Household Vulnerability Dimensions, Maternal Health Practices and Childhood Immunization Status in Nigeria

Source:
By:Author(s)

DOI: https://doi.org/10.30564/mmpp.v5i1.5399

Abstract:

Immunisation is considered one of the most cost-effective public health interventions for reducing childhood morbidity, mortality, and disability globally. However, while global achievement of over 70% coverage rates was sustained in the 1990s, wide variations exist between and within countries. In some developing countries, immunisation rates increased substantially, but in sub-Saharan Africa, immunisation rates plummeted, leaving millions of children vulnerable to life-threatening diseases. In Nigeria, coverage rates for routine immunisation of all antigens still fall below 50%. The study examined the overall influence of household vulnerability dimensions, maternal health practices on childhood immunization status in Nigeria. The study used secondary data from the 2013 Nigeria Demographic and Health Surveys (NDHS). The analytical weighted sample size was 5,824 women of reproductive ages (15-49 years) with a live birth in the past three years, whose children were within age 12-23 months at the time of the survey. The data were analyzed using frequency distribution, chi-square test and binary logistic regression. The results showed a decreasing regional variation in the proportion of fully immunized children from a high of 23.6% in the South-West, to a low of 9.1% in the North-East. The overall household vulnerability status showed that children in more and most vulnerable households were 62% (OR = 0.38; p < 0.001; CI: 0.32-0.46) and 89% less likely (OR = 0.11; p < 0.001; CI: 0.08-0.14) to receive full vaccination compared with their counterpart in non-vulnerable households. The study revealed a significant relationship between mothers’: i) Number of antenatal visits (OR = 1.66; p < 0.05; CI: 0.25-23 1.77); ii) Quality of antenatal care (OR = 2.61; p < 0.05; CI: 1.45-4.67); iii) Place of delivery (OR = 0.62; p < 0.05; CI: 0.45-0.86); iv) Assistance during delivery (OR = 0.41; p < 0.001; CI: 0.28-0.57); v) Time of postnatal check (OR = 1.81; p < 0.001; CI: 1.49-2.19) and full childhood immunisation status. The study concluded that different dimensions of household vulnerability and maternal health-seeking behavior are key underlying factors of childhood immunization in Nigeria.

References:

