Child vaccination in sub-Saharan Africa: Increasing coverage addresses inequalities

Bobo, Firew Tekle; Asante, Augustine; Woldie, Mirkuzie; Dawson, Angela; Hayen, Andrew

doi:10.1016/j.vaccine.2021.11.005

Cited by 56 publications

(63 citation statements)

References 32 publications

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“…We found that although there was a trend towards lower COVID-19 vaccine hesitancy among HCWs who had previously received the hepatitis B or Ebola vaccines, this association did not attain statistical significance. This could be partly explained by the observation that in many LMICs, coverage for most routine vaccines is generally low and rarely enforced [ 50 ]. In our study, only 29.7% and 7.9% of HCWs had received a hepatitis B or Ebola vaccine, respectively.…”

Section: Discussionmentioning

confidence: 99%

COVID-19 Vaccine Hesitancy among Healthcare Workers and Trainees in Freetown, Sierra Leone: A Cross-Sectional Study

et al. 2022

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Despite having safe and efficacious vaccines against COVID-19, vaccine hesitancy is widespread. Although a trusted source of information, vaccine hesitancy has been reported among healthcare professionals, yet few studies have explored this phenomenon in sub-Saharan Africa. We conducted a cross-sectional survey of healthcare professionals in Sierra Leone from January to March 2022. Measures included sociodemographic/health-related information and COVID-19-related concerns. From the responses, we constructed a hesitancy (VAX) score, with higher scores implying negative attitudes or unwillingness to vaccinate. Multivariate linear regression was used to access factors associated with vaccine hesitancy. Overall, 592 participants submitted responses (67.2% female, mean age 29 years, 5.6% physicians/pharmacists, 44.3% medical students, 29.2% nurses, 20.9% nursing students). The mean VAX score was 43.27 ± 8.77, with 60.1% of respondents classified as vaccine hesitant (>50th percentile) and 11.5% as highly hesitant (>75th percentile). Worries about unforeseen future effects (76.3%), a preference for natural immunity (59.5%), and profiteering/mistrust of health authorities (53.1%) were the most common concerns. Being a medical student (β = 0.105, p = 0.011) and previously refusing a recommended vaccine (β = 0.177, p < 0.001) were predictors of COVID-19 vaccine hesitancy. Our findings call for addressing vaccine hesitancy among healthcare professionals as an essential component of strategies aimed at increasing COVID-19 vaccine uptake in this setting.

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Section: Discussionmentioning

confidence: 99%

COVID-19 Vaccine Hesitancy among Healthcare Workers and Trainees in Freetown, Sierra Leone: A Cross-Sectional Study

et al. 2022

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“…Other factors that influence zero-dose vaccination include but are not limited to inequality among countries, population size, lack of vaccination services, attitude of healthcare workers toward mothers, maternal education, vaccine hesitancy and political instability [ 27 , 31 , 52 , 54 , 57 ]. Socioeconomic factors as well as perception of the risk of vaccination also pose a huge threat to early childhood vaccination [ 26 , 58 , 59 ].…”

Section: Discussionmentioning

confidence: 99%

“…More work is needed to evaluate the effects of specific interventions, including targeted healthcare campaigns and awareness creation. Additional work employing geospatial analysis and modeling strategies could be applied to address issues surrounding zero-dose children and ultimately improve the health and future of children in SSA [ 25 , 31 , 57 ].…”

Section: Discussionmentioning

confidence: 99%

“…Arambepola et al, reported that incomplete knowledge on factors influencing zero-dose children in SSA needs to be properly investigated [ 25 ]. Given the growing concern of changing the status of children from zero-dose to fully vaccinated is yet to be addressed, more studies are needed to identify factors affecting zero-dose children [ 24 , 31 ].…”

Section: Introductionmentioning

confidence: 99%

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Correlates of Zero-Dose Vaccination Status among Children Aged 12–59 Months in Sub-Saharan Africa: A Multilevel Analysis of Individual and Contextual Factors

