Childhood vaccination coverage and equity impact in Ethiopia by socioeconomic, geographic, maternal, and child characteristics

Geweniger, Anne; Abbas, Kaja

doi:10.1016/j.vaccine.2020.03.040

Cited by 64 publications

(91 citation statements)

References 28 publications

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“…Maternal education is a strong predictor of full immunisation coverage and is a consistent finding across related studies in Kenya and other countries [35,36] .…”

Section: Maternal Characteristicssupporting

confidence: 80%

Inequities in childhood immunisation coverage associated with socioeconomic, geographic, maternal, child, and place of birth characteristics in Kenya

Allan

Adetifa

Abbas

2021

Preprint

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Background: Immunisation of children is a highly cost-effective public health intervention and fosters health equity for the overall population. The WHO Immunisation Agenda 2030 highlights coverage and equity as one of the strategic priority goals to reach high equitable immunisation coverage at national levels and in all districts. We analysed full immunisation coverage among children aged 12-23 months in Kenya and estimated the inequities in full immunisation coverage associated with socioeconomic, geographic, maternal, child, and place of birth characteristics using data from the 2014 Kenya Demographic and Health Survey. Methods: We analysed full immunisation coverage (1-dose BCG, 3-dose DTP-HepB-Hib, 3-dose polio, 1-dose measles, and 3-dose pneumococcal vaccines) of 3,943 children aged 12-23 months. We disaggregated mean coverage by socioeconomic (household wealth, religion, ethnicity), geographic (place of residence, province), maternal (maternal age at birth, maternal education, maternal marital status, maternal household head status), child (sex of child, birth order), and place of birth characteristics. We conducted bivariate and multivariate logistic regression to assess associations between full immunisation coverage and socioeconomic, geographic, maternal, child, and place of birth characteristics. Results: Immunisation coverage ranged from 82% [81-84] for the third dose of polio to 97.4% [96.7-98.2] for the first dose of DTP-HepB-Hib, while full immunisation coverage was 68% [66-71] in 2014. After controlling for other background characteristics, children of mothers with primary school education or higher have at least 54% higher odds of being fully immunised compared to children of mothers with no education. Children born in clinical settings have 41% higher odds of being fully immunised compared to children born in home settings. Children in the Coast, Western, Central, and Eastern regions had at least 74% higher odds of being fully immunised compared to children in the North Eastern region, while children in urban areas had 26% lower odds of full immunisation compared to children in rural areas. Children in the middle and richer wealth quintile households were 43-57% more likely to have full immunisation coverage compared to children in the poorest wealth quintile households. Children who were sixth born or higher had 37% lower odds of full immunisation compared to first-born children. Conclusions: The inequities in full immunisation adversely affect children of mothers with no education, born in home settings, in regions with limited health infrastructure, living in poorer households, and of higher birth order. Further, the COVID-19 pandemic has disrupted routine and campaign immunisation services in 2020 and enhances the risk of vaccine-preventable disease outbreaks, but it also presents an opportunity to tackle the identified inequities in vaccine uptake as immunisation services are restored to capacity.

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“…Maternal education is a strong predictor of full immunisation coverage and is a consistent finding across related studies in Kenya and other countries [35,36] .…”

Section: Maternal Characteristicssupporting

confidence: 80%

Inequities in childhood immunisation coverage associated with socioeconomic, geographic, maternal, child, and place of birth characteristics in Kenya

Allan

Adetifa

Abbas

2021

Preprint

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“…Among the strengths of our study is the fact that 95 countries were included, whereas earlier publications on this issue covered 10 or fewer countries ( Adekanmbi et al, 2013 ; Basant Kumar Panda & Mishra, 2020 ; Ersino et al, 2018 ; Geweniger & Abbas, 2020 ; Akinyemi et al, 2017 ). We were able to include 90% of all low-income and 70% of lower-middle-income countries of the world.…”

Section: Discussionmentioning

confidence: 99%

“…Two studies, one from Punjab (Pakistan) and a national study from Nepal found that children in FHH presented a prevalence of stunting about 25% lower than children in MHH, even after adjusting for economic characteristics ( Dorsey et al, 2018 ; Khalid & Martin, 2017 ). Regarding vaccination, a national study in Ethiopia found an adjusted prevalence of full immunization 49% lower in FHH, compared to MHH ( Geweniger & Abbas, 2020 ) while a national study from India found the opposite, with children living in a FHH presenting 24% higher coverage of full immunization in comparison to MHH (Basant Kumar Panda & Mishra, 2020 ). These results exemplify the diversity of associations in different contexts of FHH, and in terms of different health and nutrition outcomes.…”

Section: Introductionmentioning

confidence: 99%

Are children in female-headed households at a disadvantage? An analysis of immunization coverage and stunting prevalence: in 95 low- and middle-income countries

