Decomposing the rural–urban gap in factors associated with childhood immunisation in sub-Saharan Africa: evidence from surveys in 23 countries

Abstract

BackgroundAbout 31 million children in sub-Saharan Africa (SSA) suffer from immunisation preventable diseases yearly and more than half a million children die because of lack of access to immunisation. Immunisation coverage has stagnated at 72% in SSA over the past 6 years. Due to evidence that full immunisation of children may be determined by place of residence, this study aimed at investigating the rural–urban differential in full childhood immunisation in SSA.MethodsThe data used for this study consisted of 26 241 children pooled from 23 Demographic and Health Surveys conducted between 2010 and 2018 in SSA. We performed a Poisson regression analysis with robust Standard Errors (SEs) to determine the factors associated with full immunisation status for rural and urban children. Likewise, a multivariate decomposition analysis for non-linear response model was used to examine the contribution of the covariates to the observed rural and urban differential in full childhood immunisation. All analyses were performed using Stata software V.15.0 and associations with a p<0.05 were considered statistically significant.ResultsMore than half of children in urban settings were fully immunised (52.8%) while 59.3% of rural residents were not fully immunised. In all, 76.5% of rural–urban variation in full immunisation was attributable to differences in child and maternal characteristics. Household wealth was an important component contributing to the rural–urban gap. Specifically, richest wealth status substantially accounted for immunisation disparity (35.7%). First and sixth birth orders contributed 7.3% and 14.9%, respectively, towards the disparity while 7.9% of the disparity was attributable to distance to health facility.ConclusionThis study has emphasised the rural–urban disparity in childhood immunisation, with children in the urban settings more likely to complete immunisation. Subregional, national and community-level interventions to obviate this disparity should target children in rural settings, those from poor households and women who have difficulties in accessing healthcare facilities due to distance.

Childhood vaccination uptake and associated factors among children 12–23 months in rural settings of the Gambia: a community-based cross-sectional study

“…Furthermore, paternal literacy, which has been used in the Gambia as a surrogate indicator of socioeconomic status, tends to be inversely linked to inadequate immunisation. Similar studies have reported this association [ 31 , 33 – 35 ].…”

“…According to this survey, parents strongly believe that vaccinations are essential for their children’s wellbeing, with the majority of respondents holding views that seem to favor immunisation. Children born to younger mothers, those with higher birth orders, and those from larger families have historically been shown to receive less health care services in general and preventive services in particular [ 35 , 38 – 41 ]. Slightly less than half of them have the decision-making powers regarding their child’s utilisation of vaccines.…”

Maternal healthcare utilsation and complete childhood vaccination in sub-Saharan Africa: a cross-sectional study of 29 nationally representative surveys

“…The dependent variable in this study is complete vaccination, also called full vaccination. Following the WHO recommendations on routine vaccination 27 and based on previous studies, 28 29 we defined complete childhood vaccination as a child who has received one dose of BCG, three doses of pentavalent pneumococcal conjugate, oral polio vaccines, two doses of rotavirus and one dose of measles vaccine. Children who did not get all these vaccines were considered as those with incomplete vaccination.…”

Rural prioritization may increase the impact of COVID-19 vaccines in a representative COVAX AMC country setting due to ongoing internal migration: A modeling study

“…If resources are not intentionally directed to rural areas, urban allocation is likely to be the default strategy throughout SSA and other LMIC. For example, Ameyaw et al examined Demographic and Health Survey data from 2010-2018 and found that children in urban areas were fully vaccinated at higher rates than their rural counterparts (by 53% to 41%, respectively) [38]. While we do not consider other mitigating factors such as the ease of distribution in urban areas, the question of whether to vaccinate a larger, immunologically naive rural population or a smaller, previously exposed urban population encapsulates what we expect is a dilemma that countries may be facing in the near future.…”