Individual and contextual factors associated with low childhood immunisation coverage in sub-Saharan Africa: a multilevel analysis.

<h4>Background</h4>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. An evidence-based approach to addressing this burden of un-immunised children requires accurate...

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Autores principales:	Charles S Wiysonge, Olalekan A Uthman, Peter M Ndumbe, Gregory D Hussey
Formato:	article
Lenguaje:	EN
Publicado:	Public Library of Science (PLoS) 2012
Materias:	Medicine R Science Q
Acceso en línea:	https://doaj.org/article/ba2e903e4d1a42c593b0a51bc1e2be60
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spelling	oai:doaj.org-article:ba2e903e4d1a42c593b0a51bc1e2be602021-11-18T07:17:14ZIndividual and contextual factors associated with low childhood immunisation coverage in sub-Saharan Africa: a multilevel analysis.1932-620310.1371/journal.pone.0037905https://doaj.org/article/ba2e903e4d1a42c593b0a51bc1e2be602012-01-01T00:00:00Zhttps://www.ncbi.nlm.nih.gov/pmc/articles/pmid/22662247/?tool=EBIhttps://doaj.org/toc/1932-6203<h4>Background</h4>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. 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.<h4>Method and findings</h4>We 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.<h4>Conclusion</h4>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.Charles S WiysongeOlalekan A UthmanPeter M NdumbeGregory D HusseyPublic Library of Science (PLoS)articleMedicineRScienceQENPLoS ONE, Vol 7, Iss 5, p e37905 (2012)
institution	DOAJ
collection	DOAJ
language	EN
topic	Medicine R Science Q
spellingShingle	Medicine R Science Q Charles S Wiysonge Olalekan A Uthman Peter M Ndumbe Gregory D Hussey Individual and contextual factors associated with low childhood immunisation coverage in sub-Saharan Africa: a multilevel analysis.
description	<h4>Background</h4>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. 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.<h4>Method and findings</h4>We 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.<h4>Conclusion</h4>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.
format	article
author	Charles S Wiysonge Olalekan A Uthman Peter M Ndumbe Gregory D Hussey
author_facet	Charles S Wiysonge Olalekan A Uthman Peter M Ndumbe Gregory D Hussey
author_sort	Charles S Wiysonge
title	Individual and contextual factors associated with low childhood immunisation coverage in sub-Saharan Africa: a multilevel analysis.
title_short	Individual and contextual factors associated with low childhood immunisation coverage in sub-Saharan Africa: a multilevel analysis.
title_full	Individual and contextual factors associated with low childhood immunisation coverage in sub-Saharan Africa: a multilevel analysis.
title_fullStr	Individual and contextual factors associated with low childhood immunisation coverage in sub-Saharan Africa: a multilevel analysis.
title_full_unstemmed	Individual and contextual factors associated with low childhood immunisation coverage in sub-Saharan Africa: a multilevel analysis.
title_sort	individual and contextual factors associated with low childhood immunisation coverage in sub-saharan africa: a multilevel analysis.
publisher	Public Library of Science (PLoS)
publishDate	2012
url	https://doaj.org/article/ba2e903e4d1a42c593b0a51bc1e2be60
work_keys_str_mv	AT charlesswiysonge individualandcontextualfactorsassociatedwithlowchildhoodimmunisationcoverageinsubsaharanafricaamultilevelanalysis AT olalekanauthman individualandcontextualfactorsassociatedwithlowchildhoodimmunisationcoverageinsubsaharanafricaamultilevelanalysis AT petermndumbe individualandcontextualfactorsassociatedwithlowchildhoodimmunisationcoverageinsubsaharanafricaamultilevelanalysis AT gregorydhussey individualandcontextualfactorsassociatedwithlowchildhoodimmunisationcoverageinsubsaharanafricaamultilevelanalysis
_version_	1718423689912909824

Individual and contextual factors associated with low childhood immunisation coverage in sub-Saharan Africa: a multilevel analysis.

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