Belay Denekew Bitew, Ali Mahad Ibrahim, Chen Ding-Geng, Jama Umalkhair Abdi
Department of Statistics, Bahir Dar University, Bahir Dar, Ethiopia.
Department of Statistics, University of Pretoria, Pretoria, South Africa.
BMC Public Health. 2025 Mar 8;25(1):924. doi: 10.1186/s12889-025-22122-7.
Children worldwide can live lives free from various illnesses and disabilities due to vaccination. For instance, vaccination has eliminated smallpox, a deformative and frequently fatal illness that claimed an estimated 300 million lives in the twentieth century. However, due to a lack of access to immunization and other health services, 14.3 million infants in 2022 still did not receive their first dose of the Diphtheria-Tetanus-Pertussis (DTP) vaccine, and an additional 6.2 million received only a portion of the scheduled dose. This study aimed to assess prevalence and determinant factors of immunization among under-five children in Somalia using Somalia Health and Demographic Survey (SHDS) Data.
The study design was cross-sectional, utilizing the SHDS 2020 data. A total of 3916 under-five children who fulfilled the inclusion criteria were included in this study. Count regression models were employed to explore factors associated with the number of vaccinations received per child.
In this study, 9.14% of children did not receive any vaccination during their childhood. Different candidate count regression models were compared. Using AIC and BIC, the Negative-binomial (NB) regression model was found to be the best fit. From this model, we found that women ages 20-24 (IRR = 1.192, 95% CI: 1.083, 1.313) and 25-29 (IRR = 1.180, 95% CI: 1.068, 1.305) had a higher number of vaccinations per child compared to women in the 15-19 age group. Women who attended primary education (IRR = 1.090, 95% CI: 1.034, 1.150) and secondary education (IRR = 1.157, 95% CI: 1.058, 1.266) had a higher number of vaccinations per child compared to uneducated women) also correlated with increased vaccination Parity (IRR = 1.090, 95% CI: 1.031-1.153), and wealth quantile (IRR = 1.110, 95% CI: 1.012, 1.217) positively influenced vaccination attendance. Regional disparities were also found to be significant, with Togdheer, Sool, Sanaag, Bari, Nugaal, Bay, Bakool, Mudug, Hiiraan and Galgaduud significantly different from Awdal region. In Negative-Binomial, age, region, residence, educational level, wealth quantile, child size at birth, parity and birth order emerged as key predictors, revealing complex determinants of vaccination utilization in Somalia.
A large proportion of children did not complete the full vaccination schedule. Socio-demographic factors, such as age, region, residence, educational level, wealth quantile, child size at birth, parity, and birth order, had a significant impact on the number of children vaccinated in Somalia. These findings underscore the importance of targeted interventions for addressing these factors. Implementing initiatives based on these conclusions has the potential to enhance vaccination coverage and child health outcomes.
通过接种疫苗，全球儿童能够过上没有各种疾病和残疾的生活。例如，疫苗接种已消灭了天花，这种致残且常常致命的疾病在20世纪估计夺去了3亿人的生命。然而，由于无法获得免疫接种和其他卫生服务，2022年仍有1430万婴儿未接种第一剂白喉-破伤风-百日咳（DTP）疫苗，另有620万婴儿仅接种了部分预定剂量的疫苗。本研究旨在利用索马里卫生和人口调查（SHDS）数据评估索马里五岁以下儿童的免疫接种率及其决定因素。
本研究采用横断面设计，利用2020年SHDS数据。共有3916名符合纳入标准的五岁以下儿童纳入本研究。采用计数回归模型探讨与每名儿童接种疫苗数量相关的因素。
在本研究中，9.14%的儿童在童年期间未接种任何疫苗。对不同的候选计数回归模型进行了比较。使用赤池信息准则（AIC）和贝叶斯信息准则（BIC），发现负二项式（NB）回归模型拟合效果最佳。从该模型中，我们发现20 - 24岁（发生率比[IRR] = 1.192，95%置信区间[CI]：1.083，1.313）和25 - 29岁（IRR = 1.180，95% CI：1.068，1.305）的女性所育儿童的接种疫苗数量高于15 - 19岁年龄组的女性。接受过小学教育（IRR = 1.090，95% CI：1.034，1.150）和中学教育（IRR = 1.157，95% CI：1.058，1.266）的女性所育儿童的接种疫苗数量高于未受过教育的女性。胎次（IRR = 1.090，95% CI：1.031 - 1.153）和财富分位数（IRR = 1.110，95% CI：1.012，1.217）也与接种疫苗数量增加相关，且对疫苗接种率有积极影响。还发现地区差异显著，托格代尔、苏勒、萨纳格、巴里、努加尔、贝、巴科勒、穆杜格、希兰和加尔古杜德与奥达勒地区有显著差异。在负二项式模型中，年龄、地区、居住地、教育水平、财富分位数、出生时儿童大小、胎次和出生顺序成为关键预测因素，揭示了索马里疫苗接种利用的复杂决定因素。
很大一部分儿童未完成全程疫苗接种计划。社会人口学因素，如年龄、地区、居住地、教育水平、财富分位数、出生时儿童大小、胎次和出生顺序，对索马里儿童的疫苗接种数量有显著影响。这些发现强调了针对这些因素进行有针对性干预的重要性。基于这些结论实施相关举措有可能提高疫苗接种覆盖率和儿童健康水平。
