Childhood Immunisation Coverage in Kenya by Socioeconomic, Geographic, Maternal, Child, and Place of Birth Characteristics: Equity Impact Analysis

Abstract Background: The WHO Immunisation Agenda 2030 highlights coverage and equity as a strategic priority goal to reach high equitable immunisation coverage at national levels and in all districts. We estimated inequities in full immunisation coverage associated with socioeconomic, geographic, maternal, child, and place of birth characteristics among children aged 12-23 months in Kenya. Methods: We analysed full immunisation coverage (1-dose BCG, 3-dose DTP-HepB-Hib, 3-dose polio, 1-dose measles, and 3-dose pneumococcal vaccines) of 3,943 children aged 12–23 months from the 2014 Kenya Demographic and Health Survey. We disaggregated mean coverage by socioeconomic (household wealth, religion, ethnicity), geographic (place of residence, province), maternal (maternal age at birth, maternal education, maternal marital status, maternal household head status), child (sex of child, birth order), and place of birth characteristics, and estimated inequities in full immunisation coverage using bivariate and multivariate logistic regression. Results: Immunisation coverage ranged from 82% [81–84] for the third dose of polio to 97.4% [96.7–98.2] for the first dose of DTP-HepB-Hib, while full immunisation coverage was 68% [66–71] in 2014. After controlling for other background characteristics, children of mothers with primary school education or higher have at least 54% higher odds of being fully immunised compared to children of mothers with no education. Children born in clinical settings have 41% higher odds of being fully immunised compared to children born in home settings. Children in the Coast, Western, Central, and Eastern regions had at least 74% higher odds of being fully immunised compared to children in the North Eastern region, while children in urban areas had 26% lower odds of full immunisation compared to children in rural areas. Children in the middle and richer wealth quintile households were 43–57% more likely to have full immunisation coverage compared to children in the poorest wealth quintile households. Children who were sixth born or higher had 37% lower odds of full immunisation compared to first-born children. Conclusions: The inequities in full immunisation adversely affect children of mothers with no education, born in home settings, in regions with limited health infrastructure, living in poorer households, and of higher birth order.

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Childhood immunisation coverage in Kenya by socioeconomic, geographic, maternal, child, and place of birth characteristics: equity impact analysis

10.1101/2021.02.14.21251721 ◽

2021 ◽

Author(s):

Simon Allan ◽

Ifedayo M. O. Adetifa ◽

Kaja Abbas

Keyword(s):

Birth Order ◽

Wealth Quintile ◽

Household Wealth ◽

Vaccine Uptake ◽

Place Of Birth ◽

Immunisation Coverage ◽

Lower Odds ◽

Full Immunisation ◽

Birth Characteristics ◽

Maternal Child

AbstractBackgroundImmunisation of children is a highly cost-effective public health intervention and fosters health equity for the overall population. The WHO Immunisation Agenda 2030 highlights coverage and equity as one of the strategic priority goals to reach high equitable immunisation coverage at national levels and in all districts. We analysed full immunisation coverage among children aged 12-23 months in Kenya and estimated the inequities in full immunisation coverage associated with socioeconomic, geographic, maternal, child, and place of birth characteristics using data from the 2014 Kenya Demographic and Health Survey.MethodsWe analysed full immunisation coverage (1-dose BCG, 3-dose DTP-HepB-Hib, 3-dose polio, 1-dose measles, and 3-dose pneumococcal vaccines) of 3,943 children aged 12–23 months. We disaggregated mean coverage by socioeconomic (household wealth, religion, ethnicity), geographic (place of residence, province), maternal (maternal age at birth, maternal education, maternal marital status, maternal household head status), child (sex of child, birth order), and place of birth characteristics. We conducted bivariate and multivariate logistic regression to assess associations between full immunisation coverage and socioeconomic, geographic, maternal, child, and place of birth characteristics.ResultsImmunisation coverage ranged from 82% [81–84] for the third dose of polio to 97.4% [96.7–98.2] for the first dose of DTP-HepB-Hib, while full immunisation coverage was 68% [66–71] in 2014. After controlling for other background characteristics, children of mothers with primary school education or higher have at least 54% higher odds of being fully immunised compared to children of mothers with no education. Children born in clinical settings have 41% higher odds of being fully immunised compared to children born in home settings. Children in the Coast, Western, Central, and Eastern regions had at least 74% higher odds of being fully immunised compared to children in the North Eastern region, while children in urban areas had 26% lower odds of full immunisation compared to children in rural areas. Children in the middle and richer wealth quintile households were 43–57% more likely to have full immunisation coverage compared to children in the poorest wealth quintile households. Children who were sixth born or higher had 37% lower odds of full immunisation compared to first-born children.ConclusionsThe inequities in full immunisation adversely affect children of mothers with no education, born in home settings, in regions with limited health infrastructure, living in poorer households, and of higher birth order. Further, the COVID-19 pandemic has disrupted routine and campaign immunisation services in 2020 and enhances the risk of vaccine-preventable disease outbreaks, but it also presents an opportunity to tackle the identified inequities in vaccine uptake as immunisation services are restored to capacity.

