Maternal healthcare utilization and full immunization coverage among 12-23 months children in Benin: a cross sectional study using population-based data

Incomplete basic vaccination and associated factors among children aged 12-23 months in resource-limited countries: a spatial and multilevel regression analysis of recent DHS data from 48 countries

Background

Childhood basic vaccinations are a cost-effective and essential preventive health strategy globally in resource-limited nations. The United Nations Sustainable Development Goals aim to reach these ambitious targets, making it crucial to identify underserved populations and address the barriers they face in accessing life-saving immunizations. To date, no spatial analyses have been performed to identify areas of hotspots of incomplete basic vaccination among children in resource-limited countries globally. Therefore, determining the geographic distribution of incomplete basic vaccinations and associated factors is important for prioritizing intervention programs in resource-limited countries.

Objective

This study aims to assess incomplete basic vaccinations and associated factors among children aged 12-23 months in resource-limited countries based on the recent Demographic and Health Survey (DHS) data of 48 countries.

Methods

Data for the study were drawn from the DHS, a nationally representative cross-sectional survey conducted by considering the era of Millennium Development Goals and Sustainable Development Goals. A total of 48 resource-limited countries and a total weighted sample of 202,029 children (12-23 months) were included in our study. The data extraction, recoding, and analysis were conducted using STATA V.17. For the spatial analysis (spatial distribution, autocorrelation, and hotspot), ArcGIS version 10.7 software was used, and for the SaTScan analysis, SaTScan version 10.1 software was used. Descriptive statistics were presented using frequency tables and percentages. We employed multilevel logistic regression to investigate the associated factors of incomplete basic vaccination. In the multivariable analysis, variables with a p-value of ≤0.05 are considered significant factors associated with incomplete basic vaccination among children aged 12-23 months.

Results

The overall incompleteness of basic vaccination among children in resource-limited countries was 51% (95%CI: 50-51%). The spatial analysis revealed that the incomplete basic vaccination among children significantly varied across resource-limited countries (Global Moran's I = 0.208468, p < 0.001). The most likely clusters were located in Nigeria, Chad, Cameroon, and Niger, which were centered at (2.028929N, 15.135990 E)/1425.16 km radius, with a Log-Likelihood Ratio (LLR) of 3519.48 and a Relative Risk (RR) of 1.38 at p-value <0.001. Based on the final model of multilevel analysis, the following variables were statistically significant in relation to incomplete basic vaccination: age, marital status, maternal education, husband's education, maternal occupation, media exposure, wealth index, antenatal care (ANC) visits, birth order, place of delivery, mode of delivery, health insurance coverage, perception of distance from a health facility, place of residence, community media exposure, community education, and country-level income status.

Conclusion and recommendations

The spatial distribution of incomplete basic vaccination was significantly varied across the resource-limited countries. Both individual- and community-level factors were significantly associated with incomplete basic vaccination. Therefore, the World Health Organization and other stakeholders involved in child healthcare should work together to expand childhood vaccination and prioritize the hotspot areas of developing countries.

Characteristics of Studies Focusing on Vaccine Series Completion Among Children Aged 12-23 Months in Sub-Saharan Africa: A Scoping Review

Vaccine preventable diseases remain the leading causes of death among children in Sub-Saharan Africa.

BACKGROUND/OBJECTIVES

As vaccines provide the best possible protection only when all required doses are received, it is essential to understand how the published literature is designed and conducted regarding the completion of recommended childhood vaccine series for children aged 12-23 months in SSA.

METHODS

A comprehensive search was conducted across five databases (PubMed, Embase, CINAHL, Web of Science, and Google Scholar) to identify the relevant literature published between January 2000 through December 2023.

RESULTS

A total of 53 studies meeting the inclusion criteria were identified from the five databases. Over half of the studies used a cross-sectional design (n = 32, 60.4%), and less than half of the studies were conducted in Ethiopia (n = 23, 43.4%). The prevalence and associated factors of vaccination series completion were the most commonly explored topics in the literature. The most frequently reported factors associated with vaccine series completion included the caregiver's education level, household wealth status, number of children under five in the household, knowledge of immunization, maternal education, place of residence, gender of the household head or decision maker, utilization of antenatal or postnatal care visits, place of delivery, distance to a healthy facility or travel time, and possession of a vaccination card.

CONCLUSIONS

This scoping review identified methodological gaps in the published literature, including a lack of publications from many Sub-Saharan Africa countries and insufficient evidence on trends and inequalities in vaccine series completion. Future research on vaccine series completion is recommended to address these gaps.

