Dataset Information

Regional inequality and vaccine uptake: a multilevel analysis of the 2007 Welfare Monitoring Survey in Malawi.

ABSTRACT:

Background

A significant part of childhood mortality can be prevented given the existence of a well functioning health care system that can deliver vaccines to children during their first year of life. This study assesses immunization differentials between regions in Malawi, and attempts to relate regional disparities in immunization to factors on individual, household and village level.

Method

We used data from the 2007 Welfare Monitoring Survey which includes 18 251 children ages 10-60 months. Multilevel logistic regression models were applied for data analysis.

Results

Major differences in full vaccine coverage (children receiving all of the 9 recommended vaccines) were documented between the 27 official regions, called districts, of Malawi. The vaccine coverage among regions varied from 2% to 74% when all children 10 - 60 months old were included. Vaccine coverage was significantly higher for women that had their delivery attended by a midwife/nurse, or gave birth at a hospital or maternity clinic. Regions with a high percentage of deliveries attended by health personnel were also characterized by a higher coverage. Characteristics of health care utilization on the individual level could in part account for the observed regional variations in coverage.Several factors related to socio-demographic characteristics of individuals and households were significantly correlated with coverage (child's age, illiteracy, income, water and sanitary conditions), implying a lower coverage among the most vulnerable parts of the population. However, these factors could only to a minor extent account for the regional variation in coverage.

Conclusions

The persistent regional inequalities suggest that the low immunization coverage in Malawi is less likely to be a result of geographical clustering of social groups with difficult level-of living conditions. Although the mean vaccine coverage in Malawi is low, some regions have succeeded in reaching a relatively high proportion of their children. The relative success of some regions implies that there is a substantial potential for political intervention to improve vaccine coverage. One important negative implication of regional inequality is the presence of clusters with under-vaccinated children, leading to an increased vulnerability during outbreaks of vaccine-preventable diseases.

SUBMITTER: Abebe DS

PROVIDER: S-EPMC3543726 | biostudies-literature | 2012 Dec

REPOSITORIES: biostudies-literature

ACCESS DATA

Publications

Regional inequality and vaccine uptake: a multilevel analysis of the 2007 Welfare Monitoring Survey in Malawi.

Abebe Dawit Shawel DS Nielsen Vibeke Oestreich VO Finnvold Jon Erik JE

BMC public health 20121213

<h4>Background</h4>A significant part of childhood mortality can be prevented given the existence of a well functioning health care system that can deliver vaccines to children during their first year of life. This study assesses immunization differentials between regions in Malawi, and attempts to relate regional disparities in immunization to factors on individual, household and village level.<h4>Method</h4>We used data from the 2007 Welfare Monitoring Survey which includes 18 251 children age ...[more]

PMID: 23237082

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Project description:BackgroundThe COVID-19 pandemic continues to have a disproportionate effect on ethnic minorities. Across countries, greater vaccine hesitancy has been observed among ethnic minorities. After excluding foreign domestic helpers, South Asians make up the largest proportion of ethnic minorities in Hong Kong. It is necessary to plan for COVID-19 vaccination promotional strategies that cater to the unique needs of South Asians in Hong Kong.ObjectiveThis study investigated the prevalence of COVID-19 vaccine uptake among a sample of South Asians in Hong Kong. We examined the effects of sociodemographic data and factors at individual level (perceptions), interpersonal level (information exposure on social media), and sociostructural level (cultural) based on the socioecological model.MethodsA cross-sectional web-based survey was conducted on May 1-31, 2021. Participants were South Asian people aged 18 years or older living in Hong Kong; able to comprehend English, Hindi, Nepali, or Urdu; and having access to a smartphone. Three community-based organizations providing services to South Asians in Hong Kong facilitated the data collection. The staff of the community-based organizations posted the study information in WhatsApp groups involving South Asian clients and invited them to participate in a web-based survey. Logistic regression models were fit for data analysis.ResultsAmong 245 participants, 81 (33.1%) had taken at least one dose of the COVID-19 vaccine (one dose, 62/245, 25.2%; and both doses, 19/245, 7.9%). After adjusting for significant background characteristics, cultural and religious reasons for COVID-19 vaccine hesitancy were associated with lower COVID-19 vaccine uptake (adjusted odds ratio [AOR] 0.83, 95% CI 0.71-0.97; P=.02). At the individual level, having more positive attitudes toward COVID-19 vaccination (AOR 1.31, 95% CI 1.10-1.55; P=.002), perceived support from significant others (AOR 1.29, 95% CI 1.03-1.60; P=.03), and perceived higher behavioral control to receive COVID-19 vaccination (AOR 2.63, 95% CI 1.65-4.19; P<.001) were associated with higher COVID-19 vaccine uptake, while a negative association was found between negative attitudes and the dependent variable (AOR 0.73, 95% CI 0.62-0.85; P<.001). Knowing more peers who had taken the COVID-19 vaccine was also associated with higher uptake (AOR 1.39, 95% CI 1.11-1.74; P=.01). At the interpersonal level, higher exposure to information about deaths and other serious conditions caused by COVID-19 vaccination was associated with lower uptake (AOR 0.54, 95% CI 0.33-0.86; P=.01).ConclusionsIn this study, one-third (81/245) of our participants received at least one dose of the COVID-19 vaccine. Cultural or religious reasons, perceptions, information exposure on social media, and influence of peers were found to be the determinants of COVID-19 vaccine uptake among South Asians. Future programs should engage community groups, champions, and faith leaders, and develop culturally competent interventions.

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Dataset Information

Regional inequality and vaccine uptake: a multilevel analysis of the 2007 Welfare Monitoring Survey in Malawi.

Background

Method

Results

Conclusions

Publications

Regional inequality and vaccine uptake: a multilevel analysis of the 2007 Welfare Monitoring Survey in Malawi.

Similar Datasets

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