Hostname: page-component-7c8c6479df-94d59 Total loading time: 0 Render date: 2024-03-28T14:57:18.625Z Has data issue: false hasContentIssue false

MULTI-YEAR TREND ANALYSIS OF CHILDHOOD IMMUNIZATION UPTAKE AND COVERAGE IN NIGERIA

Published online by Cambridge University Press:  28 May 2013

OYELOLA A. ADEGBOYE*
Affiliation:
Department of Science and Mathematics, American University of Afghanistan, Kabul Department of Statistics and Population Studies, University of the Western Cape, South Africa
DANELLE KOTZE
Affiliation:
Department of Statistics and Population Studies, University of the Western Cape, South Africa
OLASUNKANMI A. ADEGBOYE
Affiliation:
Department of Paediatrics and Child Health, University of Ilorin Teaching Hospital/University of Ilorin, Nigeria
*
1Corresponding author. Email: oyeadegboye@yahoo.com

Summary

As a leading indicator of child health, under-five mortality was incorporated in the United Nations Millennium Development Goals with the aim of reducing the rate by two-thirds between 1990 and 2015. Under-five mortality in Nigeria is alarmingly high, and many of the diseases that result in mortality are vaccine preventable. This study evaluates the uptake of childhood immunization in Nigeria from 1990 to 2008. A multi-year trend analysis was carried out using Alternating Logistic Regression on 46,130 children nested within 17,380 mothers in 1938 communities from the Nigerian Demographic and Health Surveys from 1990 to 2008. The findings reveal that mother-level and community-level variability are significantly associated with immunization uptake in Nigeria. The model also indicates that children delivered at private hospitals have a higher chance of being immunized than children who are delivered at home. Children from the poorest families (who are more likely to be delivered at home) have a lower chance of being immunized than those from the richest families (OR=0.712; 95% CI, 0.641–0.792). Similarly, the chance of children with a mother with no education being immunized is decreased by 17% compared with children whose mother has at least a primary education. In the same way, children of mothers who are gainfully employed and those of older mothers have statistically significantly higher odds of being immunized. Children of households with a female head are less likely to be immunized than those from male-headed households. The statistical significance of the community–survey year interaction term suggests an increase in the odds of a child being immunized over the years and spread over communities. Evidence-based policy should lay more emphasis on mother- and community-level risk factors in order to increase immunization coverage among Nigerian children.