Preventing vaccine drop-outs: Geographic and system-level barriers to full immunization coverage among children in Uttar Pradesh, India

Objective

Global interventions on routine immunization aim to achieve at least 90 % immunization coverage of all vaccines as per national immunization schedules, aligning with the Immunization Agenda 2030. Despite significant global progress, regions like Uttar Pradesh (UP), India's most populous state, require more efforts to meet this target.

Methods

In 2021, a quantitative survey was conducted with 10,591 mothers/caregivers of children aged 0-15 months and 479 linked community health workers (Accredited Social Health Activists, ASHAs) responsible for connecting these families with vaccine services across 444 rural villages in UP. We developed a coverage cascade to assess the coverage of all basic vaccines (1 dose of each BCG and MR, and 3 doses each of DPT/Penta and Polio), immunization dropouts, and their drivers.

Findings

While 96.4 % of service platforms had the required vaccines available and 94.7 % of children aged 12-15 months had received the first dose of Pentavalent vaccine, only 67.8 % of children received all basic vaccines, with 53.5 % completing these vaccines in the first year of life. More than half (53 %) of dropouts were concentrated in 30 % of ASHA areas. Among these areas, 13 % had no dropouts, and 29 % had more than 60 % of children aged 12-15 months with incomplete immunization. Areas with high dropout rates had higher rates of home deliveries, lower possession of parent-held vaccination records (MCP cards), and poor community-level factors such as incomplete record keeping by ASHAs, less supportive supervision by their supervisors, and relatively lower work motivation compared to areas with no dropouts.

Conclusion

The wide heterogeneity in immunization coverage and dropouts emphasize the need to identify area-specific patterns and reasons for low immunization coverage and to develop interventions to address them. Robust support systems for community health workers and comprehensive record-keeping are pivotal to improve immunization coverage and to reduce the burden of vaccine-preventable diseases.

Trends and determinants of complete vaccination coverage among children aged 12-59 months: An analysis of Bénin Demographic and Health Surveys from 1996 to 2018

Vaccination is pivotal for global public health, yet achieving complete coverage among children in low-income countries remains challenging. This study assessed vaccination trends in children aged 12-59 months using Demographic and Health Surveys (DHS) data from 1996 to 2018 in Bénin. The study incorporated a range of independent variables sourced from prior studies. The data was processed and analyzed using R version 4.2.0, employing a combination of inferential and descriptive statistical techniques. Both univariate and multivariable binary logistic regression analyses were conducted to explore the determinants of complete vaccination coverage. The trend of complete childhood vaccination coverage in Bénin has shown fluctuations, with rates increasing from 47% in 1996 to 55% in 2017-2018. Higher levels of parental education -fathers (aOR 1.41; 95% CI 1.15-1.73) and mothers (aOR 1.69; CI 1.12-2.57), and urban residence (aOR 1.08; CI 1.00-1.16), were associated with complete childhood vaccination coverage. This association was also found for other factors such as antenatal care visits (aOR 1.15; CI 1.04-1.28) and deliveries at healthcare facilities (aOR 2.48; CI 2.22-2.77). Despite significant progress overtime, challenges persist, particularly among younger and rural mothers. Targeted interventions, like community-based vaccination advocacy and effective reminder systems, are essential to addressing these issues and improving vaccination coverage.

Regional disparities of full pentavalent vaccine uptake and the determinants in Ethiopia: Mapping and spatial analysis using the EDHS data

BACKGROUND

The full pentavalent (DPT-HepB-Hib) vaccination is the main strategy to prevent five communicable diseases in early childhood, especially in countries with huge communicable disease burdens like Ethiopia. Exploring spatial distributions and determinants of full pentavalent vaccination status in minor ecological areas in Ethiopia is crucial for creating targeted immunization campaigns and monitoring the advancement of accomplishing sustainable development goals. This study aimed to investigate the spatial disparities and determinants of full pentavalent vaccination among 12-23-month-old children in Ethiopia.

METHOD

The data on pentavalent vaccine uptake was found in the Ethiopian Health and Demographic Survey (EDHS, 2019). A two-stage cluster sampling method was applied to collect the EDHS data. The enumeration area was the primary sample unit while the household served as the secondary sampling unit. The geographical variations of full pentavalent vaccine uptake were explored using Quantum Geographic Information System (QGIS) software. The significant predictors of full pentavalent vaccination were identified using a simple logistic regression model through R version 4.1 software.

RESULT

The national full pentavalent vaccine uptake was 59.2%. The spatial distribution of full pentavalent vaccine uptake was not uniform in Ethiopia. Spatial cluster analysis revealed that most of low coverage regions for full pentavalent vaccine uptake were Afar, Somali, and Harari. The regions with the highest and lowest rates of vaccine uptake were Tigray and Harari region, respectively. Maternal age of 35-49 years (AOR = 3.42; 95% CI: 1.99, 5.87), and 25-34 years (AOR = 1.55; 95% CI: 1.17, 2.19), primary education attended (AOR = 1.51; 95%CI: 1.07, 2.11), richness wealth index (AOR = 1.96; 95% CI: 1.40, 2.75), birth order of 1-3 (AOR = 1.88; 95% CI: 1.19, 2.96), and delivery in the health facility (AOR = 3.41: 95% CI: 2.52, 4.61) were the determinants of full pentavalent vaccine uptake in Ethiopia.