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Inequities in childhood immunisation coverage associated with socioeconomic, geographic, maternal, child, and place of birth characteristics in Kenya

BMC Infectious Diseases ◽

10.1186/s12879-021-06271-9 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Simon Allan ◽

Ifedayo M. O. Adetifa ◽

Kaja Abbas

Keyword(s):

Logistic Regression ◽

Birth Order ◽

Wealth Quintile ◽

Place Of Birth ◽

Immunisation Coverage ◽

Multivariate Logistic Regression ◽

Childhood Immunisation ◽

Lower Odds ◽

Full Immunisation ◽

Birth Characteristics

Abstract Background The global Immunisation Agenda 2030 highlights coverage and equity as a strategic priority goal to reach high equitable immunisation coverage at national levels and in all districts. We estimated inequities in full immunisation coverage associated with socioeconomic, geographic, maternal, child, and place of birth characteristics among children aged 12–23 months in Kenya. Methods We analysed full immunisation coverage (1-dose BCG, 3-dose DTP-HepB-Hib (diphtheria, tetanus, pertussis, hepatitis B and Haemophilus influenzae type B), 3-dose polio, 1-dose measles, and 3-dose pneumococcal vaccines) of 3943 children aged 12–23 months from the 2014 Kenya Demographic and Health Survey. We disaggregated mean coverage by socioeconomic (household wealth, religion, ethnicity), geographic (place of residence, province), maternal (maternal age at birth, maternal education, maternal marital status, maternal household head status), child (sex of child, birth order), and place of birth characteristics, and estimated inequities in full immunisation coverage using bivariate and multivariate logistic regression. Results Immunisation coverage ranged from 82% [81–84] for the third dose of polio to 97.4% [96.7–98.2] for the first dose of DTP-HepB-Hib, while full immunisation coverage was 68% [66–71] in 2014. After controlling for other background characteristics through multivariate logistic regression, children of mothers with primary school education or higher have at least 54% higher odds of being fully immunised compared to children of mothers with no education. Children born in clinical settings had 41% higher odds of being fully immunised compared to children born in home settings. Children in the Coast, Western, Central, and Eastern regions had at least 74% higher odds of being fully immunised compared to children in the North Eastern region, while children in urban areas had 26% lower odds of full immunisation compared to children in rural areas. Children in the middle and richer wealth quintile households were 43–57% more likely to have full immunisation coverage compared to children in the poorest wealth quintile households. Children who were sixth born or higher had 37% lower odds of full immunisation compared to first-born children. Conclusions Children of mothers with no education, born in home settings, in regions with limited health infrastructure, living in poorer households, and of higher birth order are associated with lower rates of full immunisation. Targeted programmes to reach under-immunised children in these subpopulations will lower the inequities in childhood immunisation coverage in Kenya.

