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

Abstract

M u l t i -y e a r t r e n d an a l y s i s of c h i l d h o o d i m m u n i z a t i o n upt a k e and c o v e r a g e i n N i g e r i aOyelola A. Adegboye, Danelle Kotze a n d Olasunkanmi A. Adegboye Summary:As a leading indicator of child health, under-five mortality was incorporated in the United Nations Millennium Development Goals with the aim of reducing the rate by two-thirds between 1990 and 2015. Under-five mortality in Nigeria is alarmingly high, and many of the diseases that result in mortality are vaccine preventable. This study evaluates the uptake of childhood immunization in Nigeria from 1990 to 2008. A multi-year trend analysis was carried out using Alternating Logistic Regression on 46,130 children nested within 17,380 mothers in 1938 communities from the Nigerian Demographic and Health Surveys from 1990 to 2008. The findings reveal that mother-level and community-level variability are significantly associated with immunization uptake in Nigeria. The model also indicates that children delivered at private hospitals have a higher chance of being immunized than children who are delivered at home. Children from the poorest families (who are more likely to be delivered at home) have a lower chance of being immunized than those from the richest families (OR ¼ 0.712; 95% CI, 0.641-0.792). Similarly, the chance of children with a mother with no education being immunized is decreased by 17% compared with children whose mother has at least a primary education. In the same way, children of mothers who are gainfully employed and those of older mothers have statistically significantly higher odds of being immunized. Children of households with a female head are less likely to be immunized than those from male-headed households. The statistical significance of the community-survey year interaction term suggests an increase in the odds of a child being immunized over the years and spread over communities. Evidence-based policy should lay more emphasis on mother-and community-level risk factors in order to increase immunization coverage among Nigerian children.

The role of place of residency in childhood immunisation coverage in Nigeria: analysis of data from three DHS rounds 2003–2013

“…In line with this adjusted odds, the PAR analysis quantified what could be achieved if these variables are optimised and provided more explanation of the FIC variation like health system related factors being more influential in the rural area compared to urban. Overall, our results are in line with those from previous studies [6][7][8][9], based on more robust methodology we provided more details such as the association in the different places of residence and the improvement that could be obtained by ensuring all mothers obtain the level of the socio-demographic variable associated with optimum FIC.…”

“…Nigeria has Africa's largest under age 1 year population, but one of the lowest immunisation coverage [4,5]; about 20% of the world's children under 1 year of age with incomplete DPT vaccination in 2017 lived in Nigeria [4]. Maternal education, antenatal care attendance and place of delivery, religion and place of residence have been reported to be associated with childhood vaccination in Nigeria [6][7][8][9].…”

“…Immunisation rates are generally worse in rural than urban areas [6][7][8][9], and studies in Asia and the near East [10], India [11], Kenya [12] and Nigeria [13] have reported lower rates of immunisation coverage in slums than in formal urban areas. The rapid urbanisation in Nigeria may become a further barrier to childhood immunisation uptake, with growth of urban slums [14,15], overstretched urban health facilities [16], leading to decreased health service quality and reduced access to health and immunisation services [13].…”

An assessment of maternal, newborn and child health implementation studies in Nigeria: implications for evidence informed policymaking and practice

“…There were also two publications 34,36 that implemented an intervention to generate evidence to improve newborn health. The existing interventions evaluated included: national emergency action plan to eradicate polio and prevention of maternal to child transmission of HIV.…”

“…Out of the 76 publications yielded in category 2, 7(9.2%) 30-36 satisfied the study inclusion criteria regarding newborn health and were selected (Table 2), while of the 249 publication from category 3, only 3 (1.2%) 37-39 met the study inclusion criteria regarding child health and were selected (Table 3). The flowchart of the study selection procedure is shown in Figure 1.…”