CONCLUSION

Ethiopia's full pentavalent vaccine uptake was far lower than the global target. Older maternal age, maternal education, wealth index, birth order, and giving birth in a health facility were the determinants of full pentavalent vaccine uptake. Special attention should be given to Afar, Somali, and Harari regions, to strengthen the vaccine uptake. Moreover, improved socioeconomic status and getting maternal health services during delivery are necessary to enhance vaccine uptake.

Exploring factors influencing childhood immunization status in East Africa using multilevel ordinal logistic regression analysis

Introduction

Childhood vaccinations are crucial in safeguarding children from infectious diseases and are recognized as one of the most cost-effective public health interventions. However, children in East African countries face more than a fifteen-fold increased risk of death from vaccine-preventable diseases compared to those in high-income nations. This study aimed to identify the factors influencing childhood immunization status in East Africa.

Methods

A sample of 22,734 children aged 12 to 23 months was included to assess immunization status, utilizing recent data from the Demographic and Health Survey conducted between 2015 and 2022 across ten East African countries. A Level-3 multilevel generalized odds model with a logit link function was employed for the analysis.

Results

Among the 22,734 children in the sample, only 67.4% were fully immunized, 27.7% were partially immunized, and the remaining were not immunized at all. The null hypothesis of proportionality was rejected based on the Brant test. Consequently, various partial and non-proportional odds models were fitted, with the generalized odds model demonstrating the best fit compared to other ordinal regression models. The findings indicated that 43.14% of the variation in children's immunization status was attributable to differences between countries, while 18.18% was due to variations between regions. Specific factors associated with immunization status revealed that mothers who attended antenatal care were 1.23 times more likely to fully immunize their children compared to those who did not, and those who received postnatal care were 1.13 times more likely to do so. Additionally, mothers who had antenatal and postnatal services were 1.07 and 1.08 times more likely, respectively, to fully or partially immunize their children compared to those who did not.

Conclusion

The fitted generalized odds model indicated that several factors significantly associated with childhood immunization status included maternal age, number of antenatal and postnatal care visits, tetanus injections received by mothers, vitamin A intake, presence of health documentation, place of delivery, birth order, mother's occupation, sex of the household head, distance to health facilities, maternal education, community maternal education, community wealth index, and community media exposure. Therefore, it is recommended that interventions focus on enhancing household wealth, educating mothers, and improving health systems.

Growth monitoring and promotion service utilization and its associated factors among children less than two years in Ethiopia: A systematic review and meta-analysis

INTRODUCTION

Growth monitoring and promotion services are strategies to promote child health and reduce child mortality. Even though Ethiopia is attempting different strategies to cope with the low rate of GMP utilization, the problem is still unresolved.

OBJECTIVE

Determine the pooled proportion of GMP utilization and its contributing factors among children less than two years in Ethiopia.

METHOD

The review protocol was registered with PROSPERO, number CRD42023472746. The PRISMA-2020 statement guided the conduct of this review. Electronic databases and grey literature were used. Heterogeneity was evaluated using I2. Subgroup analysis was conducted. The random effect model was used to summarize the pooled effect sizes with their respective 95% CI with STATA version 17. To test the small study effect, the funnel plot and Egger's test were applied.

RESULT

A total of seven (7) studies with 4027 participants were considered in this meta-analysis. The pooled proportion of GMP utilization reported by seven studies was 25.71% (95%CI: 24.39, 27.04). ANC follow-up (AOR = 2.11; 95% CI: 1.47, 2.76), PNC follow-up (AOR = 1.96; 95% CI: 1.44, 2.49), counseling (AOR = 2.88; 95% CI: 2.09, 3.68), maternal education (AOR = 2.89; 95% CI: 1.66, 4.13), paternal education (AOR = 3.78; 95% CI: 2.25, 5.32), family health card (AOR = 2.31; 95% CI: 1.67, 2.96), and mothers good knowledge towards GMP (AOR = 2.90; 95% CI: 1.72, 4.07) variables were positively associated with GMP service utilization.

CONCLUSION AND RECOMMENDATION

The pooled proportion of GMP remains low in Ethiopia. ANC and PNC follow-up, counseling, maternal and paternal education, family health cards, maternal knowledge towards GMP were significantly associated. Findings are essential for evidence-based policy making, intervention, and input for ongoing research.