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Decomposing the rural–urban gap in factors associated with childhood immunisation in sub-Saharan Africa: evidence from surveys in 23 countries

BMJ Global Health ◽

10.1136/bmjgh-2020-003773 ◽

2021 ◽

Vol 6 (1) ◽

pp. e003773

Author(s):

Edward Kwabena Ameyaw ◽

Yusuf Olushola Kareem ◽

Bright Opoku Ahinkorah ◽

Abdul-Aziz Seidu ◽

Sanni Yaya

Keyword(s):

Decomposition Analysis ◽

Household Wealth ◽

Sub Saharan Africa ◽

Demographic And Health Surveys ◽

Childhood Immunisation ◽

Urban Settings ◽

Factors Associated ◽

Rural And Urban ◽

Full Immunisation ◽

Sub Saharan

BackgroundAbout 31 million children in sub-Saharan Africa (SSA) suffer from immunisation preventable diseases yearly and more than half a million children die because of lack of access to immunisation. Immunisation coverage has stagnated at 72% in SSA over the past 6 years. Due to evidence that full immunisation of children may be determined by place of residence, this study aimed at investigating the rural–urban differential in full childhood immunisation in SSA.MethodsThe data used for this study consisted of 26 241 children pooled from 23 Demographic and Health Surveys conducted between 2010 and 2018 in SSA. We performed a Poisson regression analysis with robust Standard Errors (SEs) to determine the factors associated with full immunisation status for rural and urban children. Likewise, a multivariate decomposition analysis for non-linear response model was used to examine the contribution of the covariates to the observed rural and urban differential in full childhood immunisation. All analyses were performed using Stata software V.15.0 and associations with a p<0.05 were considered statistically significant.ResultsMore than half of children in urban settings were fully immunised (52.8%) while 59.3% of rural residents were not fully immunised. In all, 76.5% of rural–urban variation in full immunisation was attributable to differences in child and maternal characteristics. Household wealth was an important component contributing to the rural–urban gap. Specifically, richest wealth status substantially accounted for immunisation disparity (35.7%). First and sixth birth orders contributed 7.3% and 14.9%, respectively, towards the disparity while 7.9% of the disparity was attributable to distance to health facility.ConclusionThis study has emphasised the rural–urban disparity in childhood immunisation, with children in the urban settings more likely to complete immunisation. Subregional, national and community-level interventions to obviate this disparity should target children in rural settings, those from poor households and women who have difficulties in accessing healthcare facilities due to distance.

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Trends in stunting and overweight in Peruvian pre-schoolers from 1991 to 2011: findings from the Demographic and Health Surveys

Public Health Nutrition ◽

10.1017/s1368980014000275 ◽

2014 ◽

Vol 17 (11) ◽

pp. 2407-2418 ◽

Cited By ~ 16

Author(s):

Helga Bjørnøy Urke ◽

Maurice B Mittelmark ◽

Martín Valdivia

Keyword(s):

Urban Areas ◽

Health Surveys ◽

Maternal Education ◽

Wealth Quintile ◽

Household Wealth ◽

Demographic And Health Surveys ◽

Sampling Weights ◽

Cross Sectional ◽

Growth Standards ◽

Low Educated

AbstractObjectiveTo examine trends in stunting and overweight in Peruvian children, using 2006 WHO Multicentre Growth Reference Study criteria.DesignTrend analyses using nationally representative cross-sectional surveys from Demographic and Health Surveys (1991–2011). We performed logistic regression analyses of stunting and overweight trends in sociodemographic groups (sex, age, urban–rural residence, region, maternal education and household wealth), adjusted for sampling design effects (strata, clusters and sampling weights).SettingPeru.SubjectsChildren aged 0–59 months surveyed in 1991–92 (n 7999), 1996 (n 14 877), 2000 (n 11 754), 2007–08 (n 8232) and 2011 (n 8186).ResultsChild stunting declined (F(1, 5149) = 174·8, P ≤ 0·00) and child overweight was stable in the period 1991–2011 (F(1, 5147) = 0·4, P ≤ 0·54). Over the study period, levels of stunting were highest in rural compared with urban areas, the Andean and Amazon regions compared with the Coast, among children of low-educated mothers and among children living in households in the poorest wealth quintile. The trend in overweight rose among males in coastal areas (F(1, 2250) = 4·779, P ≤ 0·029) and among males in the richest wealth quintile (F(1, 1730) = 5·458, P ≤ 0·020).ConclusionsThe 2011 levels of stunting and overweight were eight times and three and a half times higher, respectively, than the expected levels from the 2006 WHO growth standards. The trend over the study period in stunting declined in most sociodemographic subgroups. The trend in overweight was stable in most sociodemographic subgroups.

