systematic review of social determinants of childhood immunisation in low and middle income CORD-Papers-2022-06-02 (Version 1)

Title: Systematic review of social determinants of childhood immunisation in low- and middle-income countries and equity impact analysis of childhood vaccination coverage in Nigeria
Abstract: Background: Nigeria has a high proportion of underimmunised children in the world. We estimated the inequities in childhood immunisation coverage associated with socioeconomic geographic maternal child and healthcare characteristics among children aged 12-23 months in Nigeria using a social determinants of health perspective. Methods: We conducted a systematic review focused on inequities in childhood immunisation in low- and middle-income countries to identify the social determinants of childhood immunisation. Using these determinants we analysed basic vaccination coverage in Nigeria (1-dose BCG 3-dose DTP-HepB-Hib (diphtheria tetanus pertussis hepatitis B and Haemophilus influenzae type B) 3-dose polio and 1-dose measles) of 6059 children aged 12-23 months using the 2018 Nigeria Demographic and Health Survey. Results: We identified social determinants of immunisation - household wealth religion and ethnicity (socioeconomic characteristics); region and place of residence (geographic characteristics); maternal age at birth maternal education and maternal household head status (maternal characteristics); sex of child and birth order (child characteristics); antenatal care and birth setting (healthcare characteristics). While basic vaccination coverage was 31% (95% CI: 29-33) 19% (18-21) of children aged 12-23 months had received none of the basic vaccines. After controlling for background characteristics there was a significant increase in the odds of basic vaccination by household wealth living in an urban area antenatal care delivery in a health facility maternal age and maternal education. Children of Fulani ethnicity in comparison to children of Igbo ethnicity had lower odds of receiving basic vaccinations. Discussion: Children of Fulani ethnicity living in rural areas born in home settings with young mothers living in the poorest households with no formal education and no antenatal care visits were associated with lower rates of basic vaccination in Nigeria. We recommend a proportionate universalism approach with targeted vaccination programmes proportionate to the level of disadvantage for addressing the immunisation barriers.
Published: 2022-01-25
DOI: 10.1101/2022.01.24.22269771
Author Name: Williams S V
Author link:
Author Name: Akande T
Author link:
Author Name: Abbas K
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license: medrxiv
source_x: MedRxiv
has_full_text: FALSE
G_ID: systematic_review_of_social_determinants_of_childhood_immunisation_in_low_and_middle_income