Utilisation and associated socio-demographic factors related to the maternal continuum of care in sub-Saharan Africa: A systematic review and meta-analysis

Background

Maternal continuum of care (MCC) is the utilisation of maternal health care services, including 4+ antenatal care (ANC) visits, skilled birth attendants (SBAs), and postnatal care (PNC). This systematic review and meta-analysis assessed the pooled proportion of MCC utilisation among women in sub-Saharan Africa (SSA) and its association with selected sociodemographic factors.

Methods

We identified keywords and MeSH terms related to the condition (MCC), the context (SSA), and population (women with history of childbirth) to search for published or unpublished observational studies. We used the Joanna Briggs Institute tool to extract data and the Newcastle Ottawa Scale for quality assessment. Meta-analysis was used to compute pooled estimates (MCC utilisation and odds ratio (OR) associates) with 95% confidence intervals (CI) using Stata 17.

Results

Of 45 402 studies identified, we included 23 involving 320 353 women. The pooled estimate of MCC utilisation across SSA was 18.72% (95% CI = 14.51, 22.93), showing a significant increase (P < 0.05) from 2015 to 2022. Southern Africa had the highest MCC utilisation (38%; 95% CI = 36.59, 39.41), while East Africa had the lowest (17.5%; 95% CI = 12.22, 22.75). Maternal continuum of care utilisation was associated with maternal age 25-34 years (pooled odds ratio (POR) = 1.27), urban residence (POR = 2.69), richer/richest wealth status (POR = 1.68), as well as higher level of education and employment (POR = 1.32).

Conclusions

MCC utilisation in SSA remains low, with significant variation across the sub-regions and sociodemographic strata. Context-specific interventions targeting identified factors are essential to enhance MCC utilisation in SSA.

Registration

PROSPERO: CRD42021272708.

Non-uptake of dual protective polio vaccine and its determinants among children in Ethiopia using Ethiopian Demographic Health Survey 2019: a mixed-effect model

INTRODUCTION

The polio vaccine is the live-attenuated antigen that prevents poliomyelitis. According to a report by the WHO, about 1 million less than 5-year-old children missed the polio vaccination from 2018 to 2021. Even though Ethiopia is the most prioritised country for polio eradication, there is not enough evidence about the combined oral and inactivated vaccine in Ethiopia.

OBJECTIVE

To assess the non-uptake of the dual protective polio vaccine and its determinants among children in Ethiopia using the Ethiopian Demographic Health Survey (EDHS) 2019.

METHODS

The secondary data analysis of a community-based cross-sectional study was conducted using EDHS 2019 data among 3094 participants. Mixed-effects binary logistic regression was used for descriptive analysis and identifying the predictors using a p value of <0.05. Intraclass correlation was used to assess the clustering effect.

RESULTS

The prevalence of non-uptake of the dual protective polio vaccine in Ethiopia was 44% (95% CI 42.2% to 45.8%). Predictors like women with low proportions of community media exposure (adjusted OR (AOR)=2.3, 95% CI 1.8 to 2.8) and no history of antenatal care visits (AOR=2.3, 95% CI 3.89 to 6.35) were significantly associated with non-uptake of the dual protective polio vaccine.

CONCLUSION

The burden of non-uptake of the dual protective polio vaccine in Ethiopia was still high. Low community media exposure and no antenatal care utilisation were the predictors of non-uptake of the dual protective polio vaccine. We recommend improving media access and antenatal care services to expand polio vaccination.

Growth monitoring and promotion service utilization and its associated factors among mothers of children under two years in Ethiopia: a systematic review and meta-analysis

BACKGROUND

Growth monitoring and promotion (GMP) is a nutritional intervention designed to identify and address growth faltering before a child's nutritional status deteriorates into severe malnutrition. Despite GMP being recognized as a priority in Ethiopia's national nutrition program, there is no national aggregated figure to show the extent of GMP service utilization. Therefore, this systematic review and meta-analysis aimed to assess GMP service utilization and associated factors in Ethiopia.

METHODS

A systematic literature search was conducted using PubMed/MEDLINE, CINAHL, Hinari, EMBASE, Scopus, and grey literature sources like Google Scholar, WorldCat, and Institutional repository. The Joanna Briggs Institution (JBI) quality assessment tool was used to appraise the quality of the articles, and articles scoring > 50% were included in the analysis. The pooled prevalence and odds ratio of associated factors with 95%CI was computed using STATA version 16. A random-effect model was employed to estimate the effect size, and I-squared statistics and Egger's test were used to assess heterogeneity and identify potential publication bias, respectively. Subgroup analysis was conducted with publication year, sample size, and region to identify the source of heterogeneity.