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Prevalence and Determinants of Nutritional Status Among Women and Children in Pakistan

10.21203/rs.3.rs-646383/v1 ◽

2021 ◽

Author(s):

Hanumant Waghmare ◽

Shekhar Chauhan ◽

Santosh Kumar Sharma

Keyword(s):

Risk Factors ◽

Nutritional Status ◽

Rural Women ◽

Urban Women ◽

Wealth Quintile ◽

Educational Status ◽

Household Wealth ◽

Poor Nutritional Status ◽

Women And Children ◽

Status Of Women

Abstract Background: Nutrition has been a low-priority area in Pakistan, with low visibility from the political leadership. Despite various efforts, Pakistan has been reported to have one of the highest prevalence of child and women malnutrition compared to other developing counties. Therefore, this study intends to examine the prevalence and determinants of nutritional status of women and children in Pakistan.Methods: The present study uses the Demographic Health Survey (DHS) data from Pakistan 2012-13 (PDHS-3). The nutritional status of women was examined through Body-Mass Index (Underweight, normal, overweight, & obese), and that of children was examined through stunting (severe and moderate), wasting (severe, moderate, overweight), and underweight (severe, moderate, overweight). Descriptive statistics and bivariate analysis have been used along with multinomial logistic regression.Results: A higher proportion of children in rural areas were severely stunted (19.57% vs. 12.49%), severe wasted (2.36% vs. 2.23%), and severe underweight (9.37% vs. 6%) than their urban counterparts. A higher proportion of rural women (9.5% vs. 5.45%) were underweight than urban women, whereas a higher proportion of urban women were obese (24.32% vs. 19.01%) than rural women. The odds of severe stunting (OR= 0.24; C.I.=0.15-0.37), severe underweight (OR= 0.11; C.I.=0.05-0.22) were lower among children from the richest wealth quintile than their poorest counterparts. The Relative Risk Ratio (RRR) of being overweight (RRR= 3.7; C.I.=2.47-5.54) and Obese (RRR= 4.35; C.I.=2.67-7.07) than normal BMI were higher among women from richest wealth quintile than women belonged to poorest wealth quintile.Conclusion: This study has highlighted determinants associated with maternal and child nutritional status, whereby child’s nutritional status was measured by stunting, wasting, and underweight, and the mother’s nutritional status was measured by BMI. The main risk factors for child’s poor nutritional status include low household wealth, urban residence, and mother’s educational status. Similarly, the main risk factors for women’s poor nutritional status include increasing the women's age, educational status, rural residence, and household wealth. Emphasis should be placed on educating mothers as it would improve their nutritional status and improve their child’s nutritional status simultaneously.

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The trend of full vaccination coverage in infants and inequalities by wealth quintile and maternal education: Analysis from four recent Demographic and Health Surveys in Nepal

10.21203/rs.2.13937/v3 ◽

2019 ◽

Author(s):

Kiran Acharya ◽

Yuba Raj Paudel ◽

Dinesh Dharel

Keyword(s):

