranged between 5.8% in Mongala province to 70.6% in Nord-Kivu province. Results from multilevel analysis revealed that, four Antenatal Care (ANC) visits [AOR: 1.64; 95%CI: 1.23, 2.18], institutional delivery [AOR: 2.37; 95%CI: 1.52, 3.72], and Postnatal Care (PNC) service utilization [AOR: 1.43; 95%CI: 1.04, 1.95] were statistically significantly associated with the full immunization coverage. Similarly, children of mothers with secondary or higher education [AOR: 1.32; 95%CI: 1.00, 1.81] and from the richest wealth quintile [AOR: 1.96; 95%CI: 1.18, 3.27] had significantly higher odds of being fully immunized compared to their counterparts whose mothers were relatively poorer and less educated. Among the community-level characteristics, residents of the community with a higher rate of institutional delivery [AOR: 2.36; 95%CI: 1.59, 3.51] were found to be positively associated with the full immunization coverage. Also, the random effect result found about 35% of the variation in immunization coverage among the communities was attributed to community-level factors.The Democratic Republic of Congo has a noteworthy gap in full immunization coverage. Modifiable factors–particularly health service utilization including four ANC visits, institutional delivery, and postnatal visits–had a strong positive effect on full immunization coverage. The study underlines the importance of promoting immunization programs tailored to the poor and women with little education.
Collapse
Affiliation(s)
- Pawan Acharya
- Nepal Development Society, Bharatpur, Chitwan, Nepal
- * E-mail:
| | - Hallgeir Kismul
- Centre for International Health, University of Bergen, Bergen, Norway
| | - Mala Ali Mapatano
- Department of Nutrition, School of Public Health, University of Kinshasa, Kinshasa, Democratic Republic of Congo
| | - Anne Hatløy
- Fafo, Institute for Labour and Social Research, Oslo, Norway
| |
Collapse
|
39
|
Shenton LM, Wagner AL, Carlson BF, Mubarak MY, Boulton ML. Vaccination status of children aged 1-4 years in Afghanistan and associated factors, 2015. Vaccine 2018; 36:5141-5149. [PMID: 30026033 DOI: 10.1016/j.vaccine.2018.07.020] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2018] [Revised: 07/10/2018] [Accepted: 07/11/2018] [Indexed: 10/28/2022]
Abstract
BACKGROUND Childhood mortality in Afghanistan fell by half between 1990 and 2015, due in part to the government's commitment to improving pediatric immunization services. Although progress has been made, immunization coverage has nonetheless remained low with only 65% of children receiving the third dose of Diphtheria-Pertussis-Tetanus (DPT3) based on WHO estimates. This study aims to calculate the proportion of Afghan children aged 1-4 years who were fully vaccinated, under-vaccinated, or non-vaccinated with government-recommended Expanded Program on Immunization vaccines and identify predictors related to the family's sociodemographic status and maternal autonomy. METHODS Data from the 2015 Afghanistan Demographic and Health Survey was used to calculate the proportion of children who were fully vaccinated (i.e. received all recommended vaccines), under-vaccinated (i.e. received some, but not all), and non-vaccinated (i.e. did not receive any vaccines) according to WHO guidelines. A multivariable multinomial logistic regression model generated odds ratios for under-vaccination and non-vaccination versus full vaccination, and examined associations between independent factors and full vaccination status. RESULTS We found 40.6% of Afghan children age 1-4 were fully vaccinated, 42.4% under-vaccinated, and 17% non-vaccinated. Large disparities characterized immunization coverage among provinces and between urban and rural regions. Birthing in a government institution (vs. non-institutional setting), a higher number of antenatal care visits, and a visit to a health facility in the past 12 months were all associated with increased odds of full immunization. Factors related to maternal autonomy including maternal decision-making and maternal attitudes towards beating were also significantly associated with vaccination status. CONCLUSION Approximately 60% of children in Afghanistan are under-vaccinated or non-vaccinated, leaving millions of children unnecessarily at risk for vaccine-preventable diseases. Engagement with community and religious leaders to create programs that increase women's autonomy and expand access to institutional delivery could lead to downstream increases in childhood vaccination coverage.