RESULTS

Nine studies with 4,768 study participants were included in this meta-analysis. The overall pooled utilization of GMP service among children under two years of age in Ethiopia was 23.21% (95% CI: 16.02, 30.41, I2 = 97.27% & P = 0.0001). Mothers who received counselling on GMP service (OR = 3.16 (95%CI: 2.49-4.00), parents who use family health card (FHC) (OR = 3.29 (95%CI: 1.49-7.28), and mother who use postnatal care (OR = 3.93 (95%CI: 2.40-6.42), and Anti natal care (OR = 3.15 (95%CI: 1.29-7.69) were the factors associated with GMP service utilization among children under two years of age.

CONCLUSIONS

The utilization of GMP services among children under the age of two in Ethiopia remains inadequate. Therefore, it is crucial to provide health education and counselling focusing on GMP to the mothers/caregivers of the child and encourage utilization of FHC. In addition, integrating GMP with other maternal health services should be promoted.

The continuum of care for maternal health in Africa: A systematic review and meta-analysis

BACKGROUND

The continuum of care for maternal health (COCM) is a critical strategy for addressing preventable causes of maternal and perinatal mortality. Despite notable progress in reducing maternal and infant deaths globally, the problem persists, particularly in low-resource settings. Additionally, significant disparities in the provision of continuous care exist both between continents and within countries on the same continent. This study aimed to assess the pooled prevalence of completion across the maternity care continuum in Africa and investigate the associated factors.

METHODS

Relevant articles were accessed through the EMBASE, CINAHL, Cochrane Library, PubMed, HINARI, and Google Scholar databases. Funnel plots and Egger's test were employed to assess publication bias, while the I-squared test was used to evaluate study heterogeneity. The inclusion criteria were limited to observational studies conducted exclusively in Africa. The quality of these studies was assessed using the JBI checklist. Data extraction from the included studies was performed using Microsoft Excel and then analysed using Stata 16 software.

RESULTS

A total of 23 studies involving 74,880 mothers met the inclusion criteria. The overall prevalence of women who successfully completed the COCM was 20.9% [95% CI: 16.9-25.0]. Our analysis revealed several factors associated with this outcome, including urban residency [OR: 2.3; 95% CI: 1.6-3.2], the highest wealth index level [OR: 2.1; 95% CI: 1.4-3.0], primiparous status [OR: 1.3; 95% CI: 2.2-5.1], planned pregnancy [OR: 3.0; 95% CI: 2.3-3.7], and exposure to mass media [OR: 2.7; 95% CI: 1.9-3.8].

CONCLUSION

The study revealed that only 20.9% of women fully completed the COCM. It also identified several factors associated with completion of the COCM, such as residing in urban areas, possessing a higher wealth index, being a first-time mother, experiencing a planned pregnancy, and having access to mass media. Based on the study's findings, it is recommended that targeted interventions be implemented in rural areas, financial assistance be provided to women with lower wealth index levels, educational campaigns be conducted through mass media, early antenatal care be promoted, and family planning services be strengthened.

REVIEW REGISTRATION

PROSPERO International Prospective Register of Systematic Reviews (ID: CRD42020205736).

Spatial variation and predictors of incomplete pneumococcal conjugate vaccine (PCV) uptake among children aged 12-35 months in Ethiopia: spatial and multilevel analyses

BACKGROUND

Despite the Ethiopian government included the Pneumococcal Conjugate Vaccine (PCV) in the national expanded program for immunization in 2011, only 56% of children aged 12-23 months received the full dose of PCV. Despite some studies on PCV uptake in Ethiopia, there was a dearth of information on the geographical distribution and multilevel factors of incomplete PCV uptake. Hence, this study aimed to identify the spatial variations and predictors of incomplete PCV uptake among children aged 12-35 months in Ethiopia.

METHODS

The study was based on an in-depth analysis of 2016 Ethiopia Demographic Health Survey data, using a weighted sample of 3,340 women having children aged 12-35 months. Arc-GIS version 10.7 and SaTScan version 9.6 statistical software were used for the spatial analysis. To explore spatial variation and locate spatial clusters of incomplete PCV, the Global Moran's I statistic and Bernoulli-based spatial scan (SaTScan) analysis were carried out, respectively. A multilevel mixed-effect multivariable logistic regression was done by STATA version 16. Adjusted odds ratio (AOR) with its corresponding 95% CI was used as a measure of association, and variables with a p < 0.05 were deemed as significant determinants of incomplete PCV.

