Two decades of regional trends in vaccination completion and coverage among children aged 12-23 months: an analysis of the Uganda Demographic Health Survey data from 1995 to 2016

Background Childhood vaccination is an important public health intervention but there is limited information on coverage, trends, and determinants of vaccination completion in Uganda at the regional level. We examined trends in regional vaccination coverage and established the determinants of vaccination completion among children aged 12-23 months in Uganda. Methods We analyzed data from the women’s questionnaire for the 1995-2016 Uganda Demographic Health Survey (UDHS). Vaccine completion was defined as having received a dose of Bacillus-Calmette Guerin (BCG) vaccine; three doses of diphtheria, pertussis, and tetanus (DPT) vaccine; three doses of oral polio vaccine (OPV) (excluding OPV given at birth); and one dose of measles vaccine. We performed Chi-square tests to compare vaccination completion by socio-demographic factors stratified by 10 sub-regions: Eastern, East Central, Central 1, Central 2, Kampala, Karamoja, North, Western, West Nile, and Southwest. We performed logistic regression analysis for each of the regions to identify factors associated with vaccination completion at 5% level of statistical significance. Results Overall vaccination completion was 48.6% (95%CI, 47.2, 50.1) and ranged from 17.3% in Central 1 to 65.9% in Southwest. Vaccination completion rates declined significantly by 10.4% (95% confidence interval (CI), − 16.1, − 4.6) between 1995 and 2000, and increased significantly by 10.0% (95% CI, 4.6, 15.4) between 2000 and 2006, and by 5.4% (95% CI, 0.2, 10.6) between 2006 and 2011. Maternal education (secondary or higher level), receipt of tetanus toxoid (TT) during pregnancy, and possession of a child health card were associated with vaccination completion across all the sub-regions. Other factors like place of residence, religious affiliation, household wealth, maternal age, childbirth order, size of child at birth, and place of delivery were associated with vaccination completion but differed between the 10 sub-regions. Conclusion Besides considerable regional variations, the vaccination completion rate among children aged 12-23 months in Uganda remains suboptimal despite the availability of vaccines. Maternal education, receipt of TT, and possession of a child health card are associated with a higher likelihood of vaccination completion among children aged 12-23 months in all the regions of Uganda. Interventions to improve the utilization of vaccination services in Uganda should consider these factors.

Multilevel Analysis of Urban–Rural Variations of Body Weights and Individual-Level Factors among Women of Childbearing Age in Nigeria and South Africa: A Cross-Sectional Survey

Background: An unhealthy body weight is an adverse effect of malnutrition associated with morbidity among women of childbearing age. While there is increasing attention being paid to the body weights of children and adolescents in Nigeria and South Africa, a major surge of unhealthy body weight in women has received less attention in both countries despite its predominance. The purpose of this study was to explore the prevalence of body weights (underweight, normal, overweight, and obese) and individual-level factors among women of childbearing age by urban–rural variations in Nigeria and South Africa. Methods: This study used the 2018 Nigeria Demographic Health Survey data (n = 41,821) and 2016 South Africa Demographic Health Survey (n = 8514). Bivariate, multilevel, and intracluster correlation coefficient analyses were used to determine individual-level factors associated with body weights across urban–rural variations. Results: The prevalence of being overweight or obese among women was 28.2% and 44.9%, respectively, in South Africa and 20.2% and 11.4% in Nigeria. A majority, 6.8%, of underweight women were rural residents in Nigeria compared to 0.8% in South Africa. The odds of being underweight were higher among women in Nigeria who were unemployed, with regional differences and according to breastfeeding status, while higher odds of being underweight were found among women from poorer households, with differences between provinces and according to cigarette smoking status in South Africa. On the other hand, significant odds of being overweight or obese among women in both Nigeria and South Africa were associated with increasing age, higher education, higher wealth index, weight above average, and traditional/modern contraceptive use. Unhealthy body weights were higher among women in clustering areas in Nigeria who were underweight (intracluster correlation coefficient (ICC = 0.0127), overweight (ICC = 0.0289), and obese (ICC = 0.1040). Similarly, women of childbearing age in clustering areas in South Africa had a lower risk of experiencing underweight (ICC = 0.0102), overweight (ICC = 0.0127), and obesity (ICC = 0.0819). Conclusions: These findings offer a deeper understanding of the close connection between body weights variations and individual factors. Addressing unhealthy body weights among women of childbearing age in Nigeria and South Africa is important in preventing disease burdens associated with body weights in promoting Sustainable Development Goal 3. Strategies for developing preventive sensitization interventions are imperative to extend the perspectives of the clustering effect of body weights on a country level when establishing social and behavioral modifications for body weight concerns in both countries.

