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

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dc.contributor.authorWiysonge, Charles Sen_ZA
dc.contributor.authorUthman, Olalekan Aen_ZA
dc.contributor.authorNdumbe, Peter Men_ZA
dc.contributor.authorHussey, Gregory Den_ZA
dc.date.accessioned2016-01-02T05:05:44Z
dc.date.available2016-01-02T05:05:44Z
dc.date.issued2012en_ZA
dc.description.abstractBACKGROUND: 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. Method and FINDINGS: 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. CONCLUSION: 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.en_ZA
dc.identifier.apacitationWiysonge, C. S., Uthman, O. A., Ndumbe, P. M., & Hussey, G. D. (2012). Individual and contextual factors associated with low childhood immunisation coverage in sub-Saharan Africa: a multilevel analysis. <i>PLoS One</i>, http://hdl.handle.net/11427/16156en_ZA
dc.identifier.chicagocitationWiysonge, Charles S, Olalekan A Uthman, Peter M Ndumbe, and Gregory D Hussey "Individual and contextual factors associated with low childhood immunisation coverage in sub-Saharan Africa: a multilevel analysis." <i>PLoS One</i> (2012) http://hdl.handle.net/11427/16156en_ZA
dc.identifier.citationWiysonge, C. S., Uthman, O. A., Ndumbe, P. M., & Hussey, G. D. (2012). Individual and contextual factors associated with low childhood immunisation coverage in sub-Saharan Africa: a multilevel analysis. PLoS One, 7(5), e37905. doi:10.1371/journal.pone.0037905en_ZA
dc.identifier.ris TY - Journal Article AU - Wiysonge, Charles S AU - Uthman, Olalekan A AU - Ndumbe, Peter M AU - Hussey, Gregory D AB - BACKGROUND: 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. Method and FINDINGS: 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. CONCLUSION: 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. DA - 2012 DB - OpenUCT DO - 10.1371/journal.pone.0037905 DP - University of Cape Town J1 - PLoS One LK - https://open.uct.ac.za PB - University of Cape Town PY - 2012 T1 - Individual and contextual factors associated with low childhood immunisation coverage in sub-Saharan Africa: a multilevel analysis TI - Individual and contextual factors associated with low childhood immunisation coverage in sub-Saharan Africa: a multilevel analysis UR - http://hdl.handle.net/11427/16156 ER - en_ZA
dc.identifier.urihttp://hdl.handle.net/11427/16156
dc.identifier.urihttp://dx.doi.org/10.1371/journal.pone.0037905
dc.identifier.vancouvercitationWiysonge CS, Uthman OA, Ndumbe PM, Hussey GD. Individual and contextual factors associated with low childhood immunisation coverage in sub-Saharan Africa: a multilevel analysis. PLoS One. 2012; http://hdl.handle.net/11427/16156.en_ZA
dc.language.isoengen_ZA
dc.publisherPublic Library of Scienceen_ZA
dc.publisher.departmentInstitute of Infectious Disease and Molecular Medicineen_ZA
dc.publisher.facultyFaculty of Health Sciencesen_ZA
dc.publisher.institutionUniversity of Cape Town
dc.rightsThis is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.en_ZA
dc.rights.holder© 2012 Wiysonge et alen_ZA
dc.rights.urihttp://creativecommons.org/licenses/by/4.0en_ZA
dc.sourcePLoS Oneen_ZA
dc.source.urihttp://journals.plos.org/plosoneen_ZA
dc.subject.otherChildrenen_ZA
dc.subject.otherVaccination and immunizationen_ZA
dc.subject.otherChild healthen_ZA
dc.subject.otherAfricaen_ZA
dc.subject.otherFertility ratesen_ZA
dc.subject.otherLiteracyen_ZA
dc.subject.otherDeath ratesen_ZA
dc.subject.otherVaccinesen_ZA
dc.titleIndividual and contextual factors associated with low childhood immunisation coverage in sub-Saharan Africa: a multilevel analysisen_ZA
dc.typeJournal Articleen_ZA
uct.type.filetypeText
uct.type.filetypeImage
uct.type.publicationResearchen_ZA
uct.type.resourceArticleen_ZA
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