Maternal healthcare utilsation and complete childhood vaccination in sub-Saharan Africa: a cross-sectional study of 29 nationally representative surveys.
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ABSTRACT: Objective
The objective of the study was to examine the association between maternal healthcare utilisation and complete childhood vaccination in sub-Saharan Africa.Design
Our study was a cross-sectional study that used pooled data from 29 countries in sub-Saharan Africa.Participants
A total of 60 964 mothers of children aged 11-23 months were included in the study.Outcome variables
The main outcome variable was complete childhood vaccination. The explanatory variables were number of antenatal care (ANC) visits, assistance during delivery and postnatal care (PNC).Results
The average prevalence of complete childhood vaccination was 85.6%, ranging from 67.0% in Ethiopia to 98.5% in Namibia. Our adjusted model, children whose mothers had a maximum of three ANC visits were 56% less likely to have complete vaccination, compared with those who had at least four ANC visits (adjusted OR (aOR)=0.44, 95% CI 0.42 to 0.46). Children whose mothers were assisted by traditional birth attendant/other (aOR=0.43, 95% CI 0.41 to 0.56) had lower odds of complete vaccination. The odds of complete vaccination were lower among children whose mothers did not attend PNC clinics (aOR=0.26, 95% CI 0.24 to 0.29) as against those whose mothers attended.Conclusion
The study found significant variations in complete childhood vaccination across countries in sub-Saharan Africa. Maternal healthcare utilisation (ANC visits, skilled birth delivery, PNC attendance) had significant association with complete childhood vaccination. These findings suggest that programmes, interventions and strategies aimed at improving vaccination should incorporate interventions that can enhance maternal healthcare utilisation. Such interventions can include education and sensitisation, reducing cost of maternal healthcare and encouraging male involvement in maternal healthcare service utilisation.
SUBMITTER: Budu E
PROVIDER: S-EPMC8126284 | biostudies-literature |
REPOSITORIES: biostudies-literature
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Project description:BackgroundThe World Health Organization recommends African children receive two doses of measles containing vaccine (MCV) through routine programs or supplemental immunization activities (SIA). Moreover, children have an additional opportunity to receive MCV through outbreak response immunization (ORI) mass campaigns in certain contexts. Here, we present the results of MCV coverage by dose estimated through surveys conducted after outbreak response in diverse settings in Sub-Saharan Africa.MethodsWe included 24 household-based surveys conducted in six countries after a non-selective mass vaccination campaign. In the majority (22/24), the survey sample was selected using probability proportional to size cluster-based sampling. Others used Lot Quality Assurance Sampling.ResultsIn total, data were collected on 60,895 children from 2005 to 2011. Routine coverage varied between countries (>95% in Malawi and Kirundo province (Burundi) while <35% in N'Djamena (Chad) in 2005), within a country and over time. SIA coverage was <75% in most settings. ORI coverage ranged from >95% in Malawi to 71.4% [95% CI: 68.9-73.8] in N'Djamena (Chad) in 2005.In five sites, >5% of children remained unvaccinated after several opportunities. Conversely, in Malawi and DRC, over half of the children eligible for the last SIA received a third dose of MCV.ConclusionsControl pre-elimination targets were still not reached, contributing to the occurrence of repeated measles outbreak in the Sub-Saharan African countries reported here. Although children receiving a dose of MCV through outbreak response benefit from the intervention, ensuring that programs effectively target hard to reach children remains the cornerstone of measles control.
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Project description:BackgroundPopulation-based surveys play an important role in measuring vaccination coverage. Surveys measuring vaccination coverage may be commissioned by the Expanded Programme on Immunization (EPI surveys) or part of multi-domain non-EPI surveys such as Demographic and Health Surveys (DHS) or Multiple Indicator Cluster Surveys (MICS). Surveys conducted too close in time to each other may not only be an inefficient use of resources but may also create problems for programme staff when results suggest inconsistent patterns of programme performance for similar time periods.ObjectiveTo summarize the occurrence of vaccination coverage surveys conducted close in time during 2000-2019 and compare results of EPI and non-EPI coverage surveys when the surveys were conducted within one year of each other.MethodsUsing a database of published national-level vaccination coverage survey results compiled by the World Health Organization (WHO) and the United Nations Children's Fund (UNICEF), the authors abstracted information on survey field work dates, sample size, percentage of children with documented history of vaccination and the percent coverage, as well as published uncertainty intervals from DHS and MICS, for the first and third doses of diphtheria-tetanus toxoid-pertussis containing vaccine (DTP1, DTP3) and first dose of measles containing vaccine (MCV1). Survey results of EPI and non-EPI surveys were compared.ResultsThe authors identified 646 surveys with final reports and estimates of national-level vaccination coverage for DTP1, DTP3, or MCV1 from a total of 687 surveys with data collection start date from 2000 to 2019. Of the 140 countries with at least one vaccination coverage survey, a median of four surveys was observed. Most countries were Gavi-eligible and located in the WHO Africa Region. Sixty-six survey dyads were identified where an EPI survey occurred within one year of a non-EPI survey. For the 66 dyads, in 49 of 59 with information available, EPI surveys reported higher proportion of documented evidence of vaccination and EPI survey results tended to suggest higher levels of vaccination coverage compared to the non-EPI surveys; quite often, differences were substantial. Surveys that found higher proportions of children with documented vaccination evidence tended to also find higher proportions of children who had been vaccinated.SummaryOpportunities exist to improve overall planning of vaccination coverage measurement in population-based household surveys so that both EPI and non-EPI surveys are more comparable and survey coverage estimates are more appropriately spaced in time. When surveys occur too close in time, careful attention is warranted to ensure comparability and assess sources of documented evidence of vaccination and related coverage differences.
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