Collapse
Affiliation(s)
- Luke M Shenton
- Department of Epidemiology, School of Public Health, University of Michigan, 1415 Washington Heights, Ann Arbor, MI 48109, USA.
| | - Abram L Wagner
- Department of Epidemiology, School of Public Health, University of Michigan, 1415 Washington Heights, Ann Arbor, MI 48109, USA.
| | - Bradley F Carlson
- Department of Epidemiology, School of Public Health, University of Michigan, 1415 Washington Heights, Ann Arbor, MI 48109, USA.
| | - Mohammad Yousuf Mubarak
- Department of Microbiology, Kabul University of Medical Science, Jamal Mina, 3rd District, Next to Ali Abad Teaching Hospital, Kabul, Afghanistan
| | - Matthew L Boulton
- Department of Epidemiology, School of Public Health, University of Michigan, 1415 Washington Heights, Ann Arbor, MI 48109, USA; Department of Internal Medicine, Division of Infectious Diseases, University of Michigan Medical School, 1500 East Medical Center Drive, Ann Arbor, MI 48109, USA.
| |
Collapse
|
40
|
Hajizadeh M. Socioeconomic inequalities in child vaccination in low/middle-income countries: what accounts for the differences? J Epidemiol Community Health 2018; 72:719-725. [DOI: 10.1136/jech-2017-210296] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2017] [Revised: 03/14/2018] [Accepted: 03/15/2018] [Indexed: 11/04/2022]
Abstract
BackgroundSocioeconomic inequalities in child vaccination continue to be a global public health concern. This study aimed to measure and identify factors associated with socioeconomic inequalities in full immunisation coverage against the four core vaccine-preventable diseases (ie, bacille Calmette-Guérin, diphtheria-tetanus-pertussis (three doses), polio (three doses) and measles vaccines) in 46 low/middle-income countries.MethodsThe most recent nationally representative samples of children (aged 10–59 months, n=372 499) collected through the Demographic Health Surveys were used to measure vaccination rates. The concentration index (C) was used to quantify socioeconomic inequalities in vaccination coverage. Furthermore, meta-regression analyses were used to determine factors affecting socioeconomic inequalities in vaccination coverage across countries.ResultsResults suggested that immunisation coverage was pro-rich in most countries (median C=0.161, IQR 0.131). Gambia (C=−0.146, 95% CI −0.223 to −0.069), Namibia (C=−0.093, 95% CI −0.145 to −0.041) and Kyrgyz Republic (C=−0.227, 95% CI −0.304 to −0.15) were the only countries where children who belong to higher socioeconomic status group were less likely to receive all the four core vaccines than their lower socioeconomic status counterparts. Meta-regression analyses suggested that, across countries, the concentration of antenatal care visits among wealthier mothers was positively associated with the concentration of vaccination coverage among wealthier children (coefficient=0.606, 95% CI 0.301 to 0.911).ConclusionsPro-rich distribution of child vaccination in most low/middle-income countries remains an important public health policy concern. Policies aimed to improve antenatal care visits among mothers in lower socioeconomic groups may mitigate socioeconomic inequalities in vaccination coverage in low/middle-income countries.
Collapse
|
41
|
Kabunga NS, Ghosh S, Webb P. Does ownership of improved dairy cow breeds improve child nutrition? A pathway analysis for Uganda. PLoS One 2017; 12:e0187816. [PMID: 29125871 PMCID: PMC5681260 DOI: 10.1371/journal.pone.0187816] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2017] [Accepted: 10/26/2017] [Indexed: 11/22/2022] Open
Abstract
The promotion of livestock production is widely believed to support enhanced diet quality and child nutrition, but the empirical evidence for this causal linkage remains narrow and ambiguous. This study examines whether adoption of improved dairy cow breeds is linked to farm-level outcomes that translate into household-level benefits including improved child nutrition outcomes in Uganda. Using nationwide data from Uganda’s National Panel Survey, propensity score matching is used to create an unbiased counterfactual, based on observed characteristics, to assess the net impacts of improved dairy cow adoption. All estimates were tested for robustness and sensitivity to variations in observable and unobservable confounders. Results based on the matched samples showed that households adopting improved dairy cows significantly increased milk yield—by over 200% on average. This resulted in higher milk sales and milk intakes, demonstrating the potential of this agricultural technology to both integrate households into modern value chains and increase households’ access to animal source foods. Use of improved dairy cows increased household food expenditures by about 16%. Although undernutrition was widely prevalent in the study sample and in matched households, the adoption of improved dairy cows was associated with lower child stunting in adopter household. In scale terms, results also showed that holding larger farms tends to support adoption, but that this also stimulates the household’s ability to achieve gains from adoption, which can translate into enhanced nutrition.
