Multilevel analysis of predictors of multiple indicators of childhood vaccination in Nigeria

Aheto, Justice Moses K.; Pannell, Oliver; Dotse‐Gborgbortsi, Winfred; Trimner, Mary Kay; Tatem, Andrew J.; Rhoda, Dale A.; Cutts, Felicity; Utazi, C. Edson

doi:10.1371/journal.pone.0269066

Cited by 14 publications

(19 citation statements)

References 52 publications

(66 reference statements)

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“…11 This is an indication that factors responsible for non-vaccination in these areas are likely responsible for the failure to complete the vaccination series. Aheto et al 42 found these factors to include non-ownership of a health card/document, non-receipt of vitamin A (both are indicators of access to health/vaccination services), poor maternal DATA AVAILABILITY STATEMENT DHS data supporting this study are publicly available from https://dhsprogram.com/data/available-datasets.cfm. Other data are publicly available via the sources referenced in the methods section.…”

Section: F I G U R Ementioning

confidence: 99%

Conditional probability and ratio‐based approaches for mapping the coverage of multi‐dose vaccines

Utazi

Aheto

Chan

et al. 2022

Statistics in Medicine

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Many vaccines are often administered in multiple doses to boost their effectiveness. In the case of childhood vaccines, the coverage maps of the doses and the differences between these often constitute an evidence base to guide investments in improving access to vaccination services and health system performance in low and middle-income countries. A major problem often encountered when mapping the coverage of multi-dose vaccines is the need to ensure that the coverage maps decrease monotonically with successive doses. That is, for doses i and j, i < j ⇒ p i (s) ≥ p j (s), where p i (s) is the coverage of dose i at spatial location s.Here, we explore conditional probability (CP) and ratio-based (RB) approaches for mapping p i (s), embedded within a binomial geostatistical modeling framework, to address this problem. The fully Bayesian model is implemented using the INLA and SPDE approaches. Using a simulation study, we find that both approaches perform comparably for out-of-sample estimation under varying point-level sample size distributions. We apply the methodology to map the coverage of the three doses of diphtheria-tetanus-pertussis vaccine using data from the 2018 Nigeria Demographic and Health Survey. The coverage maps produced using both approaches are almost indistinguishable, although the CP approach yielded more precise estimates on average in this application. We also provide estimates of zero-dose children and the dropout rates between the doses. The methodology is straightforward to implement and can be applied to other vaccines and geographical contexts.

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Section: F I G U R Ementioning

confidence: 99%

Conditional probability and ratio‐based approaches for mapping the coverage of multi‐dose vaccines

Utazi

Aheto

Chan

et al. 2022

Statistics in Medicine

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“…Although our work has revealed interesting similarities between MCV and DTP zero-dose, it will be informative to understand how these compare with the spatial distribution of children who had not received any of the basic vaccines. We will conduct multi-level analyses similar to Aheto et al [18] and Utazi et al [37] , but at the regional level, to better understand regional differences in the major drivers of poor vaccine uptake. Beyond the descriptive analysis using measles case-based surveillance data presented here, we will explore different options to model and refine the data using geospatial approaches.…”

Section: Discussionmentioning

confidence: 99%

“…A recent analysis of measles case-based surveillance data also found higher incidence rates in the north, in addition to a high proportion of MCV zero-dose individuals (70.8%) among confirmed cases during 2008-2018 [16]. Several studies have identified different demand-and supply-side factors, such as maternal access to and utilization of health services, maternal education, religion, ethnicity, wealth, maternal age, mobile phone usage, poor attitude of health workers and vaccine stockouts as being responsible for the slow rate of progress within the country [17][18][19]. All of this points to an urgent need to identify and prioritize high-risk areas for effective follow up through appropriate routine and campaign strategies and robust disease surveillance [14], to put the country on a path to achieving its disease control and elimination targets.…”

Section: Introductionmentioning

confidence: 99%

Mapping the distribution of zero-dose children to assess the performance of vaccine delivery strategies and their relationships with measles incidence in Nigeria