[1] WHO, 2016. WHO Updates Fact Sheet on Immunization Coverage (2016 Jul 15) [Internet]. Available from: https://communitymedicine4all.com/2016/07/20/who-updates-fact-sheet-on-immunization-coverage-15-july-2016/ [2] Weil, A.R., 2016. Eliminating vaccine-preventable diseases around the world. Health Affairs. 35(2), 190-194. [3] UNICEF, 2015. The State of the World’s Children 2015: Re-Imagine the Future: Innovation for Every Child. New York [Internet]. Available from: http://sowc2015.unicef.org [4] USAID, 2009. Immunization Basics. Final Project Report [Internet]. Available from: https://publications.jsi.com/JSIInternet/Inc/Common/_download_pub.cfm?id=13220&lid=3 [5] McGovern, M.E., Canning, D., 2015. Vaccination and all cause child mortality 1985-2011: Global evidence from the demographic and health surveys. American Journal of Epidemiology. 182(9), 791-798. [6] National Population Commission (NPC) (Nigeria) and ICF International, 2014. Nigeria Demographic and Health Survey 2013; 2014 Jun; Abuja, Nigeria, and Rockville, Maryland. USA: NPC and ICF International. [7] WHO, 2014. Poliomyelitis: Intensification of the Global Eradication Initiative: Report by the Secretariat. Geneva: WHO [Internet]. Available from: https://polioeradication.org/wp-content/uploads/2016/07/A67_38-en.pdf [8] Lawn, J., Blencowe, H., Oza, S., 2014. Every newborn: Progress, priorities, and potential beyond survival. The Lancet. 384, 89-120. [9] UNICEF & WHO, 2013. Immunization Summary: A Statistical Reference Containing Data Through 2010 [Internet]. Available from: https://data.unicef.org/resources/immunization-summary-a-statistical-reference-containing-data-through-2010/ [10]WHO & UNICEF, 2019. Progress Towards Global Immunization Goals. Revised Version [Internet]. Available from: https://cdn.who.int/media/docs/default-source/immunization/global_monitoring/slidesglobalimmunization.pdf [11] WHO, 2018. Department of Information, Evidence and Research. WHO Methods and Data Sources for Country-level Causes of Death 2000-2016. WHO Geneva [Internet]. Available From: https://terrance.who.int/mediacentre/data/ghe/healthinfo/Deaths/GHE2016_COD_methods.pdf [12]GAVI, 2016. Every Child Counts: The Vaccine Alliance Progress Report 2014. Geneva: GAVI [Internet]. Available from: http://www.gavi.org/progress-report/ [13]FBA, 2005.The state of routine immunization services in Nigeria and reasons for current problems. FBA health systems analysts, report for DFID [Internet]. Available from: https://slidelegend.com/the-state-of-routine-immunization-services-in-nigeria-and-reasons-_59ce62a81723ddb68a71f698.html [14]Anand, S., Bärnighausen, T., 2007. Health workers and vaccination coverage in developing countries: An econometric analysis. The Lancet. 369(9569). [15]Ayebo, E.S., Charles, O., 2009. Timeliness and completion rate of immunization among nigerian children attending a clinic-based immunization service. Journal of Health, Population and Nutrition. 27(3). [16]Abdulraheem, I.S., Onajole, A.T., Jimoh, A.A.G., et al., 2011. Reasons for incomplete vaccination and factors for missed opportunities among rural Nigerian children. Journal of Public Health and Epidemiology. 3(4), 194-203. [17]Odusanya, O.O., Alufohai, E.F., Meurice, F.P., et al., 2008. Determinants of vaccination coverage in rural Nigeria. BMC Public Health. 8(1). [18]Antai, D., 2009. Inequitable childhood immunization uptake in Nigeria: A multilevel analysis of individual and contextual determinants. BMC Infectious Diseases. 9(1). [19]Kitamura, T., Komada, K., Xeuatvongsa, A., et al., 2013. Factors affecting childhood immunization in Lao People’s Democratic Republic: A cross-sectional study from nationwide, population-based, multistage cluster sampling. Bioscience Trends. 7(4), 178-185. [20]Adeleye O.A., Mokogwu, N., 2016. Determinants of full vaccination status in a rural community with accessible vaccination services in south-south Nigeria. Journal of Community Medicine and Primary Healthcare. 27(2). [21]Bisiriyu, L., Ojewumi, T.K., 2014. Mothers’ health seeking behaviour and socio-economic differentials: A factor analysis of full childhood immunization in South-Western Nigeria. Journal of Public Health and Epidemiology. 6(3), 132-147. [22]Fineman, M.A., 2008. The vulnerable subject: Anchoring equality in the human condition. Yale Journal of Law & Feminism. 20, 1. [23]Füssel, H., 2007. Vulnerability: A generally applicable conceptual framework for CC research. Global Environmental Change. 17, 155-167. [24]Deressa, T., Hassan, R.M., Ringler, C., 2008. Measuring Ethiopian farmers’ vulnerability to climate change across regional states, IFPRI discussion paper no. 806. Research Briefs. 15(5). [25]Kelly, P.M., Adger, W.N., 2000. Theory and practice in assessing vulnerability to climate change and facilitation adaptation. Climatic Change. 47(4), 925-1352. [26]Alwang, J., Siegel, P.B., Jørgensen, S.L., 2001. Vulnerability: A View from Different Disciplines. Social Protection Discussion Paper Series [Internet]. Available from: https://documents.worldbank.org/en/publication/documents-reports/documentdetail/636921468765021121/vulnerability-a-view-from-different-disciplines [27]Moser, C., 1998. The asset vulnerability framework: Reassessing urban poverty reduction strategies. World Development. 26(1), 1-19. [28]Sen, A., 1981. Poverty and famines: An essay on entitlement and deprivation. Clarendon Press: Oxford. [29]Whitney M. 2014. Vulnerability Assessment Methodologies: A Review of the Literature [Internet]. Available from: https://www.fhi360.org/sites/default/files/media/documents/Vulnerability%20Assessment%20Literature%20Review.pdf [30]Singh, P.K., 2013. Trends in child immunization across geographical regions in India: Focus on urban-rural and gender differentials. PLoS ONE. 8(9). [31]Owais, A., Hanif, B., Siddiqui, A.R., et al., 2011. Does improving maternal knowledge of vaccines impact infant immunization rates? A community-based randomized-controlled trial in Karachi, Pakistan. BMC Public Health. 