Association of childhood vaccination with family planning, healthcare access, and women education: analysis of Nepal, Senegal and Zambia

Abstract

Background Childhood vaccination, family planning, healthcare access, and women's empowerment are goals targeted by the Sustainable Development Goals (SDG). Barriers to healthcare access impede vaccination, and tackling goals holistically could create larger gains than siloed efforts. We studied Nepal, Senegal, and Zambia to test the association between childhood vaccinations and other SDG indicators to identify clustered deprivations. We quantified how children with few - or no - vaccines and their mothers were vulnerable in other SDG areas. Methods We analyzed Demographic and Health Surveys (DHS) from Nepal, Senegal, and Zambia. Through ordinal logistic regressions, controlling for household/mother's characteristics, we identified strong predictors of the number of vaccine doses one-year-old children received. Through bootstrapping and optimal propensity scores matching, we compared children with no or few childhood doses (0-2 doses in early 2000s, or 0-4 in late 2010s) to children who received eight doses (DTP1-3, MVC1, Pol1-3, and BCG vaccines). Findings Mothers of children who received eight doses were 14-30% more likely than mothers of children with few or no doses to have accessed a health facility in the last year (95% CIs were 16-44% in Nepal 2001, -5% to 33% Nepal 2016, 3-26% Senegal 2005, 1-31% Senegal 2019, 9-38% Zambia 2001-02, 7-36% Zambia 2018), knew on average 0.7-1.5 more contraceptive methods (0.9-2.0 Nepal 2005, 0.1-1.5 Nepal 2016, 0.6-1.7 Senegal 2005, 0.2-1.7 Senegal 2019, 0.1-1.4 Zambia 2001-02, 0.5-1.4 Zambia 2018), and had 10-22% higher literacy rates (12-32% Nepal 2001, -7% to 36% Nepal 2016, 10-26% Senegal 2005, -3 to 22% Senegal 2019, -4% to 28% Zambia 2001-02, 5-36% Zambia 2018). Interpretation Children with few or no vaccine doses and their mothers were behind in access to family planning, healthcare, and education compared to fully vaccinated children and their mothers. Such differences can further impede immunizations; therefore, integrated education and health services are needed to improve vaccination outcomes.

Critical success factors for high routine immunisation performance: a qualitative analysis of interviews and focus groups from Nepal, Senegal, and Zambia

“…Adaptation at all levels enabled tailored and targeted programming based on evaluation of high-quality data. While health system improvements led by national governments were essential, our data also highlighted the importance of a deliberate and consistent focus on community engagement, which aligns with existing literature 1 27 28. Community involvement in vaccine programming facilitated the government’s understanding of cultural and social barriers and enablers which contributed to effective adaptation of interventions to increase coverage.…”

“…These quantitative analyses were published elsewhere. 28 29 Findings from the quantitative analyses provided additional context for the qualitative findings which informed the results presented here.…”

“…Additional analyses were conducted to identify indicators that may be associated with immunisation coverage success among low-income and lower-middle-income countries using regression frameworks to statistically test financial, development, demographic and other country-level indicators. These quantitative analyses were published elsewhere 28 29. Findings from the quantitative analyses provided additional context for the qualitative findings which informed the results presented here.…”