Unvaccinated children in years of increasing coverage: how many and who are they? Evidence from 96 low‐ and middle‐income countries

Abstract

Abstractobjective While childhood immunisation coverage levels have increased since the 70s, inequities in coverage between and within countries have been widely reported. Unvaccinated children remain undetected by routine monitoring systems and strikingly unreported. The objective of this study was to provide evidence on the magnitude of the problem and to describe predictors associated with nonvaccination.methods Two hundred and forty-one nationally representative household surveys in 96 countries were analysed. Proportions and changes in time of 'unvaccinated' (children having not received a single dose of vaccine), 'partially vaccinated' and 'fully vaccinated' children were estimated. Predictors of nonvaccination were explored.results The percentage of unvaccinated children was 9.9% across all surveys. 66 countries had more than one survey: 38 showed statistically significant reductions in the proportion of unvaccinated children between the first and last survey, 10 countries showed increases and the rest showed no significant changes. However, while 18 of the 38 countries also improved in terms of partially and fully vaccinated, in the other 20 the proportion of fully vaccinated decreased. The predictors more strongly associated with being unvaccinated were education of the caregiver, education of caregiver's partner, caregiver's tetanus toxoid (TT) status, wealth index and type of family member participation in decision-making when the child is ill. Multivariable logistic regression identified the TT status of the caregiver as the strongest predictors of unvaccinated children. Country-specific summaries were produced and sent to countries.conclusion The number of unvaccinated children is not negligible and their proportion and the predictors of non-vaccination have to be drawn from specific surveys. Specific vaccine indicators cannot properly describe the performance of immunisation programmes in certain situations. National immunisation programmes and national and international immunisation stakeholders should also consider monitoring the proportion of unvaccinated children (i.e. those who have received no vaccines at all) and draw specific plans on the determinants of non-vaccination.

Multi-Year Trend Analysis of Childhood Immunization Uptake and Coverage in Nigeria

“…Others have found poor socioeconomic development, a weak health care system and high socio-cultural barriers to care utilization as associated risk factors for the high rate of maternal and child mortality in Nigeria (Ogunjimi et al, 2012); people's beliefs, attitudes and behavioural practices (Ogunjuyigbe, 2004) add to the burden. Bosch-Capblanch et al (2012) found caregiver's and partner's education, and caregiver's tetanus toxoid status to be strongly associated with being unvaccinated. Also, Kayode et al (2012) reported that the mother's age at first marriage plays an important role in reducing underfive mortality in Nigeria; other favourable practices include health-seeking behaviour, breast-feeding children for more than 18 months, use of contraception, small family size, having one wife, low birth order, normal birth weight, child spacing, living in urban areas and good sanitation.…”

“…In his study, Antai (2009) employed the use of a three-level multi-level logistic regression model to assess the risk factors for childhood immunization in Nigeria in 2003 using DHS data at the child level nested within mothers who were in turn nested within com-munities. Bosch-Capblanch et al (2012) carried out a logistic regression analysis on data from 241 nationally representative household surveys in 96 countries using the unique or most recent survey for each country. They dichotomized the vaccination status as children having not received any vaccination ('unvaccinated') vs children who had received at least one dose (partially vaccinated) of any vaccine and fully vaccinated children.…”

Exposing concerns about vaccination in low- and middle-income countries: a systematic review

“…The quality of studies was assessed using criteria adapted from several quality assessment tools for qualitative (Bedford et al 2013;Critical Appraisal Skills Programme (CASP) 2014) and quantitative studies (Effective Public Health Practice Project 2010; Jackson et al 2005).…”

“…Accomplishing these goals requires efforts at community level and in each tier of health systems and globally. Under-and no-vaccination remains a problem in many countries (Bosch-Capblanch et al 2012), a challenge not only for health systems, but also for communities and families. Vaccination coverage has been increasing in the last decades worldwide; however, Sub-Saharan Africa coverage rates remain constantly below other regions, and countries within it show large disparities in coverage (WHO 2014d).…”

Complete Child Immunisation: A Cluster Analysis of Positive Deviant Regions in Ghana

“…Analysis of 126 documents from the global grey literature cited many barriers of incomplete child vaccinations, including poor access to services, unsupportive health staff attitudes, parents' poor practical knowledge of vaccination, and fear of side effects [23]. On the other hand, antenatal care follow-up, being born in a health facility and wealth index, have been associated with vaccination status [24,25]. The many socio-demographic factors associated with immunisation coverage in recent research include ethnicity and religion [26], caregiver's education [27], household economic status [28,29], maternal health literacy [29], maternal decision latitude [30], use of maternal and child health facilities [27], participation in vaccination campaigns [31] and urban versus rural living [32].…”