Incomplete childhood immunization in Nigeria: a multilevel analysis of individual and contextual factors

Abstract

BackgroundUnder-five mortality remains high in sub-Saharan Africa despite global decline. One quarter of these deaths are preventable through interventions such as immunization. The aim of this study was to examine the independent effects of individual-, community- and state-level factors on incomplete childhood immunization in Nigeria, which is one of the 10 countries where most of the incompletely immunised children in the world live.MethodsThe study was based on secondary analyses of cross-sectional data from the 2013 Nigeria Demographic and Health Survey (DHS). Multilevel multivariable logistic regression models were applied to the data on 5,754 children aged 12–23 months who were fully immunized or not (level 1), nested within 896 communities (level 2) from 37 states (level 3).ResultsMore than three-quarter of the children (76.3%) were not completely immunized. About 83% of children of young mothers (15–24 years) and 94% of those whose mothers are illiterate did not receive full immunization. In the fully adjusted model, the chances of not being fully immunized reduced for children whose mothers attended antenatal clinic (adjusted odds ratio [aOR] = 0.49; 95% credible interval [CrI] = 0.39–0.60), delivered in health facility (aOR = 0.62; 95% CrI = 0.51–0.74) and lived in urban area (aOR = 0.66; 95% CrI = 0.50–0.82). Children whose mothers had difficulty getting to health facility (aOR = 1.28; 95% CrI = 1.02–1.57) and lived in socioeconomically disadvantaged communities (aOR = 2.93; 95% CrI = 1.60–4.71) and states (aOR = 2.69; 955 CrI =1.37–4.73) were more likely to be incompletely immunized.ConclusionsThis study has revealed that the risk of children being incompletely immunized in Nigeria was influenced by not only individual factors but also community- and state-level factors. Interventions to improve child immunization uptake should take into consideration these contextual characteristics.

Barriers to Childhood Immunization in Sub-Saharan Africa: A Systematic Review

“…Forty-eight articles met all inclusion criteria for this study; 28 articles were excluded for various reasons. [See supplementary materials 3] Nine articles employed second-hand data analysis [7,12,18,27,37,40,41,47,42]; thirty-six used cross-sectional design [1-3, 11, 13-17, 19, 21-26, 28-36, 38-39, 42, 45-46, 48-51, 53, 54] and three used case-control study [20,[43][44]. All described studies were conducted on Africa populations (103,655 adults and 76,327 children).…”

Non-uptake of childhood vaccination among the children of HIV-infected mothers in sub-Saharan Africa: A multilevel analysis

“…The older women, having cared for many children, are likely to know the importance of immunization. 21,22 This study shows that education plays a major role in improving vaccination coverage. The probability of a child of an HIV positive mother not taking DTP3 is reduced in women with any form of formal education compared to their uneducated counterparts.…”

“…19,20 Unemployment leads to poverty, and studies have shown that the more the poverty level of a household, the more likely it is that its children would be incompletely vaccinated. 21 Lack of basic resources leads to poor health seeking behaviour and deprivation of required immunization, and subsequently being exposed to vaccine-preventable diseases. 21 …”

“…21 Lack of basic resources leads to poor health seeking behaviour and deprivation of required immunization, and subsequently being exposed to vaccine-preventable diseases. 21 …”

“…This gives credence to similar studies on immunization in the general population in some African countries. 19–21,23 Many of the countries that have low adult literacy rate are also among the countries that are in dire need of support by GAVI in order to meet their individual national targets for immunization. 24 All of these show that literacy level has a significant impact on vaccination coverage and national immunization programmes.…”