Collapse
Affiliation(s)
- Nassul S. Kabunga
- International Food Policy Research Institute (IFPRI), Kampala, Uganda
- * E-mail:
| | - Shibani Ghosh
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA, United States of America
| | - Patrick Webb
- Friedman School of Nutrition Science and Policy, Tufts University, Boston, MA, United States of America
| |
Collapse
|
42
|
Dimensions of antenatal care service and the alacrity of mothers towards institutional delivery in South and South East Asia. PLoS One 2017; 12:e0181793. [PMID: 28742809 PMCID: PMC5526542 DOI: 10.1371/journal.pone.0181793] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2017] [Accepted: 07/09/2017] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND A number of studies have assessed the effectiveness of antenatal care (ANC) on uptake of institutional delivery care. However, none address the issue of association between the different components of ANC i.e. ANC component which is independent of health care delivery systems (timing and number of ANC visits), ANC components which depends on health care delivery systems (specific ANC procedures that women receive) with institutional delivery. METHODS Data for the study has been taken from the DHS conducted in the six selected South and South-East Asian countries during 1998-2013. The two dimensions of ANC are the key predictors. The outcome variable is a binary variable, where zero '0' denotes a home delivery and one '1' denotes an institutional delivery. In addition to probit estimation biprobit estimation method has been used to correct for the possible endogeneity. FINDINGS Analysis suggests that both the factors show a positive effect on institutional delivery but the level of associations are different. Probit estimation for each country suggests that the association is higher for the factor- which depends on health care delivery systems than the other factor. After correction of endogeneity through biprobit estimation we get the true associations for both the dimensions and it confirms that the ANC components which depends on health care delivery systems is more associated with the utilization of institutional delivery than the other factor. CONCLUSIONS The content of care may fulfill the women's need and expectations while visiting for ANC care. The study suggests that the quality of antenatal care must be improved which depends on health care delivery systems to motivates the women to utilize the institutional delivery.
Collapse
|
43
|
Timeliness and risk factors associated with delay for pneumococcal conjugate 10-valent routine immunization in Brazilian children. Vaccine 2017; 35:1030-1036. [DOI: 10.1016/j.vaccine.2017.01.012] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2016] [Revised: 01/04/2017] [Accepted: 01/05/2017] [Indexed: 11/21/2022]
|
44
|
Shrivastwa N, Gillespie BW, Kolenic GE, Lepkowski JM, Boulton ML. Predictors of vaccination in India for children aged 12-36 months. Vaccine 2016; 33 Suppl 4:D99-105. [PMID: 26615176 DOI: 10.1016/j.vaccine.2015.09.034] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
INTRODUCTION India has one of the lowest immunization rates worldwide despite a longstanding Universal Immunization Program (UIP) that provides free childhood vaccines. This study characterizes the predictors for under- and non-vaccination among Indian children aged 12-36 months. METHODS This study utilized District Level Household and Facility Survey Data, 2008 (DLHS3), from India. DLHS3 is a nationally representative sample collected from December 2007 through December 2008; this analysis was conducted during 2014. Children's vaccination status was categorized as fully, under-, and non-vaccinated based on whether children received all, some, or none of the UIP-recommended vaccines (one dose each of bacillus Calmette-Guérin and measles, and three doses of diphtheria-pertussis-tetanus). A multinomial logistic regression model estimated the odds of undervaccination compared with full vaccination, and odds of non-vaccination compared with full vaccination. Analytic predictors included socioeconomic, cultural, household, maternal, and childhood characteristics. RESULTS The analysis included 108,057 children; the estimated proportions of fully, under-, and non-vaccinated children were 57%, 31%, and 12%, respectively. After adjusting for state of residence, age, gender, household wealth, and maternal education, additional significant predictors of children's vaccination status were religion, caste, place of delivery, number of antenatal care visits, and maternal tetanus vaccination, all of which demonstrated large effect sizes. CONCLUSIONS India's immunization coverage remained low in 2008, with just slightly more than half of all children aged 12-36 months fully vaccinated with UIP-recommended vaccines. A better understanding of the predictors for vaccination can help shape interventions to reduce disparities in full vaccination among children of differing demographic/cultural groups.
