Fenta Setegn Muche, Biresaw Hailegebrael Birhan, Fentaw Kenaw Derebe, Gebremichael Shewayiref Geremew
Department of Statistics, Faculty of Natural and Computational Sciences, Debre Tabor University, Debre Tabor, Ethiopia.
Trop Med Health. 2021 Apr 1;49(1):29. doi: 10.1186/s41182-021-00319-x.
Sub-Saharan Africa is one of the highest under-five mortality and low childhood immunization region in the world. Children in Sub-Saharan Africa are 15 times more likely to die than children from high-income countries. In sub-Saharan Africa, more than half of under-five deaths are preventable through immunization. Therefore, this study aimed to identify the determinant factors of full childhood immunization among children aged 12-23 months in sub-Saharan Africa.
Data for the study was drawn from the Demographic and Health Survey of nine sub-Saharan African countries. A total of 21,448 children were included. The two-level mixed-effects logistic regression model was used to identify the individual and community-level factors associated with full childhood immunization RESULT: The prevalence of full childhood immunization coverage in sub-Saharan Africa countries was 59.40% (95% CI: 58.70, 60.02). The multilevel logistic regression model revealed that secondary and above maternal education (AOR = 1.38; 95% CI: 1.25, 1.53), health facility delivery (AOR = 1.51; 95% CI: 1.41, 1.63), fathers secondary education and above (AOR = 1.28, 95% CI: 1.11, 1.48), four and above ANC visits (AOR = 2.01; 95% CI: 1.17, 2.30), PNC visit(AOR = 1.55; 95% CI: 1.46, 1.65), rich wealth index (AOR = 1.26; 95% CI: 1.18, 1.40), media exposure (AOR = 1.11; 95% CI: 1.04, 1.18), and distance to health facility is not a big problem (AOR = 1.42; 95% CI: 1.28, 1.47) were significantly associated with full childhood immunization.
The full childhood immunization coverage in sub-Saharan Africa was poor with high inequalities. There is a significant variation between SSA countries in full childhood immunization. Therefore, public health programs targeting uneducated mothers and fathers, rural mothers, poor households, and those who have not used maternal health care services to promote full childhood immunization to improve child health. By enhancing institutional delivery, antenatal care visits and maternal tetanus immunization, the government and other stakeholders should work properly to increase child immunization coverage. Furthermore, policies and programs aimed at addressing cluster variations in childhood immunization need to be formulated and their implementation must be strongly pursued.
撒哈拉以南非洲是世界上五岁以下儿童死亡率最高且儿童免疫接种率低的地区之一。撒哈拉以南非洲的儿童死亡可能性是高收入国家儿童的15倍。在撒哈拉以南非洲，超过一半的五岁以下儿童死亡可通过免疫接种预防。因此，本研究旨在确定撒哈拉以南非洲12至23个月儿童全程儿童免疫接种的决定因素。
本研究数据取自九个撒哈拉以南非洲国家的人口与健康调查。共纳入21448名儿童。采用两级混合效应逻辑回归模型确定与全程儿童免疫接种相关的个体和社区层面因素。结果：撒哈拉以南非洲国家全程儿童免疫接种覆盖率为59.40%（95%置信区间：58.70，60.02）。多水平逻辑回归模型显示，母亲接受过中等及以上教育（调整后比值比[AOR]=1.38；95%置信区间：1.25，1.53）、在医疗机构分娩（AOR=1.51；95%置信区间：1.41，1.63）、父亲接受过中等及以上教育（AOR=1.28，95%置信区间：1.11，1.48）、四次及以上产前检查（AOR=2.01；95%置信区间：1.17，2.30）、产后检查（AOR=1.55；95%置信区间：1.46，1.65）、富裕的财富指数（AOR=1.26；95%置信区间：1.18，1.40）、媒体曝光（AOR=1.11；95%置信区间：1.04，1.18）以及距离医疗机构不是大问题（AOR=1.42；95%置信区间：1.28，1.47）与全程儿童免疫接种显著相关。
撒哈拉以南非洲的全程儿童免疫接种覆盖率较低且不平等现象严重。撒哈拉以南非洲国家在全程儿童免疫接种方面存在显著差异。因此，针对未受过教育的父母、农村母亲、贫困家庭以及那些未使用孕产妇保健服务的人群开展公共卫生项目，以促进全程儿童免疫接种，改善儿童健康。政府和其他利益相关者应通过加强机构分娩、产前检查和孕产妇破伤风免疫接种来努力提高儿童免疫接种覆盖率。此外，需要制定旨在解决儿童免疫接种集群差异的政策和项目，并大力推进其实施。