Vaccination Coverage ◽

Maternal Education ◽

Immunization Coverage ◽

Wealth Quintile ◽

Educational Status ◽

Household Wealth ◽

Demographic And Health Surveys ◽

Relative Index ◽

Index Of Inequality ◽

Over Time

Abstract Background Despite policy intention to reach disadvantaged populations, inequalities in child health care use and health outcomes persist in Nepal. The current study aimed to investigate the trend of full vaccination coverage among infants and its equity gaps between Nepal Demographic and Health Surveys (NDHS) 2001 and 2016.Methods Using data from NDHS conducted in 2001, 2006, 2011 and 2016, we investigated the trend of coverage of six antigens:Bacille Calmette Guerin (BCG), Diptheria, Pertussis, Tetanus (DPT), Polio, and Measles during their infancy among children aged 12-23 months. We presented trends and correlates of vaccination coverage by different socio-demographic factors. We measured inequalities in full vaccination coverage by wealth quintile and maternal education using absolute measure (slope index of inequality) and relative measures (Relative index of inequality, concentration index) of inequalities.Results Full immunization coverage among infants steadily increased from 65.6% in 2001 to 87.0% in 2011; however, it decreased to 77.8% in 2016. Province 2 had a significantly lower full vaccination coverage compared to Province1.Although decreasing over time, there were significant inequalities by household wealth quintiles and maternal educational status. The slope index of inequality (SII) for wealth quintiles decreased from -32.3 [-45.5,-19.1] in 2001 to an SII of-8.4 [-18.6,-1.7] in 2016. Similarly, the SII for education decreased from -61.8 [-73.5,-50.1] in 2001 to an SII of -30.5 [-40.7,-20.2] in 2016. Similarly, the relative index of inequality (RII) also showed an improvement over time, indicating the narrowing equity gap. Additionally, concentration index on full immunization coverage by wealth quintiles dropped from 0.21 (0.12-0.28) in 2001 to 0.054 (-0.01-0.12) in 2016. Absolute and relative inequalities were persistently larger by maternal educational status compared to household wealth quintiles throughout the study period.Conclusion Full vaccination coverage in Nepal increased from 2001 until 2011 but saw a significant decrement away from the national target after 2011. However, the equity gap by household wealth quintile and maternal education status has narrowed over time. National Immunization programs need to give higher emphasis to infants born to mothers with less education, those born in the poorer wealth quintile households, and those living in Province 2.

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Correction: High prevalence of spondyloarthritis-like MRI lesions in postpartum women: a prospective analysis in relation to maternal, child and birth characteristics

Annals of the Rheumatic Diseases ◽

10.1136/annrheumdis-2020-217095corr1 ◽

2021 ◽

Vol 80 (2) ◽

pp. e28-e28

Keyword(s):

Postpartum Women ◽

Prospective Analysis ◽

High Prevalence ◽

Birth Characteristics ◽

Maternal Child

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Clustering of hypertension, diabetes and overweight/obesity according to socioeconomic status among Bangladeshi adults

Journal of Biosocial Science ◽

10.1017/s0021932020000085 ◽

2020 ◽

pp. 1-10

Author(s):

Gulam Muhammed Al Kibria ◽

Mohammad Rashidul Hashan ◽

Md Mahbub Hossain ◽

Sojib Bin Zaman ◽

Christina A. Stennett

Keyword(s):

Socioeconomic Status ◽

Formal Education ◽

Healthy Lifestyle ◽

Wealth Quintile ◽

Household Wealth ◽

Cross Sectional Study ◽

Cross Sectional ◽

Education Levels ◽

Healthy Lifestyle Interventions ◽

Fasting Plasma Glucose Concentration

Abstract The prevalences of hypertension, diabetes and overweight/obesity are increasing in most developing countries, including Bangladesh. Although earlier studies have investigated the factors associated with these three conditions, little is known about whether socioeconomic status is associated with their co-existence. This cross-sectional study analysed data from the 2011 Bangladesh Demographic and Health Survey. An individual was considered hypertensive, diabetic and overweight/obese if their systolic/diastolic blood pressure, fasting plasma glucose concentration, and body mass index were ≥130/80 mmHg, ≥7 mmol/l and ≥23 kg/m2, respectively. Furthermore, individuals who reported taking anti-hypertensive and anti-diabetic drugs were also considered as hypertensive and diabetic, respectively. Two socioeconomic variables were investigated: education level and household wealth quintile. Descriptive analyses and multilevel logistic regression were conducted. Among the 7932 respondents (50.5% female) aged ≥35 years, the prevalences of hypertension, diabetes, overweight/obesity, any one condition and the co-existence of the three conditions were 48.0%, 11.0%, 25.3%, 60.9% and 3.6%, respectively. In adjusted analysis, individuals with secondary (adjusted odds ratio [AOR]: 1.8, 95% confidence interval [CI]: 1.2–2.8) and college or above (AOR: 3.6; 95% CI: 2.2–5.7) education levels had higher odds of the co-existence of all three conditions compared with those with no formal education. Similarly, compared with the poorest wealth quintile, the richer (AOR: 4.6; 95% CI: 2.2–9.4) and richest (AOR: 11.8; 95% CI: 5.8–24.1) wealth quintiles had higher odds of co-existence of these three conditions. Education and wealth quintile also showed significant relationships with each of the three conditions separately. In conclusion, in Bangladesh, hypertension, diabetes and overweight/obesity are associated with indicators of higher socioeconomic status. These findings highlight the importance of developing healthy lifestyle interventions (e.g. physical exercise and dietary modification) targeting individuals of higher socioeconomic status to minimize the burden of these non-communicable diseases.