Type
Articles
Copyright
Copyright © Cambridge University Press 2013 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Abdulraheem, I. S., Onajole, A. T., Jimoh, A. A. G. & Oladipo, A. R. (2011) Reasons for incomplete vaccination and factors for missed opportunities among rural Nigerian children. Journal of Public Health and Epidemiology 3, 194203.Google Scholar
Adegboye, O. A. (2010) Under-five mortality in Nigeria: spatial exploration and spatial scan statistics for cluster detection. International Journal of Statistics and Systems 5, 203214.Google Scholar
Adeiga, A., Omilabu, S., Audu, R., Sanni, F., Lakehinde, G., Balogun, O. & Olagbaju, O. (2005) Infant immunization coverage in difficult-to-reach area of Lagos Metropolis. African Journal of Clinical and Experimental Microbiology 6, 227231.Google Scholar
Anah, M. U., Etuk, I. S. & Udo, J. J. (2006) Opportunistic immunization with in-patient programme: eliminating a missed opportunity in Calabar, Nigeria. Annals of African Medicine 5(4), 188191.Google Scholar
Antai, D. (2009) Inequitable childhood immunization uptake in Nigeria: a multilevel analysis of individual and contextual determinants. BMC Infectious Diseases 9, 181.CrossRefGoogle ScholarPubMed
Bosch-Capblanch, X., Banerjee, K. & Burton, A. (2012) Unvaccinated children in years of increasing coverage: how many and who are they? Evidence from 96 low- and middle-income countries. Tropical Medicine and International Health 17, 697710.CrossRefGoogle ScholarPubMed
Carey, V., Zeger, S. & Diggle, P. (1993) Modelling multivariate binary data with alternating logistic regressions. Biometrika 80, 517526.CrossRefGoogle Scholar
Diddy, A. (2009) Inequitable childhood immunization uptake in Nigeria: a multilevel analysis of individual and contextual determinants. BMC Infectious Diseases 9, 181.Google Scholar
Diggle, P., Liang, K. Y. & Zeger, S. (1994) Analysis of Longitudinal Data (second edition). Oxford University Press, Oxford.Google Scholar
Fitzmaurice, G. M., Laird, N. M. & Ware, J. H. (2004) Applied Longitudinal Analysis. John Wiley and Sons, New York.Google Scholar
Kabir, M., Iliyasu, Z., Abubakar, I. S. & Nwosuh, J. I. (2004) Immunization coverage among children below two years of age in Fanshakara, Kano, Nigeria. Nigerian Journal of Basic and Clinical Sciences 1(1), 1013.Google Scholar
Kayode, G. A., Adekanmbi, V. T. & Uthman, O. A. (2012) Risk factors and a predictive model for under-five mortality in Nigeria: evidence from Nigeria demographic and health survey. BMC Pregnancy and Childbirth 12, 10.Google Scholar
Kunle-Olowu, A., Kunle-Olowu, E. O. & Ugwu, M. E. (2011) Immunization coverage of antenatal and immunization clinics attendees in the Niger Delta University Teaching Hospital. Journal of Public Health and Epidemiology 3(3), 9093.Google Scholar
Maekawa, M., Douangmala, S., Sakisaka, K., Takahashi, K., Phathammavong, O., Xeuatvongsa, A. & Kuroiwa, C. (2007) Factors affecting routine immunization coverage among children aged 12–59 months in LaoPDR after regional polio eradication in Western Pacific Region. BioScience Trends 1(1), 4351.Google Scholar
Liang, K. & Zeger, S. (1986) Longitudinal data analysis using generalized linear models. Biometrika 73, 1322.Google Scholar
Molenberghs, G. & Lesaffre, E. (1994) Marginal modelling of correlated ordinal data using a multivariate placket distribution. Journal of the American Statistical Association 89, 633644.CrossRefGoogle Scholar
Molenberghs, G. & Verbeke, G. (2006) Models for Discrete Longitudinal Data. Springer-Verlag, New York.Google Scholar
National Population Commission (NPC) [Nigeria] & ICF Macro (2009) Nigeria Demographic and Health Survey 2008. National Population Commission and ICF Macro, Abuja, Nigeria.Google Scholar
Ogunjimi, L. O., Ibe, R. T. & Ikorok, M. M. (2012) Curbing maternal and child mortality: the Nigerian experience. International Journal of Nursing and Midwifery 4(3), 3339.Google Scholar
Ogunjuyigbe, P. O. (2004) Under-five mortality in Nigeria: perception and attitudes of the Yorubas towards the existence of ‘Abiku’. Demographic Research 11(2), 4356.Google Scholar
Onyiriuka, A. N. (2005) Vaccination default among children attending a static immunization clinic in Benin city, Nigeria. Journal of Medicine and Biomedical Research 4(1), 7177.Google Scholar
Preisser, J. S., Arcury, T. A. & Quandt, S. A. (2003) Detecting patterns of occupational illness clustering with alternating logistic regressions applied to longitudinal data. American Journal of Epidemiology 158, 495501.CrossRefGoogle ScholarPubMed
SAS Institute Inc. (2008) SAS/STAT 9.2 User's Guide. SAS Institute Inc., Cary, NC.Google Scholar
Sorungbe, A. (1989) Expanded programme on immunization in Nigeria. Reviews of Infectious Diseases 11, S509511.Google Scholar
Rammohan, A., Awofeso, N. & Fernandez, R. C. (2012) Paternal education status significantly influences infants' measles vaccination uptake, independent of maternal education status. BMC Public Health 12, 336.Google Scholar
Renne, E. P. (2010) The Politics of Polio in Northern Nigeria. Indiana University Press, Indiana, USA.Google Scholar
UNICEF (2010) At a Glance: Nigeria Statistics. URL: http://www.unicef.org/infobycountry/nigeria_statistics.htmlGoogle Scholar
United Nations (n.d.) United Nations Millennium Development Goals. URL: http://www.un.org/millenniumgoals/childhealth.shtmlGoogle Scholar
USAID (n.d.) Immunization Basics: Country Activities. URL: http://www.immunizationbasics.jsi.com/CountryActivities.htmGoogle Scholar
Wammanda, R., Gambo, M. & Abdulkadir, I. (2011) Age at BCG administration during routine immunization. Journal of Community Medicine and Primary Health Care 16, 3335.Google Scholar
WHO (2008) Global Networks for Surveillance of Rotavirus Gastroenteritis, 2001–2008. Weekly Epidemiological Record, WHO, Switzerland.Google Scholar
Wiysonge, C., Uthman, O., Ndumbe, P. & Hussey, G. (2012) Individual and contextual factors associated with low childhood immunisation coverage in sub-Saharan Africa: a multilevel analysis. PLoSONE, 7.Google Scholar