RESULTS

The overall prevalence of incomplete PCV in Ethiopia was found to be 54.0% (95% CI: 52.31, 55.69), with significant spatial variation across regions (Moran's I = 0.509, p < 0.001) and nine most likely significant SaTScan clusters. The vast majority of Somali, southeast Afar, and eastern Gambela regions were statistically significant hot spots for incomplete PCV. Lacking ANC visits (AOR = 2.76, 95% CI: 1.91, 4.00), not getting pre-birth Tetanus injections (AOR = 1.84, 95% CI: 1.29, 2.74), home birth (AOR = 1.72, 95% CI: 1.23, 2.34), not having a mobile phone (AOR = 1.64, 95% CI: 1.38, 1.93), and residing in a peripheral region (AOR = 4.63; 95% CI: 2.34, 9.15) were identified as statistically significant predictors of incomplete PCV.

CONCLUSION

The level of incomplete PCV uptake was found to be high in Ethiopia with a significant spatial variation across regions. Hence, the federal and regional governments should collaborate with NGOs to improve vaccination coverage and design strategies to trace those children with incomplete PCV in peripheral regions. Policymakers and maternal and child health program planners should work together to boost access to maternal health services like antenatal care and skilled delivery services to increase immunization coverage.

Factors Associated with Vaccination Coverage among 0-59-Month-Old Children: A Multilevel Analysis of the 2020 Somaliland Demographic and Health Survey

Globally, there has been little growth in vaccination coverage, with countries in the Horn of Africa having the lowest vaccination rates. This study investigated factors associated with vaccination status among children under five years old in Somaliland. The 2020 Somaliland Demographic and Health Survey surveyed women aged 15-49 years from randomly selected households. This multilevel analysis included 2673 primary caregivers of children under five. Only 34% of children were ever vaccinated. Childhood vaccination coverage was positively associated with high-budget regions, high healthcare facility density, and children older than 23 months. Vaccination coverage was greater for urban and rural residents than for nomadic people. Children whose mothers could read part of one sentence or one complete sentence were more likely to be vaccinated than illiterate mothers. Children whose mothers received antenatal care (ANC) once, two to three times, or four times or more were more likely to be vaccinated than those whose mothers received no ANC. Childhood vaccination coverage in Somaliland is low. Promoting maternal ANC visits and increasing women's literacy may enhance vaccination coverage. Funds should be allocated to areas with low resources, particularly for nomadic people, to boost vaccination uptake.

Complete childhood vaccination and associated factors among children aged 12-23 months in Dabat demographic and health survey site, Ethiopia, 2022

INTRODUCTION

Childhood immunization is one of the most cost-effective public health strategies to prevent children's mortality and morbidity from infectious diseases, but the Covid-19 pandemic and associated disruptions have strained health systems, and worldwide 25 million children missing out on vaccination in 2021. Of the 25 million, more than 60% of these children live in 10 countries including Ethiopia. Therefore, this study aimed to assess complete childhood vaccination coverage and associated factors in the Dabat district.

METHOD

A community-based cross-sectional study was conducted from December 10/2020 to January 10/2021Gregorian Calendar. The data for this study was extracted from information collected for the assessment of maternal, Neonatal, and Child Health and health services utilization in the Dabat demographic and health survey site. Vaccine-related data were collected using an interviewer-administered questionnaire. An adjusted odds ratio with a 95% confidence interval was used to identify the presence and the direction of the association.

RESULTS

Based on vaccination cards and mothers/caretakers' recall 30.9% (95%CI: 27.9-34.1%) of children aged 12-23 months in the Dabat district were completely immunized. Urban residency [AOR 1.813, 95% CI: (1.143, 2.878)], delivered in the health facility [AOR = 5.925, 95% CI: (3.680, 9.540)], ANC follow-up during their pregnancy [AOR 2.023, 95% CI: (1.352, 3.027)], rich wealth index [AOR = 2.392, 95% CI: (1.296, 4.415)], and parity [AOR 2.737, 95% CI: (1.664, 4.500)] were significantly associated with complete child vaccination.

RECOMMENDATION AND CONCLUSION

Complete vaccination coverage among children aged 12-23 months in the Dabat district was lower than the Global vaccine plan and Ethiopian ministry of health goal in 2020. Therefore, Health care providers and other stakeholders should mobilize the community to improve mothers' health-seeking behavior toward pregnancy follow-up and health facility delivery to improve childhood vaccination. Besides, expanding the service to remote areas are necessary to increase the immunization access.

Socioeconomic and residence-based related inequality in childhood vaccination in Sub-Saharan Africa: Evidence from Benin

Background and Aims

Childhood vaccination remains a cost-effective strategy that has expedited the control and elimination of numerous diseases. Although coverage of new vaccines in low- and middle-income countries increased exponentially in the last two decades, progress on expanding routine vaccination services to reach all children remains low, and coverage levels in many countries remains inadequate. This study aimed to examine the pattern of wealth and residence-based related inequality in vaccination coverage through an equity lens.