Ozigbu

Olatosi

et al. 2022

Vaccines

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Despite ongoing efforts to improve childhood vaccination coverage, including in hard-to-reach and hard-to-vaccinate communities, many children in sub-Saharan Africa (SSA) remain unvaccinated. Considering recent goals set by the Immunization Agenda 2030 (IA2030), including reducing the number of zero-dose children by half, research that goes beyond coverage to identify populations and groups at greater risk of being unvaccinated is urgently needed. This is a pooled cross-sectional study of individual- and country-level data obtained from Demographic and Health Surveys Program and two open data repositories. The sample includes 43,131 children aged 12–59 months sampled between 2010 and 2020 in 33 SSA countries. Associations of zero-dose status with individual and contextual factors were assessed using multilevel logistic regression. 16.5% of children had not received any vaccines. Individual level factors associated lower odds of zero-dose status included mother’s primary school or high school education, employment, use of antenatal care services and household wealth. Compared to children in countries with lower GDP, children in countries with relatively high GDP had nearly four times greater odds of being unvaccinated. Both individual and contextual factors are correlated with zero-dose status in SSA. Our results can inform efforts to identify and reach children who have not received any vaccines.

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“…Across 92 low-and middle-income countries, an estimated 7.7% of one-year-old children did not receive any of four basic vaccines delivered in infancy, with higher zero-dose prevalence among the poorest (12.5%) than the richest (3.4%) wealth quintiles [9]. In their assessment of economic-related inequality in full vaccination coverage in 25 sub-Saharan African countries, Bobo et al (2022) included a secondary outcome of unvaccinated status, reporting a concentration of zero-dose children in disadvantaged subgroups in most study countries [12]. In 2012, Bosch-Capblanch et al assessed factors associated with non-vaccination across 96 low-and middle-income countries, reporting caregiver (and their partner) education levels, caregiver tetanus toxoid vaccination status, wealth index, and the type of family member involved in decision-making around illness to be the strongest predictors [13]; gender-related barriers also affect childhood immunization [14].…”

Section: Introductionmentioning

confidence: 99%

Economic-Related Inequalities in Zero-Dose Children: A Study of Non-Receipt of Diphtheria–Tetanus–Pertussis Immunization Using Household Health Survey Data from 89 Low- and Middle-Income Countries

et al. 2022

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Despite advances in scaling up new vaccines in low- and middle-income countries, the global number of unvaccinated children has remained high over the past decade. We used 2000–2019 household survey data from 154 surveys representing 89 low- and middle-income countries to assess within-country, economic-related inequality in the prevalence of one-year-old children with zero doses of diphtheria–tetanus–pertussis (DTP) vaccine. Zero-dose DTP prevalence data were disaggregated by household wealth quintile. Difference, ratio, slope index of inequality, concentration index, and excess change measures were calculated to assess the latest situation and change over time, by country income grouping for 17 countries with high zero-dose DTP numbers and prevalence. Across 89 countries, the median prevalence of zero-dose DTP was 7.6%. Within-country inequalities mostly favored the richest quintile, with 19 of 89 countries reporting a rich–poor gap of ≥20.0 percentage points. Low-income countries had higher inequality than lower–middle-income countries and upper–middle-income countries (difference between the median prevalence in the poorest and richest quintiles: 14.4, 8.9, and 2.7 percentage points, respectively). Zero-dose DTP prevalence among the poorest households of low-income countries declined between 2000 and 2009 and between 2010 and 2019, yet economic-related inequality remained high in many countries. Widespread economic-related inequalities in zero-dose DTP prevalence are particularly pronounced in low-income countries and have remained high over the previous decade.

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Child vaccination in sub-Saharan Africa: Increasing coverage addresses inequalities

Cited by 56 publications

References 32 publications

COVID-19 Vaccine Hesitancy among Healthcare Workers and Trainees in Freetown, Sierra Leone: A Cross-Sectional Study

COVID-19 Vaccine Hesitancy among Healthcare Workers and Trainees in Freetown, Sierra Leone: A Cross-Sectional Study

Correlates of Zero-Dose Vaccination Status among Children Aged 12–59 Months in Sub-Saharan Africa: A Multilevel Analysis of Individual and Contextual Factors

Economic-Related Inequalities in Zero-Dose Children: A Study of Non-Receipt of Diphtheria–Tetanus–Pertussis Immunization Using Household Health Survey Data from 89 Low- and Middle-Income Countries

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