11(1). [32]Chidiebere, O.D.I., Uchenna, E., Kenechi, O.S., 2014. Maternal socio-demographic factors that influence full child immunization uptake in Nigeria. South African Journal of Child Health. 8(4), 138-142. [33]Okwaraji, Y.B., Mulholland, K., Schellenberg, J., et al., 2012. The association between travel time to health facilities and childhood vaccine coverage in rural Ethiopia: A community based cross sectional study. BMC Public Health. 12(476). [34]Wickrama, K., Keith, P., 1990. Use and evaluation of healthcare services by male-and female-headed households in rural Sri Lanka. Journal of Developing Areas. 25(1), 1-14. [35]Kishor, S., Neitzel, K., 1997. “Examining women’s status using core demographic and health surveys data”, women and families: Evolution of the status of women as factor and consequence of changes in family dynamics, Maria Eugenia COSIO-ZAVALA (editors). CICRED: Paris. pp 371-420. [36]Becker, G.S., 1981. A Treatise on the Family [Master’s thesis]. Cambridge: Harvard University Press. [37]Lloyd, C.B., Blanc, A.K., 1996. Children’s schooling in sub-Saharan Africa: The role of fathers, mothers, and others. Population and Development Review. 22(2), 265-291. [38]Louat, F., Grosh, M.E., van der, Gaag, J., 1993. Welfare Implications of Female Headship in Jamaican Households [Internet]. Living Standards Measurement Study Working Paper No. 96. The World Bank: Washington, DC. Available from: https://documents.worldbank.org/en/publication/documents-reports/documentdetail/563421468752720573/welfare-implicationsof-female-headship-in-jamaican-households [39]Amato, P.R., Bruce, K., 1991. Parental divorce and the wellbeing of children: A meta-analysis. Psychological Bulletin. 110, 26-46. [40]Astone, N.M., McLanahan, S.S., 1991. Family structure, parental practices and high school completion. American Sociological Review. 56(3), 309-320. [41]Thompson, E., Hanson, T.L., Mc Lanahan, S.S., 1994. Family structure and child weil-being: Economic resources vs. parental behaviors. Social Forces. 73(1), 221-245. [42]Coreil, J., 1983. Allocation of family resources for health care in rural Haiti. Social Science and Medicine. 17(11), 709-719. [43]Kishor, S., 2000. Empowerment of women in Egypt and links to the survival and health of their infants. Women’s Empowerment and Demographic Processes: Moving Beyond Cairo. New York: Oxford University Press. [44]Partha, D., 2002. Determinants of child immunization in four less-developed states of North India. Journal of Child Health Care. 6(34), 34-50. [45]Adedokun, S.T., Uthman, O.A., Adekanmbi, V.T., et al., 2017. Incomplete childhood immunization in Nigeria: A multilevel analysis of individual and contextual factors. BMC Public Health. 17, 236. [46]Costa, M., 2002. A multidimensional approach to the measurement of poverty: An Integrated Research Infrastructure in the Socio-Economic Sciences. IRISS Working Paper Series. p. 2002-2005. [47]Antai, D., 2012. Gender inequities, relationship power, and childhood immunization uptake in Nigeria: A population-based cross-sectional study. International Journal of Infectious Diseases. 16(2), e136-e145. [48]Tagbo, B., Uleanya, N.D., Nwokoye, I.C., et al., 2012. Mothers’ knowledge, perception and practice of childhood immunization in Enugu. Nigerian Journal of Pediatrics. 39(3), 90-96. [49]WHO & UNICEF, 2014. Estimates of National Immunization Coverage. [50]Kidane, T., Yigzaw, A., Sahilemariam, Y., et al., 2006. National EPI coverage survey report. Ethiopian Journal of Health Development. 22(2), 148-157. [51]Kiros, G.E., White, M.J., 2004. Migration, community context, and child immunization in Ethiopia. Social Science & Medicine. 59, 2603-2616. [52]Ndirangu, J., Bärnighausen, T., Tanser, F., et al., 2009. Levels of childhood vaccination coverage and the impact of maternal HIV status on child vaccination status in rural KwaZulu-Natal, South Africa. Tropical Medicine for International Health. 14, 1383-1393. [53]Sarab, K., Abedalrahman, A.R.S., Ruqiya, S.T., 2008. Factors predicting immunization coverage in Tikrit city middle east. Journal of Family Medicine. 6(1), 8-10. [54]Geronimus, A.T., Korenman, S., Hillemeier, M.M., 1994. Does young maternal age adversely affect child development? Evidence from cousin comparisons in the United States. Population and Development Review. 20, 585-609. [55]Meredith, C., Lucy, S., Jane, B., et al., 2011. Who attends antenatal care and expanded programme on immunization services in Chad, Mali and Niger? The implications for insecticide-treated net delivery. Department of Disease Control, London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, UK. [56]Jagrati, V.J., Caroline, D.S., Ilesh, V.J., et al., 2008. Risk factors for incomplete vaccination and missed opportunity for immunization in rural Mozambique. BMC Public Health. 8(1). [57]Odiit, A., Amuge, B., 2003.Comparison of vaccination status of children born in health units and those born at Home. East African Medical Journal. 80(1). [58]Klevens, R.M., Luman, E.T., 2001. U.S. children living in and near poverty: Risk of vaccine-preventable diseases. American Journal of Preventive Medicine. 20(4), 55-60. [59]Cutts, F.T., Diallo, S., Zell, E., et al., 1991. Determinants of vaccination in urban population in Conakry, Guinea. International Journal of Epidemiology. 20(4), 1099-1106. [60]Favin, M., Steinglass, R., Fields., R., et al., 2012. Why children are not vaccinated: A review of Grey Literature. International Health. 4, 229-238. [61]GID/CDC, 2009. The Epidemiology of the Unimmunized Child: Findings from the Peer-Reviewed Published Literature, 1999-2009.