Abstract
IntroductionPrevious studies in Nigeria have documented significant association between maternal education and child immunization. However, little is known about the pathway through which maternal education improves immunization uptake. This study aims to examine whether maternal literacy and socioeconomic status mediates the relationship between maternal education and complete immunization coverage in children.MethodsNationally representative data from the first wave of the Nigeria General Household Survey-Panel were used, which includes 661 children aged one year and below. Regression analyses were used to model the association between maternal education and child's immunization uptake; we then examined whether maternal literacy and household economic status mediates this association.ResultsOf the 661 children, 40% had complete immunization. The prevalence ratio (PR) of complete immunization in children whose mothers were educated versus those whose mothers were not educated was 1.44 (95% CI: 1.16-1.77). Maternal literacy substantially reduced the estimated association between maternal education and complete immunization by 90%, whereas household economic status reduced the estimates by 27%.ConclusionThese findings suggest that complete immunization was higher in children whose mothers were educated, partly because maternal education leads to acquisition of literacy skills and better health-seeking behavior which then improves immunization uptake for their children. Socioeconomic status is an alternative pathway but with less substantial indirect effect.
Highlights
Previous studies in Nigeria have documented significant association between maternal education and child immunization
After adjusting for maternal literacy (Table 2, column 4), the association between maternal education and complete immunization in children becomes non-significant (PR=1.04, 95% CI: 0.77-1.40, P=0.808) and the standardized magnitude of the effect of maternal education on complete immunization was reduced by 90% (P-value for mediation =0.001)
The prevalence ratio (PR) of complete immunization was lower after controlling for household economic status (PR=1.29, 95% CI: 1.041.60, P=0.022), and the standardized magnitude of the effect of maternal education on complete immunization in children was reduced by 27%
Summary
Previous studies in Nigeria have documented significant association between maternal education and child immunization. Several studies in Nigeria like other sub-Saharan African countries have provided evidence that maternal education is associated with reduced risk of incomplete immunization as well as reduced risk of other child health outcomes such as malaria, malnutrition and mortality [6,7,8]. This evidence was documented in a Nigerian study which reported that the odds of complete immunization was 3.6 times higher in children whose mothers had at least a secondary school education compared to those with lower or no education [7]. We aim to examine whether maternal literacy and socioeconomic status mediate the relationship between maternal education and child immunization
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