Applying a social-ecological model to understand factors impacting demand for childhood vaccinations in Nigeria, Uganda, and Guinea

Bell, James; Lartey, Bélinda; Spickernell, Gemma; Darrell, Natasha; Salt, Frances; Gardner, Cassie; Richards, Emily; Fasakin, Lanre; Egbeniyi, Shadrach; Odongo, Emmanuel; Ssenkungu, James; Kouadio, Rigobert Kotchi; Cissé, Mamadi; Rérambyah, Axel Bruno Ayiya Igowa; Adou, Maikol; West, Robin; Sharma, Sunny

doi:10.1016/j.ssmqr.2022.100180

Cited by 4 publications

(28 citation statements)

References 37 publications

(44 reference statements)

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“…• Having many vaccinations at once is hard for children to bear • It is difficult to manage the side effects of vaccination • Vaccines are a way to control us Side-effects are a commonly cited concern about vaccinations among caregivers (7). Vaccination rumours have also been shown to contribute to low uptake (7,9,15,19,34,37,38,(41)(42)(43). There is also some evidence that caregivers may believe too many vaccines are administered at once (7).…”

Section: Belief That Vaccines Are Harmfulmentioning

confidence: 99%

“…In an analysis of Demographic and Health (DHS) vaccination coverage surveys, Guinea had the lowest percentage of fully vaccinated children of the 25 countries included, Nigeria ranked 22/25 and Uganda 16/25 (25). Data Collection Data were collected using a questionnaire (S2 File), designed using the results of a formative qualitative study (19) and a literature review. The questionnaire collected demographic data, household income, and the vaccination status of the participant's child, as well as perceptual information on their family and community relationships, traditional and religious beliefs, methods of child protection and attitudes to vaccination and vaccination services.…”

Section: Settingmentioning

confidence: 99%

“…• The staff in the hospital are rude to me • The clinic or hospital is dirty • The queues are too long Literature on vaccination demand, including our qualitative study, has consistently shown that poor experiences of the healthcare system contribute to low vaccination uptake (7)(8)(9)(10)12,14,19,33,40).…”

Section: Introductionmentioning

confidence: 99%

“…Parents may have conflicting priorities, which reduce the likelihood that a child will be vaccinated (9,19,35,37,38). Communities may also have other ways to protect children which are more culturally embedded (9,19,39). Poor service delivery experience…”

Section: Introductionmentioning

confidence: 99%

“…Research on this topic in sub-Saharan Africa proposes that demand for vaccination is informed by family and community priorities and power structures; belief in traditional or religious forms of disease prevention; the exchange of information (including rumours and conspiracy theories) in communities; personal experience of vaccination; and interactions with healthcare systems and providers at the point of delivery (6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18). The research on vaccine demand to date suggests that many inter-dependent and context-specific factors contribute to uptake of vaccination services (19). Despite this, quantitative analyses of determinants of demand or uptake of vaccination are rarely based on an underlying theory, may use single variables as proxies for complex and multidimensional factors, and often use statistical models that do not consider the relationships between constructs that drive demand for vaccination in the real world.…”

Section: Introductionmentioning

confidence: 99%

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A structural equation modelling approach to understanding the determinants of childhood vaccination in Nigeria, Uganda and Guinea

Bell

Lartey

Fernandez

et al. 2022

Preprint

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Vaccines have contributed to reductions in morbidity and mortality from preventable diseases globally, but low demand for vaccination threatens to reverse these gains. Explorations of the determinants of vaccination uptake may rely on proxy variables to describe complex phenomena and construct models without reference to underlying theories of vaccine demand. This study aimed to use the results of a formative qualitative study (described elsewhere) to construct and test a model to explain the determinants of vaccination uptake. Using the results of a survey among more than 3,000 primary caregivers of young children in Nigeria, Uganda and Guinea, factor analysis produced six explanatory factors. We then estimated the effects of each of these factors on uptake of immunization using a structural equation model. The results showed that the probability that a child is fully vaccinated increases if a caregiver has support from others to vaccinate them (B= 0.33, β= 0.21, p<0.001) and if caregivers had poor experiences with the healthcare system (B= 0.09, β= 0.09, p= 0.007). Conversely, the probability of full vaccination decreases if the caregiver’s husband exerts control over her decision-making ability (B= -0.29, β = -0.20, p<0.001) , or if the caregiver perceives vaccines to be of low importance (B= -0.37, β= -0.27, p<0.001). Belief in religious protection (B= -0.07, β= -0.05, p=0.118) and a belief that vaccines are harmful (B= -0.12, β= -0.04, p= 0.320) did not have an observed effect on vaccination status . This research suggests that interventions may benefit from that including entire families and communities in their design.

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Section: Belief That Vaccines Are Harmfulmentioning

confidence: 99%

Section: Settingmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

A structural equation modelling approach to understanding the determinants of childhood vaccination in Nigeria, Uganda and Guinea

Bell

Lartey

Fernandez

et al. 2022

Preprint

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A social-ecological view of the factors affecting the effectiveness of reintegration interventions targeting children out of family-based care situations: A scoping review

Zewude,

Tadele,

Engdawork

et al. 2023

Cogent Social Sciences

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A structural equation modelling approach to understanding the determinants of childhood vaccination in Nigeria, Uganda and Guinea

Bell

Lartey

Fernandez

et al. 2023

PLOS Glob Public Health

Self Cite

View full text Add to dashboard Cite

Vaccines have contributed to reductions in morbidity and mortality from preventable diseases globally, but low demand for vaccination threatens to reverse these gains. Explorations of the determinants of vaccination uptake may rely on proxy variables to describe complex phenomena and construct models without reference to underlying theories of vaccine demand. This study aimed to use the results of a formative qualitative study (described elsewhere) to construct and test a model to explain the determinants of vaccination uptake. Using the results of a survey among more than 3,000 primary caregivers of young children in Nigeria, Uganda and Guinea, factor analysis produced six explanatory factors. We then estimated the effects of each of these factors on uptake of immunization using a structural equation model. The results showed that the probability that a child is fully vaccinated increases if a caregiver has support from others to vaccinate them (B = 0.33, β = 0.21, p<0.001) and if caregivers had poor experiences with the healthcare system (B = 0.09, β = 0.09, p = 0.007). Conversely, the probability of full vaccination decreases if the caregiver’s husband exerts control over her decision-making ability (B = -0.29, β = -0.20, p<0.001), or if the caregiver perceives vaccines to be of low importance (B = -0.37, β = -0.27, p<0.001). Belief in religious protection (B = -0.07, β = -0.05, p = 0.118) and a belief that vaccines are harmful (B = -0.12, β = -0.04, p = 0.320) did not have an observed effect on vaccination status. This research suggests that interventions may benefit from that including entire families and communities in their design.

show abstract

Applying a social-ecological model to understand factors impacting demand for childhood vaccinations in Nigeria, Uganda, and Guinea

Cited by 4 publications

References 37 publications

A structural equation modelling approach to understanding the determinants of childhood vaccination in Nigeria, Uganda and Guinea

A structural equation modelling approach to understanding the determinants of childhood vaccination in Nigeria, Uganda and Guinea

A social-ecological view of the factors affecting the effectiveness of reintegration interventions targeting children out of family-based care situations: A scoping review

A structural equation modelling approach to understanding the determinants of childhood vaccination in Nigeria, Uganda and Guinea

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