Incomplete childhood immunization in Nigeria: a multilevel analysis of individual and contextual factors

• Published in: BMC public health Vol. 17; no. 1; p. 236
• Main Authors: Adedokun, Sulaimon T, Uthman, Olalekan A, Adekanmbi, Victor T, Wiysonge, Charles S
• Format: Journal Article
• Language: English
• Published: England BioMed Central 08-03-2017; BMC
• Subjects: Adolescent; Age; Birth order; Children; Children & youth; Contextual; Cross-Sectional Studies; Data collection; Demographics; Demography; Ethnicity; Factors; Female; Health care facilities; Health facilities; Health Literacy - statistics & numerical data; Health Services Accessibility - statistics & numerical data; Health Surveys; Households; Humans; Immunization; Immunization - psychology; Immunization - statistics & numerical data; Immunization Programs - statistics & numerical data; Incomplete; Infant; International organizations; Logistic Models; Male; Marital status; Minority & ethnic groups; Mothers; Mothers - psychology; Mothers - statistics & numerical data; Multiculturalism & pluralism; Multilevel; Multilevel Analysis; Nigeria; Odds Ratio; Poliomyelitis; Prenatal care; Prenatal Care - statistics & numerical data; Preventable deaths; Principal components analysis; Public health; Regression analysis; Regression models; Residence Characteristics - statistics & numerical data; Rural areas; Sampling techniques; Socioeconomic factors; Studies; Tuberculosis; Urban areas; Vaccines; Variables; Womens health; Young Adult; Nigeria; Africa; Incomplete; Contextual; Immunization; Multilevel; Factors; Model; Children
• ISSN: 1471-2458; 1471-2458
• DOI: 10.1186/s12889-017-4137-7

Under-five mortality remains high in sub-Saharan Africa despite global decline. One quarter of these deaths are preventable through interventions such as immunization. The aim of this study was to examine the independent effects of individual-, community- and state-level factors on incomplete childhood immunization in Nigeria, which is one of the 10 countries where most of the incompletely immunised children in the world live.
The study was based on secondary analyses of cross-sectional data from the 2013 Nigeria Demographic and Health Survey (DHS). Multilevel multivariable logistic regression models were applied to the data on 5,754 children aged 12-23 months who were fully immunized or not (level 1), nested within 896 communities (level 2) from 37 states (level 3).
More than three-quarter of the children (76.3%) were not completely immunized. About 83% of children of young mothers (15-24 years) and 94% of those whose mothers are illiterate did not receive full immunization. In the fully adjusted model, the chances of not being fully immunized reduced for children whose mothers attended antenatal clinic (adjusted odds ratio [aOR] = 0.49; 95% credible interval [CrI] = 0.39-0.60), delivered in health facility (aOR = 0.62; 95% CrI = 0.51-0.74) and lived in urban area (aOR = 0.66; 95% CrI = 0.50-0.82). Children whose mothers had difficulty getting to health facility (aOR = 1.28; 95% CrI = 1.02-1.57) and lived in socioeconomically disadvantaged communities (aOR = 2.93; 95% CrI = 1.60-4.71) and states (aOR = 2.69; 955 CrI =1.37-4.73) were more likely to be incompletely immunized.
This study has revealed that the risk of children being incompletely immunized in Nigeria was influenced by not only individual factors but also community- and state-level factors. Interventions to improve child immunization uptake should take into consideration these contextual characteristics.