Monguno Abubakar Kawu
Department of Geography, University of Maiduguri , Nigeria.
J Public Health Afr. 2013 Sep 25;4(1):e10. doi: 10.4081/jphia.2013.e10. eCollection 2013 Jun 25.
Immunisation has been an important strategy for disease prevention globally. Despite proven successes in other settings, child immunisation has continued to be problematic in developing countries including Nigeria. In addressing the problems, policy in Nigeria is largely directed at overcoming socio cultural issues surrounding parents' rejection of vaccines. However, determinants of immunisation have geographical implications as well. A cross sectional survey was used to select 484 mothers/caregivers through a multi stage cluster sampling technique from the three senatorial districts of Borno State, Nigeria. Mothers or caregivers of children 12-23 months were interviewed using a structured questionnaire adapted from the Nigeria Demographic and Health Survey (2008). Socio cultural factors measured include mother's education, religion, husband's permission and sex of child while spatial variables include location whether rural or urban, and distance measured in terms of physical distance, cost and perception of physical distance. Descriptive statistics, univariate and multivariate logistic regressions were used to analyse the results. Data indicate that only 10.5% of children were fully immunised. Though immunisation uptake differed between the senatorial districts, this was not significant (P=0.1). In the bivariate analysis, mothers living in urban areas, <1 km to immunisation centre, their perception of travel distance and travel cost were the spatial predictors of immunisation while literacy and husband's permission were the socio-cultural factors of significance. However, in the multivariate regression only two geographical factors living in an urban area [odds ratio (OR) 3.42, confidence interval (CI) 1.40-8.33] and mothers' perception of distance (OR 4.52, CI 2.14-9.55) were protective against under immunisation while mother's education was the only socio cultural variable of significance (OR 0.10, CI 0.03-0.41). It was concluded that while it is important to address socio cultural issues, policies directed at overcoming the friction of distance especially mobile clinics in rural areas are required to significantly improve immunisation uptake in the state.
免疫接种一直是全球疾病预防的一项重要策略。尽管在其他地区已取得了确凿的成功，但在包括尼日利亚在内的发展中国家，儿童免疫接种仍然存在问题。为解决这些问题，尼日利亚的政策主要致力于克服围绕父母拒绝接种疫苗的社会文化问题。然而，免疫接种的决定因素也具有地理方面的影响。采用横断面调查，通过多阶段整群抽样技术从尼日利亚博尔诺州的三个参议院选区中选取了484名母亲/照料者。使用一份根据《尼日利亚人口与健康调查》（2008年）改编的结构化问卷，对12至23个月大儿童的母亲或照料者进行了访谈。所测量的社会文化因素包括母亲的教育程度、宗教信仰、丈夫的许可和孩子的性别，而空间变量包括地点（农村或城市）以及以实际距离、成本和对实际距离的感知来衡量的距离。使用描述性统计、单变量和多变量逻辑回归来分析结果。数据表明，只有10.5%的儿童得到了充分免疫接种。尽管参议院选区之间的免疫接种率有所不同，但差异并不显著（P = 0.1）。在双变量分析中，居住在城市地区、距离免疫接种中心<1公里、对出行距离和出行成本的感知是免疫接种的空间预测因素，而识字率和丈夫的许可则是具有显著意义的社会文化因素。然而，在多变量回归中，只有两个地理因素——居住在城市地区[优势比（OR）3.42，置信区间（CI）1.40 - 8.33]和母亲对距离的感知（OR 4.52，CI 2.14 - 9.55）对免疫接种不足具有保护作用，而母亲的教育程度是唯一具有显著意义的社会文化变量（OR 0.10，CI 0.03 - 0.41）。研究得出结论，虽然解决社会文化问题很重要，但需要制定旨在克服距离障碍的政策，特别是在农村地区设立流动诊所，以显著提高该州的免疫接种率。