Methods

We used data from the 2017-2018 Benin Demographic and Health Survey. Statistical and econometrics modeling were used to investigate factors associated with childhood vaccination. The Wagstaff decomposition analysis was used to disentangle the concentration index.

Results

A total of 1993 children were included, with 17% in the wealthiest quintile and 63% were living in rural areas. Findings showed that wealth is positively and significantly associated with vaccination coverage, particularly, for middle-wealth households. A secondary or higher education level of women and partners increased the odds of vaccination compared to no education (p < 0.05). Women with more antenatal care visits, with multiple births, attending postnatal care and delivery in a health facility had increased vaccination coverage (p < 0.01). Inequalities in vaccination coverage are more prominent in rural areas; and are explained by wealth, education, and antenatal care visits.

Conclusion

Inequality in child vaccination varies according to socioeconomic and sociodemographic characteristics and is of interest to health policy. To mitigate inequalities in child vaccination coverage, policymakers should strengthen the availability and accessibility of vaccination and implement educational programs dedicated to vulnerable groups in rural areas.

Inequalities in infant vaccination coverage during the COVID-19 pandemic: A population-based study in Peru

OBJECTIVE

To identify the associated factors and assess the inequalities of full vaccination coverage (FVC) among Peruvian infants aged 12-23 months during the COVID-19 pandemic in a nationally representative sample.

METHODS

We carried out a population-based cross-sectional study based on a secondary data analysis using the 2021 Peruvian Demographic Health Survey (DHS) in infants aged 12 to 23 months. The sampling design was probabilistic, multistage, stratified, and independent at both departmental and area of residence levels. FVC was defined according to the WHO definition. We performed generalized linear models (GLM) Poisson family log link function to estimate crude (aPR) and adjusted prevalence ratios (aPR). Also, for inequality assessment, we calculated the concentration curve (CC), concentration index (CI), and Erreygers normalized concentration index (ECI).

RESULTS

We included 4,189 infants in our analysis. Nationwide, the prevalence of FVC was 66.19% (95% CI: 64.33-68). Being younger, having a mother with no education or primary education, belonging to a large family, having no access to mass media, having had six or fewer ANC visits, and having a mother whose age was under 20 at first delivery were inversely associated with FVC. Meanwhile, living in the Highlands or on the rest of the coast, and living in rural areas were directly associated with FVC. We found a pro-rich inequality in FVC based on wealth-ranked households (CI: 0.0066; ECI: 0.0175).

CONCLUSION

FVC has dropped among Peruvian infants aged between 12 and 23 months. There were several factors associated with FVC. It was more concentrated among the better-off infants, although in low magnitude.

Maternal Tetanus Toxoid Vaccination in Benin: Evidence from the Demographic and Health Survey

Tetanus toxoid vaccination is critical for improving maternal and child health. Yet, the prevalence and correlates of maternal tetanus toxoid vaccination coverage remain largely underexplored in Benin where infant and child mortality rates are high. Using the 2017−18 Benin Demographic and Health Survey, we apply logistic regression analysis to address this void in the literature. We find that overall maternal vaccination coverage is 69%. A range of demographic, health care, and socioeconomic factors are associated with maternal tetanus toxoid vaccination coverage. Women aged 20−34 (OR = 0.84, p < 0.05) and 35−49 (OR = 0.63, p < 0.01) are less likely to receive tetanus toxoid vaccination in comparison to those aged 15−19. Health care factors are also significantly associated with maternal tetanus toxoid vaccination, indicating that women who deliver at home (OR = 0.20, p < 0.001) and visit antenatal care fewer than eight times (OR = 0.62, p < 0.001) are less likely to receive tetanus toxoid vaccination than their counterparts who deliver in a health facility and visit antenatal care eight times or more. We also find that women with secondary (OR = 0.54, p < 0.05), primary (OR = 0.47, p < 0.01), and no education (OR = 0.47, p < 0.01) are less likely to receive tetanus toxoid vaccination compared to their counterparts with higher education. Based on these findings, we discuss several implications for policymakers.

Multilevel analysis of predictors of multiple indicators of childhood vaccination in Nigeria

Background

Substantial inequalities exist in childhood vaccination coverage levels. To increase vaccine uptake, factors that predict vaccination coverage in children should be identified and addressed.

Methods

Using data from the 2018 Nigeria Demographic and Health Survey and geospatial data sets, we fitted Bayesian multilevel binomial and multinomial logistic regression models to analyse independent predictors of three vaccination outcomes: receipt of the first dose of Pentavalent vaccine (containing diphtheria-tetanus-pertussis, Hemophilus influenzae type B and Hepatitis B vaccines) (PENTA1) (n = 6059) and receipt of the third dose having received the first (PENTA3/1) (n = 3937) in children aged 12–23 months, and receipt of measles vaccine (MV) (n = 11839) among children aged 12–35 months.

