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

Sulaimon T Adedokun,Charles S Wiysonge,Victor T Adekanmbi,Olalekan A Uthman

doi:10.1186/s12889-017-4137-7

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.

Highlights

Under-five mortality remains high in sub-Saharan Africa despite global decline
Children whose mothers had difficulty getting to health facility (OR = 1.28; 95% credible intervals (CrI) = 1.02–1.57) and lived in socioeconomically disadvantaged communities (OR = 2.93; 95% CrI = 1.60–4.71) and states (OR = 2.69; 955 CrI = 1.37–4.73) are more likely to be incompletely immunized
We found that individual characteristics and community and state factors are important in explaining the variations in incomplete immunization status of children in Nigeria

Summary

Introduction

Under-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. The world witnessed a tremendous reduction in child mortality between 1990 and 2015, sub-Saharan Africa (SSA) is still characterised by high under-five deaths. One-quarter of these deaths are preventable through interventions such This effort was mirrored in Nigeria as the Expanded Programme on Immunization (EPI) was introduced in the country in 1979. The strategy aimed at truncating the spread of the poliovirus, introducing new vaccines and improving immunization coverage generally, among others. In May 2012, Nigeria joined other member states of the World Health Assembly to endorse the Global Vaccine Action Plan; an agenda for universal access to immunisation by 2020 [5]

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