Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, Michigan; Global Institute for Vaccine Equity, School of Public Health, University of Michigan, Ann Arbor, Michigan.
Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, Michigan; Global Institute for Vaccine Equity, School of Public Health, University of Michigan, Ann Arbor, Michigan.
Am J Prev Med. 2021 Jan;60(1 Suppl 1):S87-S97. doi: 10.1016/j.amepre.2020.08.015. Epub 2020 Nov 12.
Although vaccination coverage is high in Kenya relative to other African nations, undervaccinated children remain, making it important to identify characteristics of these children and their caregivers. Potentially relevant but understudied factors are women's empowerment and early marriage. Women who marry older and have more autonomous decision-making authority may be better able to ensure their children receive health services, including immunizations. This analysis examines the relationship between early marriage and multiple dimensions of women's empowerment and child vaccination status in Kenya and explores whether these relationships are modified by wealth.
Data were from the 2014 Kenya Demographic and Health Survey. The analysis was completed in 2020 using updated data made available to researchers in 2019. Logistic regressions assessed relationships among early marriage, 3 dimensions of women's empowerment (enabling conditions, intrinsic agency, and instrumental agency), and child vaccination. Analyses were stratified by wealth to explore potential effect modification.
For women in the middle wealth tertile, the odds of having a fully vaccinated child were 3.45 (95% CI=1.51, 7.91) times higher for those with higher versus lower empowerment. Further, among the wealthiest women, those with middle empowerment were 5.99 (95% CI=2.06, 17.40) times more likely to have a fully vaccinated child than women with lower empowerment.
Results suggest a threshold effect of wealth's role in the relationship between empowerment and vaccination. Enabling conditions may not influence immunization among the poorest women but exert a stronger positive influence on childhood vaccination among wealthier women.
This article is part of a supplement entitled Global Vaccination Equity, which is sponsored by the Global Institute for Vaccine Equity at the University of Michigan School of Public Health.
尽管肯尼亚的疫苗接种率相对其他非洲国家较高，但仍存在未接种疫苗的儿童，因此确定这些儿童及其照顾者的特征非常重要。具有潜在相关性但研究不足的因素是妇女赋权和早婚。与较年长和拥有更多自主决策权的妇女结婚的妇女可能更有能力确保其子女获得包括免疫接种在内的卫生服务。这项分析研究了肯尼亚早婚与妇女赋权的多个维度之间的关系，以及儿童疫苗接种状况，并探讨了这些关系是否受到财富的影响。
数据来自 2014 年肯尼亚人口与健康调查。2020 年，使用 2019 年提供给研究人员的最新数据完成了分析。使用逻辑回归评估了早婚、妇女赋权的 3 个维度（赋权条件、内在能动性和工具性能动性）与儿童疫苗接种之间的关系。按财富分层进行分析，以探讨潜在的效应修饰作用。
在中等财富三分位数的妇女中，与赋权较低的妇女相比，赋权较高的妇女其子女完全接种疫苗的几率高 3.45 倍（95%CI=1.51，7.91）。此外，在最富裕的妇女中，赋权处于中等水平的妇女比赋权较低的妇女更有可能让其子女完全接种疫苗，几率高 5.99 倍（95%CI=2.06，17.40）。
结果表明，财富在赋权与疫苗接种之间的关系中存在阈值效应。对于最贫困的妇女，赋权条件可能不会影响免疫接种，但对较富裕妇女的儿童疫苗接种会产生更强的积极影响。
本文是由密歇根大学公共卫生学院全球疫苗公平研究所赞助的题为“全球疫苗公平”的补充内容的一部分。
