Incomplete childhood immunization in Nigeria: a multilevel analysis of individual and contextual factors
Incomplete childhood immunization in Nigeria: a multilevel analysis of individual and contextual factors
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DOI：
10.1186/s12889-017-4137-7
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发表时间：
2017-03-08
影响因子：
4.5
通讯作者：
Wiysonge, Charles S.
中科院分区：
文献类型：
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作者：
Adedokun, Sulaimon T.;Uthman, Olalekan A.;Wiysonge, Charles S.
背景：尽管全球死亡率有所下降，但撒哈拉以南非洲五岁以下儿童死亡率仍然很高。其中四分之一的死亡可以通过免疫接种等干预措施来预防。本研究的目的是探讨个人、社区和国家层面因素对尼日利亚儿童不完全免疫的独立影响，尼日利亚是世界上大多数不完全免疫儿童居住的 10 个国家之一。 方法：该研究基于对 2013 年尼日利亚人口和健康调查 (DHS) 横断面数据的二次分析。对来自 37 个州（3 级）896 个社区（2 级）的 5,754 名 12-23 月龄儿童的数据应用多级多变量逻辑回归模型，这些儿童是否完全免疫（1 级）。结果：超过四分之三的儿童（76.3%）没有完全免疫。大约 83% 的年轻母亲（15-24 岁）的孩子和 94% 的文盲母亲的孩子没有接受充分的免疫接种。在完全调整模型中，母亲参加产前门诊（调整后比值比[aOR]=0.49；95%可信区间[CrI]=0.39-0.60）、在卫生机构分娩（aOR=0.62；95%CrI=0.51-0.74）并居住在城市地区（aOR=0.66；95%CrI=0.51-0.74）的孩子未完全免疫的机会降低。 95% CrI = 0.50-0.82)。母亲难以前往医疗机构（aOR = 1.28；95% CrI = 1.02-1.57）且生活在社会经济弱势社区（aOR = 2.93；95% CrI = 1.60-4.71）和州（aOR = 2.69；955 CrI = 1.37-4.73）的儿童更有可能不完全结论：这项研究表明，尼日利亚儿童免疫不完全的风险不仅受到个人因素的影响，还受到社区和州层面因素的影响。提高儿童免疫接种率的干预措施应考虑到这些背景特征。
Background: Under-five mortality remains high in sub-Saharan Africa despite global decline. One quarter of these deaths are preventable through interventions such as immunization. The aim of this study was to examine the independent effects of individual-, community-and state-level factors on incomplete childhood immunization in Nigeria, which is one of the 10 countries where most of the incompletely immunised children in the world live.Methods: The study was based on secondary analyses of cross-sectional data from the 2013 Nigeria Demographic and Health Survey (DHS). Multilevel multivariable logistic regression models were applied to the data on 5,754 children aged 12-23 months who were fully immunized or not (level 1), nested within 896 communities (level 2) from 37 states (level 3).Results: More than three-quarter of the children (76.3%) were not completely immunized. About 83% of children of young mothers (15-24 years) and 94% of those whose mothers are illiterate did not receive full immunization. In the fully adjusted model, the chances of not being fully immunized reduced for children whose mothers attended antenatal clinic (adjusted odds ratio [ aOR] = 0.49; 95% credible interval [ CrI] = 0.39-0.60), delivered in health facility (aOR = 0.62; 95% CrI = 0.51-0.74) and lived in urban area (aOR = 0.66; 95% CrI = 0.50-0.82). Children whose mothers had difficulty getting to health facility (aOR = 1.28; 95% CrI = 1.02-1.57) and lived in socioeconomically disadvantaged communities (aOR = 2.93; 95% CrI = 1.60-4.71) and states (aOR = 2.69; 955 CrI = 1.37-4.73) were more likely to be incompletely immunized.Conclusions: This study has revealed that the risk of children being incompletely immunized in Nigeria was influenced by not only individual factors but also community-and state-level factors. Interventions to improve child immunization uptake should take into consideration these contextual characteristics.