Factors associated with completion of childhood immunization in Malawi: a multilevel analysis of the 2015–16 Malawi demographic and health survey

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.

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

“…Children from medium- and high-wealth households were more likely to complete their vaccination than children from poor households. this finding is in line with studies done in Maynamar [ 33 ], Malawi [ 38 ], Democratic Republic of Congo [ 35 ], sub-Saharan Africa [ 23 ], and Ethiopia [ 21 ]. The possible explanation might be due to wealthier people have healthier childcare practices and better health-seeking behavior, or travel cost to health facilities can restrict poor people’s willingness to immunize their children [ 12 ].…”

Multilevel Analysis of Individual and Contextual Factors Associated with Polio Non-Vaccination in Africa: Further Analyses to Enhance Policy and Opportunity to Save More Lives

“…Previous findings from the United States show that under vaccination was more likely in male than female children [ 21 ]. Similarly, studies conducted in African countries indicated that children born to mothers with no formal education, children who resided in the poorest households [ 22 ], children whose households reported distance to the nearest health facility as a big problem, children whose delivery occurred in a non-health facility, and children who had no health card were more likely to be non- and under-vaccinated [ 23 , 24 ]. More importantly, the findings uncover new evidence by demonstrating that neighbourhood and country-level factors influence non-vaccination for polio above and beyond individual level factors.…”

Modeling the Factors Associated with Incomplete Immunization among Children

“…ere is both direct and indirect cost associated with immunization updates such as transportation to the nearest point to receive the services [26]. As a result, mothers from wealthier families may have a better chance of getting modern health care for their families, especially their children, implying greater liberty [27]. Children of mothers in the poorest wealth quintile, on the other hand, are less likely to fully vaccinate their children due to difficulty in access to facilities such as transportation fees [27].…”