Collapse
Affiliation(s)
- Nijika Shrivastwa
- Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, MI, United States.
| | - Brenda W Gillespie
- Center for Statistical Consultation and Research, University of Michigan, Ann Arbor, MI, United States
| | - Giselle E Kolenic
- Center for Statistical Consultation and Research, University of Michigan, Ann Arbor, MI, United States
| | - James M Lepkowski
- Institute for Social Research, University of Michigan, Ann Arbor, MI, United States
| | - Matthew L Boulton
- Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, MI, United States; Division of Infectious Diseases, Department of Internal Medicine, School of Medicine, University of Michigan, Ann Arbor, MI, United States
| |
Collapse
|
45
|
Dansereau E, McNellan CR, Gagnier MC, Desai SS, Haakenstad A, Johanns CK, Palmisano EB, Ríos-Zertuche D, Schaefer A, Zúñiga-Brenes P, Hernandez B, Iriarte E, Mokdad AH. Coverage and timing of antenatal care among poor women in 6 Mesoamerican countries. BMC Pregnancy Childbirth 2016; 16:234. [PMID: 27542909 PMCID: PMC4991111 DOI: 10.1186/s12884-016-1018-5] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2015] [Accepted: 08/08/2016] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Poor women in the developing world have a heightened need for antenatal care (ANC) but are often the least likely to attend it. This study examines factors associated with the number and timing of ANC visits for poor women in Guatemala, Honduras, Mexico, Nicaragua, Panama, and El Salvador. METHODS We surveyed 8366 women regarding the ANC they attended for their most recent birth in the past two years. We conducted logistic regressions to examine demographic, household, and health characteristics associated with attending at least one skilled ANC visit, four skilled visits, and a skilled visit in the first trimester. RESULTS Across countries, 78 % of women attended at least one skilled ANC visit, 62 % attended at least four skilled visits, and 56 % attended a skilled visit in the first trimester. The proportion of women attending four skilled visits was highest in Nicaragua (81 %) and lowest in Guatemala (18 %) and Panama (38 %). In multiple countries, women who were unmarried, less-educated, adolescent, indigenous, had not wanted to conceive, and lacked media exposure were less likely to meet international ANC guidelines. In countries with health insurance programs, coverage was associated with attending skilled ANC, but not the timeliness. CONCLUSIONS Despite significant policy reforms and initiatives targeting the poor, many women living in the poorest regions of Mesoamérica are not meeting ANC guidelines. Both supply and demand interventions are needed to prioritize vulnerable groups, reduce unplanned pregnancies, and reach populations not exposed to common forms of media. Top performing municipalities can inform effective practices across the region.
Collapse
Affiliation(s)
- Emily Dansereau
- Institute for Health Metrics and Evaluation, 2301 5th Ave, Suite 600, Seattle, WA USA
| | - Claire R. McNellan
- Institute for Health Metrics and Evaluation, 2301 5th Ave, Suite 600, Seattle, WA USA
| | - Marielle C. Gagnier
- Institute for Health Metrics and Evaluation, 2301 5th Ave, Suite 600, Seattle, WA USA
| | - Sima S. Desai
- Institute for Health Metrics and Evaluation, 2301 5th Ave, Suite 600, Seattle, WA USA
| | - Annie Haakenstad
- Harvard School of Public Health, 677 Huntington Ave., Boston, MA USA
| | - Casey K. Johanns
- Institute for Health Metrics and Evaluation, 2301 5th Ave, Suite 600, Seattle, WA USA
| | - Erin B. Palmisano
- Institute for Health Metrics and Evaluation, 2301 5th Ave, Suite 600, Seattle, WA USA
| | - Diego Ríos-Zertuche
- Salud Mesoamérica Initiative/Inter-American Development Bank, Calle 50, Edificio Tower Financial Center (Towerbank), Piso 23, Panamá, Panamá
| | - Alexandra Schaefer
- Institute for Health Metrics and Evaluation, 2301 5th Ave, Suite 600, Seattle, WA USA
| | - Paola Zúñiga-Brenes
- Salud Mesoamérica Initiative/Inter-American Development Bank, Calle 50, Edificio Tower Financial Center (Towerbank), Piso 23, Panamá, Panamá
| | - Bernardo Hernandez
- Institute for Health Metrics and Evaluation, 2301 5th Ave, Suite 600, Seattle, WA USA
| | - Emma Iriarte
- Salud Mesoamérica Initiative/Inter-American Development Bank, Calle 50, Edificio Tower Financial Center (Towerbank), Piso 23, Panamá, Panamá
| | - Ali H. Mokdad
- Institute for Health Metrics and Evaluation, 2301 5th Ave, Suite 600, Seattle, WA USA
| |
Collapse
|
46
|