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Planning of births and childhood undernutrition in Nepal: evidence from a 2016 national survey

BMC Public Health ◽

10.1186/s12889-020-09915-8 ◽

2020 ◽

Vol 20 (1) ◽

Author(s):

Ishwar Tiwari ◽

Kiran Acharya ◽

Yuba Raj Paudel ◽

Bhim Prasad Sapkota ◽

Ramesh Babu Kafle

Keyword(s):

Logistic Regression ◽

Mass Media ◽

Birth Order ◽

Statistical Significance ◽

Household Survey ◽

Wealth Quintile ◽

Public Health Issue ◽

Sampling Weights ◽

Cross Sectional ◽

Childhood Undernutrition

Abstract Background Childhood undernutrition is a significant public health issue in low-and middle-income countries, including Nepal. However, there is limited evidence showing the association between the planning of birth (PoB) and childhood undernutrition (stunting and underweight). We aimed to investigate the relationship between PoB and childhood undernutrition in the current study. Methods We used the Nepal Demographic and Health Survey (NDHS) 2016 data, a nationally representative cross-sectional household survey. We used two anthropometric indicators of childhood undernutrition as the outcome of this study. PoB is the main predictor. We used binary logistic regression with sampling weights to estimate adjusted odds ratios (ORs) and 95% confidence intervals (CIs) to examine the association between the PoB and childhood undernutrition. Unless stated, the significant association between the variables is calculated with p < 0.001. Results The overall prevalence of stunting was 35.8%, and underweight was 27.1% in children under 5 years of age in Nepal. We found a higher rate of stunting (52.7%) and underweight (41.1%) in children with birth order > 3 and < 2 years of the interval between birth and subsequent birth (IBBSB). The association between the children’s birth order and the prevalence of undernutrition had strong statistical significance. Mother’s age at marriage (p = 0.001), underweight mother, mother’s education, father’s education, wealth quintile, no exposure to mass media, children’s age, and place of residence(p = 0.001) were significantly associated with childhood undernutrition. The result of the multiple logistic regression showed that children with birth order one and 12–24 months of the interval between marriage and first birth (IBMFB) had significantly decreased odds of stunting than those children with birth order one and < 12 months of IBMFB (OR 0.6, 95% CI 0.4–0.9). Conclusion The findings of the study demonstrate that PoB has a protective effect on childhood undernutrition. Delaying of childbirth until 12–24 months after marriage was found to be associated with reduced childhood stunting odds. To mitigate childhood undernutrition, Nepal’s government needs to promote delayed childbearing after marriage while focusing on uplifting the household economics status and wide coverage of and utilization of mass media.

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Factors determining child mortality in Uganda

International Journal of Social Economics ◽

10.1108/ijse-08-2015-0201 ◽

2017 ◽

Vol 44 (5) ◽

pp. 633-642 ◽

Cited By ~ 3

Author(s):

Will Kaberuka ◽

Alex Mugarura ◽

Javan Tindyebwa ◽

Debra S. Bishop

Keyword(s):

Health Care ◽

Logistic Regression ◽

Birth Weight ◽

Regression Model ◽

Marital Status ◽

Birth Order ◽

Child Mortality ◽

Logistic Regression Model ◽

Household Wealth ◽

Content Type

Purpose The purpose of this paper is to establish socio-economic factors and maternal practices that determine child mortality in Uganda. Design/methodology/approach The paper examines the role of sex, birth weight, birth order and duration of breastfeeding of a child; age, marital status and education of the mother; and household wealth in determining child mortality. The study employs a logistic regression model to establish which of the factors significantly impacts child mortality in Uganda. Findings The study established that education level, age and marital status of the mother as well as household wealth significantly impact child mortality. Also important are the sex, birth weight, birth order and breastfeeding duration. Research limitations/implications Policies aimed at promoting breastfeeding and education of female children can make a significant contribution to the reduction of child mortality in Uganda. Practical implications Health care intervention programs should focus on single, poor and uneducated mothers as their children are at great risk due to poor and inadequate health care utilization. Originality/value This paper could be the first effort in examining child mortality status in Uganda using a logistic regression model.

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