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

Abstract

The aim of this study was to develop and test models for non–uptake of three doses of diphtheria-tetanus-pertussis containing vaccines (DTP3) among children of women living with HIV in sub-Saharan Africa. The study used demographic and health survey data from 27 sub-Saharan African countries that have the required HIV and immunization data sets. Multivariable logistic regression models were used to assess the relationship between individual and contextual factors associated with non-uptake of DTP3 among the children. At the individual level, the odds of non-uptake of DTP3 decreased with formal education, increasing age and access to media. The full model shows that the odds of non-uptake of DTP3 is increased among unemployed women, those living in communities with high illiteracy rate and in countries with low adult literacy level. For a child who moved to another country or community with a higher probability of DTP3 non-uptake, the median increase for the odds of DTP3 non-uptake would be 2.24% and 1.22% respectively for country and community. This study shows that individual and contextual factors contributed significantly to non-uptake of DTP3 among the children of women living with HIV. Interventions should be focused on women living with HIV who are young mothers, unemployed women, those without formal education, individuals living in communities with high illiteracy rate and in countries with low adult literacy rate. The use of mass media tools and creation of more employment opportunities for HIV-infected women could improve vaccination coverage among their children.

Special focus on challenges and opportunities for the development and use of vaccines in Africa

“…This led to proposals for interventions that are focussed on young HIV-infected, unemployed women, those without formal education, individuals living in communities with high illiteracy rate and in countries with low adult literacy rate. 22 The need for community-engagement and a bottom-up approach that is cognisant of societal, cultural and religious considerations to address the barriers contributing to underimmunization of children was clearly also evident with the experience around polio eradication efforts in countries such as Nigeria, Pakistan and Afghanistan. A further example of this is the experience shared by Kpanake et al in this journal, on the hypothetical willingness of Guineans to be vaccinated against Ebola; with 25% of respondents not supporting vaccination, and a further 19% demonstrating hesitancy toward vaccination.…”

Vaccination assessments using the Demographic and Health Survey, 2005–2018: a scoping review

“…Overall, 23 (18%) studies used DHS datasets from multiple countries, ranging from 2 [17][18][19] to 86 countries. 11 Seven studies used data from multiple African countries, [20][21][22][23][24][25][26] 4 from just Asian countries, 17 18 27 28 1 from the Americas 19 and the remainder (11) used data from multiple continents. 10-12 29-36 For one study, we were unable to determine what exact countries were included in the analysis.…”

Factors Affecting the Utilization of Maternal and Child Health Services in Urban Primary Health Care Centers in Enugu State (Abakpa and Uwani)'

“…In recent times, studies have explored the predictors and barriers to immunisation or full immunisation while series of reviews have been conducted on this subject. Some of these recent studies have reported that lack of knowledge of immunisation, lack of partner support, financial deprivation and distrust in immunisation programmes account for incomplete or nonimmunisation [23][24][25] . Nigeria is a major contributor of global childhood death from vaccine preventable deaths.…”