Utazi

Aheto

Wigley

et al. 2022

Preprint

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Geographically precise identification and targeting of populations at risk of vaccine-preventable diseases has gained renewed attention within the global health community over the last few years. District level estimates of vaccination coverage and corresponding zero-dose prevalence constitute a potentially useful evidence base to evaluate the performance of vaccination strategies. These estimates are also valuable for identifying missed communities, hence enabling targeted interventions and better resource allocation. Here, we fit Bayesian geostatistical models to map the routine coverage of the first doses of diphtheria-tetanus-pertussis vaccine (DTP1) and measles-containing vaccine (MCV1) and corresponding zero-dose estimates at 1x1 km resolution and the district level using geospatial data sets. We also map MCV1 coverage before and after the 2019 measles vaccination campaign in the northern states to further explore variations in routine vaccine coverage and to evaluate the effectiveness of both routine immunization (RI) and campaigns in reaching zero-dose children. Additionally, we map the spatial distributions of reported measles cases during 2018 to 2020 and explore their relationships with MCV zero-dose prevalence to highlight the public health implications of varying performance of vaccination strategies across the country. Our analysis revealed strong similarities between the spatial distributions of DTP and MCV zero dose prevalence, with districts with the highest prevalence concentrated mostly in the northwest and the northeast, but also in other areas such as Lagos state and the Federal Capital Territory. Although the 2019 campaign reduced MCV zero-dose prevalence substantially in the north, pockets of vulnerabilities remained in areas that had among the highest prevalence prior to the campaign. Importantly, we found strong correlations between measles case counts and MCV RI zero-dose estimates, which provides a strong indication that measles incidence in the country is mostly affected by RI coverage. Our analyses reveal an urgent and highly significant need to strengthen the country's RI program as a longer-term measure for disease control, whilst ensuring effective campaigns in the short term.

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“…The nested structure of the demographic health survey (DHS) data in which children were selected from household within communities necessitated the use of the methodology. Use of multilevel logistic regression models for the analysis of DHS data has been documented and used severally in literature [29][30][31] therefore we would not document the theory in this paper. For this paper we constructed a model for CU5 and children of school age independently.…”

Section: Discussionmentioning

confidence: 99%

Use of insecticide treated nets in children under five and children of school age in Nigeria: Evidence from a secondary data analysis of demographic health survey

Ujuju¹,

Okoronkwo

Okoko

et al. 2022

PLoS ONE

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Background and objective Use of insecticide treated nets (ITN), one of the most cost-effective malaria interventions contributes to malaria cases averted and reduction in child mortality. We explored the use of ITN in children under five (CU5) and children of school age to understand factors contributing to ITN use. Methods A cross-sectional study analyzed 2018 Nigeria Demographic and Health Survey data. The outcome variable was CU5 or children of school age who slept under ITN the night before the survey. Independent variables include child sex, head of household’s sex, place of residence, state, household owning radio and television, number of household members, wealth quintile, years since ITN was obtained and level of malaria endemicity. Multi-level logistic regression model was used to access factors associated with ITN use among children. Results In total, 32,087 CU5 and 54,692 children of school age were examined with 74.3% of CU5 and 57.8% of children of school age using ITN the night before the survey. While seven states had more than 80% of CU5 who used ITN, only one state had over 80% of school children who used ITN. ITN use in CU5 is associated with living in rural area (aOR = 1.20, 95% CI 1.14 to 1.26) and residing in meso endemic area (aOR = 3.1, 95% CI 2.89 to 3.54). While In children of school age, use of ITN was associated with female headed households (aOR = 1.14, 95% CI 1.09 to 1.19), meso (aOR = 3.17, 95% CI 2.89 to 3.47) and hyper (aOR = 14.9, 95% CI 12.99 to 17.07) endemic areas. Children residing in larger households were less likely to use ITN. Conclusions This study demonstrated increased use of ITN in CU5 from poor households and children living in rural and malaria endemic areas. Findings provide some policy recommendations for increasing ITN use in school children.

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Multilevel analysis of predictors of multiple indicators of childhood vaccination in Nigeria

Cited by 14 publications

References 52 publications

Conditional probability and ratio‐based approaches for mapping the coverage of multi‐dose vaccines

Conditional probability and ratio‐based approaches for mapping the coverage of multi‐dose vaccines

Mapping the distribution of zero-dose children to assess the performance of vaccine delivery strategies and their relationships with measles incidence in Nigeria

Use of insecticide treated nets in children under five and children of school age in Nigeria: Evidence from a secondary data analysis of demographic health survey

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