Prakash R, Manthri S, Tayyaba S, Joy A, Raj SS, Singh D, Agarwal A. Effect of Physical Violence on Sexually Transmitted Infections and Treatment Seeking Behaviour among Female Sex Workers in Thane District, Maharashtra, India. PLoS One 2016; 11:e0150347. [PMID: 26933884 PMCID: PMC4774990 DOI: 10.1371/journal.pone.0150347] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2015] [Accepted: 02/14/2016] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Violence against sex workers can heighten their vulnerability to HIV and other sexually transmitted infections (STIs). Evidence suggests the risk of acquiring STI/HIV infections among female sex workers (FSWs) who have experienced violence to be almost three-times higher than FSWs, who have not experienced violence. Moreover, an experience of physical and sexual violence makes it difficult for them to negotiate safer sex with their partners and often act as a barrier to utilization of prevention services. METHODS This study utilizes data from 2785 FSWs aged 18 years and above who participated in a cross-sectional behavioural study conducted during 2013-14 in Thane district, Maharashtra. A probability-based two-stage cluster sampling method was used for data collection. This study assesses the effect of physical violence on self-reported STI symptoms (any STI and multiple STIs) and treatment seeking for the last STI symptom using propensity score matching method. RESULTS About 18% of sampled FSWs reported physical violence at the time of the survey. The likelihood of experiencing such violence was significantly higher among FSWs who solicited clients at public places, engaged in other economic activities apart from sex work, had savings, and reported high client volume per week. FSWs experiencing violence were also inconsistent condom users while engaging in sex with regular partners and clients. The average adjusted effect of violence clearly depicted an increase in the risk of any STI (11%, p<0.05) and multiple STIs (8%, p<0.10) and reduction in treatment seeking (10%, p<0.05). CONCLUSIONS This study demonstrates a significant effect of physical violence on reporting of any STI symptom and treatment seeking. Findings call for the immediate inclusion of strategies aimed to address violence related challenges in HIV prevention program currently being provided at Thane district. Such strategies would further help in enhancing the access to tailored STI prevention and care services among FSWs in the district.
Collapse
Affiliation(s)
- Ravi Prakash
- HIV/AIDS Partnership for Impact through Prevention, Private Sector and Evidence-based Programming (PIPPSE) Project, Public Health Foundation of India, New Delhi, India
- * E-mail: ;
| | - Suneedh Manthri
- HIV/AIDS Partnership for Impact through Prevention, Private Sector and Evidence-based Programming (PIPPSE) Project, Public Health Foundation of India, New Delhi, India
| | - Shaikh Tayyaba
- HIV/AIDS Partnership for Impact through Prevention, Private Sector and Evidence-based Programming (PIPPSE) Project, Public Health Foundation of India, New Delhi, India
| | - Anna Joy
- HIV/AIDS Partnership for Impact through Prevention, Private Sector and Evidence-based Programming (PIPPSE) Project, Public Health Foundation of India, New Delhi, India
| | - Sunil Saksena Raj
- HIV/AIDS Partnership for Impact through Prevention, Private Sector and Evidence-based Programming (PIPPSE) Project, Public Health Foundation of India, New Delhi, India
| | - Devender Singh
- HIV/AIDS Partnership for Impact through Prevention, Private Sector and Evidence-based Programming (PIPPSE) Project, Public Health Foundation of India, New Delhi, India
| | - Ashok Agarwal
- HIV/AIDS Partnership for Impact through Prevention, Private Sector and Evidence-based Programming (PIPPSE) Project, Public Health Foundation of India, New Delhi, India
| |
Collapse
|
47
|
Shrivastwa N, Gillespie BW, Kolenic GE, Lepkowski JM, Boulton ML. Predictors of Vaccination in India for Children Aged 12-36 Months. Am J Prev Med 2015; 49:S435-44. [PMID: 26297449 DOI: 10.1016/j.amepre.2015.05.008] [Citation(s) in RCA: 68] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2015] [Revised: 05/01/2015] [Accepted: 05/12/2015] [Indexed: 11/30/2022]
Abstract