Regional Disparities of Facility-Based Childbirth in Indonesia

Specifically, the characteristics of regions in Indonesia are unique. The situation is because the division of the region refers to the main islands. The study aims to analyze regional disparities of childbirth services in Indonesia. Meanwhile, the analysis in this study uses raw data from the 2017 Indonesian Demographic Health Survey (IDHS). The IDHS used stratification and multistage random sampling. The sample used in this study was 17,769 women aged 15 - 49 years with live births in the last 5 years. The study employed all region (7 regions) in the analysis, and analyzed data using the binary logistic regression test. The result shows national average of the utilization of healthcare facilities for delivery in Indonesia is 72.0 %. The 3 highest-ranking regions were in the Java-Bali region with 89.5 %, Sumatra region 73.5 %, and Kalimantan region 69.1 %. The study shows a significant disparity between all regions than the Papua region, except for Kalimantan and Sulawesi regions. Sumatra region has 1.475 times more possibilities to utilize healthcare facilities for delivery than the Papua region. The Java-Bali region has 3.010 times more potential to use healthcare facilities for delivery than the Papua region. The Nusa Tenggara region has 1.891 times more opportunities to use healthcare facilities for delivery than the Papua region. At the same time, the Maluku region has lower utilization than the Papua region. Maluku region has the possibility of 0.304 times utilizing healthcare facilities for delivery than the Papua region. The study concluded that there were significant disparities between regions in using healthcare facilities for delivery in Indonesia. HIGHLIGHTS Indonesia has made many efforts in shifting labor into health care facilities. However, this increase is still lacking, and in some cases, the community still feels that the health services received are not expected The characteristics of regions in Indonesia are unique. Economic and development movements between regions keep the development gap between areas continuing. Disparity as a result of this development also affects the accessibility of the community to health service facilities The study proved there were disparities between regions in using healthcare facilities for delivery in Indonesia GRAPHICAL ABSTRACT

Levels, Trends and Determinants of Infant Mortality in Nigeria: An Analysis using the Logistic Regression Model

This paper presents a statistical analysis of the levels, trends and determinants of infant mortality in Nigeria using the logistic regression model. Infant mortality data for each of the five years preceding the 2003, 2008, 2013 and 2018 Nigeria Demographic Health Survey (NDHS) was retrieved and used for the analysis. Findings from the study revealed that infant mortality rates decline have stagnated in the five year period prior to the 2018 survey with an Annual Rate of Reduction (ARR) of 0% relative to an initial ARR of 5.7% between 2003 and 2008. The ARR of 2.039% over the 15 year period spanning 2003 to 2018 suggests that the rate of infant mortality reduction is slow. This study also showed that maternal characteristics such as age and educational levels as well as cultural practises like use of clean water and toilet facilities were statistically significant determinants of infant mortality in Nigeria with P-values < 0.05 across each of the survey years.

Key Areas to Economic Takeoff from Demographic Dividend: A Case of Nepal

Rapid demographic change in the context of age structure and basic demographic indicators have created opportunity to accelerate economic growth and development in Nepal. At the time of favorable demographic context, it is required to qualify and mobilize currently existing large volume of active years population to fulfill the mission of sustained economic development. For this, it is necessary to invest on health, education, infrastructure along with creating employment opportunities but such opportunity period is missing out due low attention on social, economic, political and cultural sectors, which may misfortune for Nepal. Focusing on the key areas of economic take off in the declined fertility context, this paper reviews literature related to reaping demographic dividend. Based on secondary data from journal articles, census and Nepal Demographic Health Survey (NDHS) results, descriptive and content analysis method is applied. National Census data from Central Bureau of Statistics (CBS) and Nepal Demographic Health Survey (NDHS) is taken as reference and some estimation from United Nations (UN) are also taken as requirement. To identify vital areas and situation to support economic take off and support to formulate and implement proper future population policy in Nepal are the main objectives of this article. Coping with socio-economic challenges need to focus on primary area of social development like education, productivity of labor, proper use of remittance to economic take off. Need to open gate for secondary demographic dividend with appropriate policy formulation in the recent context.