Multilevel analysis of predictors of multiple indicators of childhood vaccination in Nigeria.
Multilevel analysis of predictors of multiple indicators of childhood vaccination in Nigeria.
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DOI：
10.1371/journal.pone.0269066
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发表时间：
2022
期刊：
影响因子：
3.7
通讯作者：
Utazi, C. Edson
中科院分区：
文献类型：
--
作者：
Aheto, Justice Moses K. A.;Pannell, Oliver T.;Dotse-Gborgbortsi, Winfred;Trimner, Mary;Tatem, Andrew;Rhoda, Dale;Cutts, Felicity;Utazi, C. Edson
儿童疫苗接种覆盖水平存在严重不平等。为了提高疫苗接种率，应确定并处理预测儿童疫苗接种覆盖率的因素。利用2018年尼日利亚人口与健康调查数据和地理空间数据集，我们拟合了贝叶斯多水平二项和多项逻辑回归模型，分析了三种疫苗接种结果的独立预测因素：12-23月龄儿童接种第一剂五价疫苗（含白喉-破伤风-百日咳、B型流感嗜血杆菌和乙型肝炎疫苗）（PENTA1） （n = 6059），在接种第一剂疫苗（PENTA1 /1） （n = 3937）后接种第三剂，12-35月龄儿童接种麻疹疫苗（MV） （n = 11839）。与疫苗接种相关的因素在记录的和召回的疫苗接种证据中大致相似。根据接种疫苗的任何证据，我们发现保健卡/文件的所有权、维生素A的接受情况和母亲的教育水平与每个结果都有显著关联。尽管城市的每一剂疫苗覆盖率高于农村地区，但在包括旅行时间在内的多变量分析中，城市居住并不显著。与社会经济地位、族裔群体、熟练的助产服务、较短的到最近的保健设施的旅行时间以及寻求保健的问题有关的指标与PENTA1和MV都有显著关联。母亲宗教信仰与PENTA1和PENTA3/1相关，母亲年龄与MV和PENTA3/1相关；其他重要变量分别与一个结果相关。在每个结果的拟合模型中，观察到不同阶层的大量剩余群落水平差异。我们的分析强调了社会人口和卫生保健获取因素，这些因素不仅影响尼日利亚疫苗接种系列的开始，也影响疫苗接种系列的完成。还应调查和处理卫生服务质量和社区态度等国土安全部未衡量的其他因素，以解决覆盖面不平等问题。
Substantial inequalities exist in childhood vaccination coverage levels. To increase vaccine uptake, factors that predict vaccination coverage in children should be identified and addressed. Using data from the 2018 Nigeria Demographic and Health Survey and geospatial data sets, we fitted Bayesian multilevel binomial and multinomial logistic regression models to analyse independent predictors of three vaccination outcomes: receipt of the first dose of Pentavalent vaccine (containing diphtheria-tetanus-pertussis, Hemophilus influenzae type B and Hepatitis B vaccines) (PENTA1) (n = 6059) and receipt of the third dose having received the first (PENTA3/1) (n = 3937) in children aged 12–23 months, and receipt of measles vaccine (MV) (n = 11839) among children aged 12–35 months. Factors associated with vaccination were broadly similar for documented versus recall evidence of vaccination. Based on any evidence of vaccination, we found that health card/document ownership, receipt of vitamin A and maternal educational level were significantly associated with each outcome. Although the coverage of each vaccine dose was higher in urban than rural areas, urban residence was not significant in multivariable analyses that included travel time. Indicators relating to socio-economic status, as well as ethnic group, skilled birth attendance, lower travel time to the nearest health facility and problems seeking health care were significantly associated with both PENTA1 and MV. Maternal religion was related to PENTA1 and PENTA3/1 and maternal age related to MV and PENTA3/1; other significant variables were associated with one outcome each. Substantial residual community level variances in different strata were observed in the fitted models for each outcome. Our analysis has highlighted socio-demographic and health care access factors that affect not only beginning but completing the vaccination series in Nigeria. Other factors not measured by the DHS such as health service quality and community attitudes should also be investigated and addressed to tackle inequities in coverage.
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