Household Vulnerability and Childhood Immunization Status in Nigeria

Abstract

Immunization is considered one of the most cost-effective public health interventions for reducing childhood morbidity, mortality, and disability globally. However, while global achievement of over 70% coverage rates was sustained in 1990s, wide variations exist between and within countries. In some developing countries, immunization rates increased substantially, but in sub-Saharan Africa, immunization rates plummeted, leaving millions of children vulnerable to life-threatening diseases. In Nigeria, coverage rates for routine immunization for all antigens still fall below 50%. The study examined the overall influence of household vulnerability dimensions, maternal health practices on childhood immunization status in Nigeria. The study used secondary data from 2013 Nigeria Demographic and Health Surveys (NDHS). The analytical weighted sample size was 5,824women of reproductive ages (15–49 years) with a live birth in the past 3 years, whose children were within age 12 to 23 months at the time of the survey. The data was analyzed using frequency distribution, chi-square test, and binary logistic regression. The results showed a decreasing regional variation in the proportion of fully immunized children from high of 23.6% in South-West, to a low of 9.1% in North-East. The overall household vulnerability status showed that children in more and most vulnerable households were 62% (OR = 0.38; p < .001; CI [0.32-0.46]) and 89%less likely (OR = 0.11; p < .001; CI [0.08-0.14]) to receive full vaccination compared with their counterpart in non-vulnerable households. The study revealed significant relationship between mothers’: (i) number of antenatal visits (OR = 1.66; p < .05; CI [0.25-1.77]); (ii) quality of antenatal care (OR = 2.61; p < .05; CI [1.45-4.67]); (iii) place of delivery (OR = 0.62; p < .05; CI [0.45-0.86]); (iv) assistance during delivery (OR = 0.41; p < .001; CI [0.28-0.57]); (v) time of postnatal check (OR = 1.81; p < .001; CI [1.49-2.19]) and full childhood immunization status.

Challenges and enablers in measles vaccination implementation in Ethiopia: Insights from a qualitative study

“…In addition, outreach vaccination services were highly interrupted and not available in some areas due to a shortage of transportation. This finding is consistent with studies done in Ethiopia [ 8 , 10 – 12 ] and Nigeria [ 21 ]. Re-establishing outreach services might be mandatory to reach every child in those communities [ 22 ].…”

Challenges and enablers in measles vaccination implementation in Ethiopia: Insights from a qualitative study

“…In addition, outreach vaccination services were highly interrupted and not available in some areas due to a shortage of transportation. This finding is consistent with studies done in Ethiopia [ 8 , 10 – 12 ] and Nigeria [ 21 ]. Re-establishing outreach services might be mandatory to reach every child in those communities [ 22 ].…”

Mapping Community Vulnerability to reduced Vaccine Impact in Uganda and Kenya: A spatial Data-driven Approach

“…These findings are consistent findings from spatial analysis in Uganda and Kenya, which shown that long travel times, limited media access and rural residence significantly increased risk of being under or no vaccination 5 , 72 . Similarly, findings from a multidimensional household vulnerability index in Nigeria shown that a combination of demographic, social, geographical, and economic factors were associated with increased risk of partial or no vaccination 73 . While these studies primarily focused on identifying geographic hotspots of unvaccinated or under vaccinated children and the associated determinants of vaccine coverage, the CVIVI extends this body of literature by focusing on vulnerability to reduced vaccine impact, not just vaccine coverage gaps.…”

To what extent are vulnerability issues included and addressed in Kenya's health and immunization policy documents? A systematic review of documents

“…Whereas this strategy would help bring immunization services closer to those experiencing physical accessibility challenges to health facilities, it may not address other forms of vulnerabilities highlighted in primary studies, including household, caregiver and health system level vulnerabilities. For instance, in Kenya, previous studies have shown that children’s vulnerability to vaccine-related disparities is not only influenced by geographical factors, but also household and caregivers’ characteristics 8 , 10 , 38 – 40 , 44 , 45 . Therefore, a more comprehensive and flexible approach would be suitable to addressing the different forms of vaccine-related vulnerabilities.…”

Challenges and enablers in measles vaccination implementation in Ethiopia: Insights from a qualitative study

“…In addition, outreach vaccination services were highly interrupted and not available in some areas due to a shortage of transportation. This finding is consistent with studies done in Ethiopia [ 8 , 10 – 12 ] and Nigeria [ 21 ]. Re-establishing outreach services might be mandatory to reach every child in those communities [ 22 ].…”

Mapping Community Vulnerability to reduced Vaccine Impact in Uganda and Kenya: A spatial Data-driven Approach

“…These findings are consistent findings from spatial analysis in Uganda and Kenya, which shown that long travel times, limited media access and rural residence significantly increased risk of being under or no vaccination 5 , 72 . Similarly, findings from a multidimensional household vulnerability index in Nigeria shown that a combination of demographic, social, geographical, and economic factors were associated with increased risk of partial or no vaccination 73 . While these studies primarily focused on identifying geographic hotspots of unvaccinated or under vaccinated children and the associated determinants of vaccine coverage, the CVIVI extends this body of literature by focusing on vulnerability to reduced vaccine impact, not just vaccine coverage gaps.…”

To what extent are vulnerability issues included and addressed in Kenya's health and immunization policy documents? A systematic review of documents

“…Whereas this strategy would help bring immunization services closer to those experiencing physical accessibility challenges to health facilities, it may not address other forms of vulnerabilities highlighted in primary studies, including household, caregiver and health system level vulnerabilities. For instance, in Kenya, previous studies have shown that children’s vulnerability to vaccine-related disparities is not only influenced by geographical factors, but also household and caregivers’ characteristics 8 , 10 , 38 – 40 , 44 , 45 . Therefore, a more comprehensive and flexible approach would be suitable to addressing the different forms of vaccine-related vulnerabilities.…”

Challenges and enablers in measles vaccination implementation in Ethiopia: Insights from a qualitative study

“…In addition, outreach vaccination services were highly interrupted and not available in some areas due to a shortage of transportation. This finding is consistent with studies done in Ethiopia [ 8 , 10 – 12 ] and Nigeria [ 21 ]. Re-establishing outreach services might be mandatory to reach every child in those communities [ 22 ].…”

Mapping Community Vulnerability to reduced Vaccine Impact in Uganda and Kenya: A spatial Data-driven Approach

“…These findings are consistent findings from spatial analysis in Uganda and Kenya, which shown that long travel times, limited media access and rural residence significantly increased risk of being under or no vaccination 5 , 72 . Similarly, findings from a multidimensional household vulnerability index in Nigeria shown that a combination of demographic, social, geographical, and economic factors were associated with increased risk of partial or no vaccination 73 . While these studies primarily focused on identifying geographic hotspots of unvaccinated or under vaccinated children and the associated determinants of vaccine coverage, the CVIVI extends this body of literature by focusing on vulnerability to reduced vaccine impact, not just vaccine coverage gaps.…”

To what extent are vulnerability issues included and addressed in Kenya's health and immunization policy documents? A systematic review of documents

“…Whereas this strategy would help bring immunization services closer to those experiencing physical accessibility challenges to health facilities, it may not address other forms of vulnerabilities highlighted in primary studies, including household, caregiver and health system level vulnerabilities. For instance, in Kenya, previous studies have shown that children’s vulnerability to vaccine-related disparities is not only influenced by geographical factors, but also household and caregivers’ characteristics 8 , 10 , 38 – 40 , 44 , 45 . Therefore, a more comprehensive and flexible approach would be suitable to addressing the different forms of vaccine-related vulnerabilities.…”