Abstract
BackgroundIn 2010, more than six million children in sub-Saharan Africa did not receive the full series of three doses of the diphtheria-tetanus-pertussis vaccine by one year of age. An evidence-based approach to addressing this burden of un-immunised children requires accurate knowledge of the underlying factors. We therefore developed and tested a model of childhood immunisation that includes individual, community and country-level characteristics.Method and FindingsWe conducted multilevel logistic regression analysis of Demographic and Health Survey data for 27,094 children aged 12–23 months, nested within 8,546 communities from 24 countries in sub-Saharan Africa. According to the intra-country and intra-community correlation coefficient implied by the estimated intercept component variance, 21% and 32% of the variance in unimmunised children were attributable to country- and community-level factors respectively. Children born to mothers (OR 1.35, 95%CI 1.18 to 1.53) and fathers (OR 1.13, 95%CI 1.12 to 1.40) with no formal education were more likely to be unimmunised than those born to parents with secondary or higher education. Children from the poorest households were 36% more likely to be unimmunised than counterparts from the richest households. Maternal access to media significantly reduced the odds of children being unimmunised (OR 0.94, 95%CI 0.94 to 0.99). Mothers with health seeking behaviours were less likely to have unimmunised children (OR 0.56, 95%CI 0.54 to 0.58). However, children from urban areas (OR 1.12, 95% CI 1.01 to 1.23), communities with high illiteracy rates (OR 1.13, 95% CI 1.05 to 1.23), and countries with high fertility rates (OR 4.43, 95% CI 1.04 to 18.92) were more likely to be unimmunised.ConclusionWe found that individual and contextual factors were associated with childhood immunisation, suggesting that public health programmes designed to improve coverage of childhood immunisation should address people, and the communities and societies in which they live.
Highlights
The 2015 deadline for achievement of the Millennium Development Goals (MDGs) is less than five years away, and Africa is significantly behind the rest of the world in making good its commitment to reduce child mortality by two-thirds [1]
We found that individual and contextual factors were associated with childhood immunisation, suggesting that public health programmes designed to improve coverage of childhood immunisation should address people, and the communities and societies in which they live
Children born to mothers or fathers with no formal education were more likely to be unimmunised than those born to parents with secondary or higher education respectively
Summary
The 2015 deadline for achievement of the Millennium Development Goals (MDGs) is less than five years away, and Africa is significantly behind the rest of the world in making good its commitment to reduce child mortality by two-thirds [1]. Africa has the highest under-five mortality rate of all the world’s continents, with 40% of all global deaths in under five year olds occurring in African countries located south of the Sahara desert. Of African infants receive the full series of three doses of the diphtheria-tetanus-pertussis vaccine (DTP3). Overall more than six million children in sub-Saharan Africa did not receive DTP3 by one year of age in 2010. Vaccine efficacy tends to be lower in low-income countries than in higher-income countries [3,4], emphasising the need to attain and sustain high and equitable childhood immunisation coverage in sub-Saharan Africa; where most countries are lowincome. In 2010, more than six million children in sub-Saharan Africa did not receive the full series of three doses of the diphtheria-tetanus-pertussis vaccine by one year of age. We developed and tested a model of childhood immunisation that includes individual, community and country-level characteristics
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