Wendt¹,

Hellwig²,

Saad³

et al. 2021

SSM - Population Health

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Studies of inequalities in child health have given limited attention to household structure and headship. The few existing reports on child outcomes in male and female-headed households have produced inconsistent results. The aim of our analyses was to provide a global view of the influence of sex of the household head on child health in cross-sectional surveys from up to 95 LMICs. Studied outcomes were full immunization coverage in children aged 12–23 months and stunting prevalence in under-five children. We analyzed the most recent nationally-representative surveys for each country (since 2010) with available data. After initial exploratory analyses, we focused on three types of households: a) male-headed household (MHH) comprised 73.1% of all households in the pooled analyses; b) female Headed Household (FHH) with at least one adult male represented 9.8% of households; and c) FHH without an adult male accounted for 15.0% of households. Our analyses also included the following covariates: wealth index, education of the child’s mother and urban/rural residence. Meta-analytic approaches were used to calculate pooled effects across the countries with MHH as the reference category. Regarding full immunization, the pooled prevalence ratio for FHH (any male) was 0.99 (0.97; 1.01) and that for FHH (no male) was 0.99 (0.97; 1.02). For stunting prevalence, the pooled prevalence ratio for FHH (any male) was 1.00 (0.98; 1.02) and for FHH (no male) was 1.00 (0.98; 1.02). Adjustment for covariates did not lead to any noteworthy change in the results. No particular patterns were found among different world regions. A few countries presented significant inequalities with different directions of association, indicating the diversity of FHH and how complex the meaning and measurement of household headship may be. Further research is warranted to understand context, examine mediating factors, and exploring alternative definitions of household headship in countries with some association.

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“…1 shows full immunisation coverage in the eight regions (defunct provinces) of Kenya. Full immunisation coverage ranged from 42% [36][37][38][39][40][41][42][43][44][45][46][47][48][49] in the North Eastern region to 78% [72][73][74][75][76][77][78][79][80][81][82][83] in the Central and Eastern regions. Ethnicity and religion was excluded from the multivariable logistic regression analysis due to collinearity with the region of residence -ethnic groups in Kenya tend to cluster in specific regions, and while the predominant religion in Kenya is Christianity, Muslims are predominantly based in the Coastal and North Eastern regions.…”

Section: Immunisation Coveragementioning

confidence: 99%

“…Figure 1shows full immunisation coverage in the eight regions (defunct provinces) of Kenya. Full immunisation coverage ranged from 42%[36][37][38][39][40][41][42][43][44][45][46][47][48][49] in the North Eastern region to 78%[72-83] in the Central and Eastern regions.…”

mentioning

confidence: 99%

Childhood Immunisation Coverage in Kenya by Socioeconomic, Geographic, Maternal, Child, and Place of Birth Characteristics: Equity Impact Analysis

Allan

Imo.

Abbas

2021

Preprint

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Background: The WHO Immunisation Agenda 2030 highlights coverage and equity as a strategic priority goal to reach high equitable immunisation coverage at national levels and in all districts. We estimated inequities in full immunisation coverage associated with socioeconomic, geographic, maternal, child, and place of birth characteristics among children aged 12-23 months in Kenya. Methods: We analysed full immunisation coverage (1-dose BCG, 3-dose DTP-HepB-Hib, 3-dose polio, 1-dose measles, and 3-dose pneumococcal vaccines) of 3,943 children aged 12–23 months from the 2014 Kenya Demographic and Health Survey. We disaggregated mean coverage by socioeconomic (household wealth, religion, ethnicity), geographic (place of residence, province), maternal (maternal age at birth, maternal education, maternal marital status, maternal household head status), child (sex of child, birth order), and place of birth characteristics, and estimated inequities in full immunisation coverage using bivariate and multivariate logistic regression. Results: Immunisation coverage ranged from 82% [81–84] for the third dose of polio to 97.4% [96.7–98.2] for the first dose of DTP-HepB-Hib, while full immunisation coverage was 68% [66–71] in 2014. After controlling for other background characteristics, children of mothers with primary school education or higher have at least 54% higher odds of being fully immunised compared to children of mothers with no education. Children born in clinical settings have 41% higher odds of being fully immunised compared to children born in home settings. Children in the Coast, Western, Central, and Eastern regions had at least 74% higher odds of being fully immunised compared to children in the North Eastern region, while children in urban areas had 26% lower odds of full immunisation compared to children in rural areas. Children in the middle and richer wealth quintile households were 43–57% more likely to have full immunisation coverage compared to children in the poorest wealth quintile households. Children who were sixth born or higher had 37% lower odds of full immunisation compared to first-born children. Conclusions: The inequities in full immunisation adversely affect children of mothers with no education, born in home settings, in regions with limited health infrastructure, living in poorer households, and of higher birth order.

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Childhood vaccination coverage and equity impact in Ethiopia by socioeconomic, geographic, maternal, and child characteristics

Cited by 64 publications

References 28 publications

Inequities in childhood immunisation coverage associated with socioeconomic, geographic, maternal, child, and place of birth characteristics in Kenya

Inequities in childhood immunisation coverage associated with socioeconomic, geographic, maternal, child, and place of birth characteristics in Kenya

Are children in female-headed households at a disadvantage? An analysis of immunization coverage and stunting prevalence: in 95 low- and middle-income countries

Childhood Immunisation Coverage in Kenya by Socioeconomic, Geographic, Maternal, Child, and Place of Birth Characteristics: Equity Impact Analysis

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