Results

Factors associated with vaccination were broadly similar for documented versus recall evidence of vaccination. Based on any evidence of vaccination, we found that health card/document ownership, receipt of vitamin A and maternal educational level were significantly associated with each outcome. Although the coverage of each vaccine dose was higher in urban than rural areas, urban residence was not significant in multivariable analyses that included travel time. Indicators relating to socio-economic status, as well as ethnic group, skilled birth attendance, lower travel time to the nearest health facility and problems seeking health care were significantly associated with both PENTA1 and MV. Maternal religion was related to PENTA1 and PENTA3/1 and maternal age related to MV and PENTA3/1; other significant variables were associated with one outcome each. Substantial residual community level variances in different strata were observed in the fitted models for each outcome.

Conclusion

Our analysis has highlighted socio-demographic and health care access factors that affect not only beginning but completing the vaccination series in Nigeria. Other factors not measured by the DHS such as health service quality and community attitudes should also be investigated and addressed to tackle inequities in coverage.

Child Vaccination Coverage, Trends and Predictors in Eastern Ethiopia: Implication for Sustainable Development Goals

BACKGROUND

Every year, immunization prevents about 4-5 million child fatalities from vaccine preventable morbidities. Conversely, in Ethiopia, achieving full coverage of vaccination has continued to be challenging. Socio-demographic, caregivers and child related factors determine vaccination coverage. Therefore, this study aimed to find out recent coverage, trends in coverage, and its predictors in eastern Ethiopia.

METHODS

A population-based longitudinal study design was conducted among 14,246 children aged 12-24 months from 2017 to 2021 in Kersa Health and Demographic Surveillance System site (KHDSS). The data were collected from caregivers of the child by face to face interview. Multinomial logistic regressions were used to identify predictors of vaccination. The association between vaccination coverage and its predictors was presented by adjusted odds ratio with 95% confidence interval. A p-value of <0.05 was used to establish statistical significance.

RESULTS

From the 14,198 included children, only 39% of children were fully vaccinated, with highest proportion in 2020 (45%) and lowest proportion in 2019 (32%). In comparison to fully vaccinated, being partially vaccinated was positively associated with older maternal age, rural residence, unemployment, rich wealth index, no antenatal care, facility delivery, and birth order whereas negatively associated with semi-urban residence. In compared to fully vaccinated, being not vaccinated was positively associated with older maternal age, rural residence, maternal education, unemployment, and no antenatal care whereas negatively associated with semi-urban residence, poor wealth index, multipara, grand multipara, and facility delivery.

CONCLUSION

Less than two-fifths of children aged 12 to 24 months were fully vaccinated. Socio-demographic factors and maternity care utilization were found to be predictors of vaccination coverage. Therefore, strategies that emphasize women's empowerment in terms of education, economy, and employment status, and enhancing maternal healthcare utilization may improve vaccination coverage.

Maternal healthcare utilsation and complete childhood vaccination in sub-Saharan Africa: a cross-sectional study of 29 nationally representative surveys

OBJECTIVE

The objective of the study was to examine the association between maternal healthcare utilisation and complete childhood vaccination in sub-Saharan Africa.

DESIGN

Our study was a cross-sectional study that used pooled data from 29 countries in sub-Saharan Africa.

PARTICIPANTS

A total of 60 964 mothers of children aged 11-23 months were included in the study.

OUTCOME VARIABLES

The main outcome variable was complete childhood vaccination. The explanatory variables were number of antenatal care (ANC) visits, assistance during delivery and postnatal care (PNC).

RESULTS

The average prevalence of complete childhood vaccination was 85.6%, ranging from 67.0% in Ethiopia to 98.5% in Namibia. Our adjusted model, children whose mothers had a maximum of three ANC visits were 56% less likely to have complete vaccination, compared with those who had at least four ANC visits (adjusted OR (aOR)=0.44, 95% CI 0.42 to 0.46). Children whose mothers were assisted by traditional birth attendant/other (aOR=0.43, 95% CI 0.41 to 0.56) had lower odds of complete vaccination. The odds of complete vaccination were lower among children whose mothers did not attend PNC clinics (aOR=0.26, 95% CI 0.24 to 0.29) as against those whose mothers attended.

CONCLUSION

The study found significant variations in complete childhood vaccination across countries in sub-Saharan Africa. Maternal healthcare utilisation (ANC visits, skilled birth delivery, PNC attendance) had significant association with complete childhood vaccination. These findings suggest that programmes, interventions and strategies aimed at improving vaccination should incorporate interventions that can enhance maternal healthcare utilisation. Such interventions can include education and sensitisation, reducing cost of maternal healthcare and encouraging male involvement in maternal healthcare service utilisation.