Inequitable childhood immunization uptake in Nigeria: a multilevel analysis of individual and contextual determinants

Abstract

BackgroundImmunization coverage in many parts of Nigeria is far from optimal, and far from equitable.Nigeria accounts for half of the deaths from Measles in Africa, the highest prevalence of circulating wild poliovirus in the world, and the country is among the ten countries in the world with vaccine coverage below 50 percent. Studies focusing on community-level determinants therefore have serious policy implicationsMethodsMultilevel multivariable regression analysis was used on a nationally-representative sample of women aged 15-49 years from the 2003 Nigeria Demographic and Health Survey. Multilevel regression analysis was performed with children (level 1) nested within mothers (level 2), who were in turn nested within communities (level 3).ResultsResults show that the pattern of full immunization clusters within families and communities, and that socio-economic characteristics are important in explaining the differentials in full immunization among the children in the study. At the individual level, ethnicity, mothers' occupation, and mothers' household wealth were characteristics of the mothers associated with full immunization of the children. At the community level, the proportion of mothers that had hospital delivery was a determinant of full immunization status.ConclusionSignificant community-level variation remaining after having controlled for child- and mother-level characteristics is indicative of a need for further research on community-levels factors, which would enable extensive tailoring of community-level interventions aimed at improving full immunization and other child health outcomes.

Evaluation of invalid vaccine doses in 31 countries of the WHO African Region

“…The wealth index was divided into quintiles; from the poorest 20% to the richest 20%. Selected individual-level variables were hypothesised to be associated with invalid vaccinations based on previous literature [15,27,28]. In addition, we added a variable "year of survey" to control for possible unmeasured birth cohort effects.…”

Multi-Year Trend Analysis of Childhood Immunization Uptake and Coverage in Nigeria

“…Rammohan et al (2012) used logistic regression analysis to explore the likelihood of a child under five years of age being vaccinated for measles separately for Indonesia, India, Pakistan, Nigeria, Democratic Republic of Congo and Ethiopia, while Wiysonge et al (2012) used multi-level logistic regression to examine the risk factors associated with childhood immunization in 24 countries in sub-Saharan Africa at the child, community and country level. In his study, Antai (2009) employed the use of a three-level multi-level logistic regression model to assess the risk factors for childhood immunization in Nigeria in 2003 using DHS data at the child level nested within mothers who were in turn nested within com-munities. Bosch-Capblanch et al (2012) carried out a logistic regression analysis on data from 241 nationally representative household surveys in 96 countries using the unique or most recent survey for each country.…”

Place Matters: Community Level Effects of Women’s Autonomy on Ethiopian Children’s Immunization Status

“…Communities with average delivery scores between 0.03 and 0.09 were categorized as having middle hospital delivery access. Communities with average delivery scores higher than 0.10 were categorized as having high hospital delivery access (Antai 2009). …”

“…Then, each value for all women in each cluster was used to calculate an average cluster prenatal access score, which ranged from 0-0.77. Next, scores were collapsed into two categories, low versus high access to prenatal care, using a cut-off at 0.50 (Antai 2009). …”

“…Many studies have shown that measures of community context including education, wealth, literacy, and health infrastructure influence children's mortality (Kravdal 2004), children's nutrition (Fotso and Kuate-Defo 2006;Linnemayr, Alderman and Ka 2008), and women's health knowledge (Andrzejewski, Reed and White 2009), and children's immunization status. Yet, there are few studies that examine how children's immunization status may be influenced by women's autonomy at the community level (Antai 2009;Babalola 2009). The decision making capabilities of women in a community might have an effect on children's immunization status, above and beyond the effect of individual women's autonomy.…”