INTRODUCTION India has one of the lowest immunization rates worldwide despite a longstanding Universal Immunization Program (UIP) that provides free childhood vaccines. This study characterizes the predictors for under- and non-vaccination among Indian children aged 12-36 months. METHODS This study utilized District Level Household and Facility Survey Data, 2008 (DLHS3), from India. DLHS3 is a nationally representative sample collected from December 2007 through December 2008; this analysis was conducted during 2014. Children's vaccination status was categorized as fully, under-, and non-vaccinated based on whether children received all, some, or none of the UIP-recommended vaccines (one dose each of bacillus Calmette-Guérin and measles, and three doses of diphtheria-pertussis-tetanus). A multinomial logistic regression model estimated the odds of under-vaccination compared with full vaccination, and odds of non-vaccination compared with full vaccination. Analytic predictors included socioeconomic, cultural, household, maternal, and childhood characteristics. RESULTS The analysis included 108,057 children; the estimated proportions of fully, under-, and non-vaccinated children were 57%, 31%, and 12%, respectively. After adjusting for state of residence, age, gender, household wealth, and maternal education, additional significant predictors of children's vaccination status were religion, caste, place of delivery, number of antenatal care visits, and maternal tetanus vaccination, all of which demonstrated large effect sizes. CONCLUSIONS India's immunization coverage remained low in 2008, with just slightly more than half of all children aged 12-36 months fully vaccinated with UIP-recommended vaccines. A better understanding of the predictors for vaccination can help shape interventions to reduce disparities in full vaccination among children of differing demographic/cultural groups.
Collapse
Affiliation(s)
- Nijika Shrivastwa
- Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, Michigan.
| | - Brenda W Gillespie
- Center for Statistical Consultation and Research, University of Michigan, Ann Arbor, Michigan
| | - Giselle E Kolenic
- Center for Statistical Consultation and Research, University of Michigan, Ann Arbor, Michigan
| | - James M Lepkowski
- Institute for Social Research, University of Michigan, Ann Arbor, Michigan
| | - Matthew L Boulton
- Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, Michigan; Division of Infectious Diseases, Department of Internal Medicine, School of Medicine, University of Michigan, Ann Arbor, Michigan
| |
Collapse
|
48
|
Yadav D, Dhillon P. Assessing the impact of family planning advice on unmet need and contraceptive use among currently married women in Uttar Pradesh, India. PLoS One 2015; 10:e0118584. [PMID: 25738707 PMCID: PMC4349805 DOI: 10.1371/journal.pone.0118584] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2014] [Accepted: 01/21/2015] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Counseling/advice is one of the key interventions to promote family planning (FP) in developing countries, including India. It helps to improve the quality of care and reduce maternal deaths. This paper investigates the continuity of maternal health (MH) service utilization from antenatal care to post-natal care and the impact this service utilization has on contraceptive use and on meeting the demand for family planning among currently married women in rural Uttar Pradesh, India. METHODS AND FINDINGS The study assesses the impact of FP advice on unmet need and contraceptive use by adopting the propensity score matching method. It uses data from the District Level Household Survey (DLHS) (2007-08) that covered 76,147 currently married women (CMW) in the age group 15-44 years in Uttar Pradesh. Results show that the utilization of MH services [Antenatal care (ANC), institutional delivery, Postnatal care (PNC)] and FP advice during ANC and PNC has led to increase in current use of contraception by 3.7% (p<.01), 7.3% (p<.01) and 6.8% (p<.01), respectively. However, a greater utilization of these services has not translated into a reduction of unmet need for contraception at a similar manner. CONCLUSION MH service utilization including FP advice is more effective in increasing current use of spacing methods as compared to limiting methods. Findings support the need for "effective FP advice" interventions to reduce unintended births and unmet need. However, women from Scheduled Caste/Scheduled Tribe communities are less likely to receive MH services. Thus, efforts are required to ensure that currently married women across socio-economic backgrounds have equal opportunity to receive MH services and information on contraceptive use to meet the demand for family planning methods.
Collapse
Affiliation(s)
- Diwakar Yadav
- Population Services International, Lucknow, Uttar Pradesh, India
- * E-mail:
| | | |
Collapse
|