Women’s Empowerment and Children’s Complete Vaccination in the Democratic Republic of the Congo: A Cross-Sectional Analysis

Lu, Xinran; Fu, Chuchu; Wang, Qianyun; He, Qiwei; Hee, Jiayi; Takesue, Rie; Tang, Kun

doi:10.3390/vaccines9101117

Cited by 6 publications

(5 citation statements)

References 59 publications

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“…It was evident from this study that the odds of vaccination dropout in children from women with low levels of empowerment was 1.63 higher compared to children from women with high levels of empowerment. This aligns with studies conducted in Mozambique and the Democratic Republic of the Congo ( 51 , 53 ).…”

Section: Discussionsupporting

confidence: 89%

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Vaccination dropout and wealth related inequality among children aged 12–35 months in remote and underserved settings of Ethiopia: a cross-sectional evaluation survey

Shiferie,

Gebremedhin,

Andargie

et al. 2023

Front. Pediatr.

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BackgroundVaccination is one of the most cost-effective public health interventions that prevents millions of deaths. Although immunization coverage is increasing globally, many children in low- and middle-income countries drop out of the vaccination continuum. This study aimed at determining vaccination dropout rates and predictors in children aged 12–35 months in remote and underserved areas of Ethiopia.MethodsThis study was part of a cross-sectional evaluation survey that was conducted in 2022 in Ethiopia. The study settings include pastoralist, developing & newly established regions, conflict affected areas, urban slums, internally displaced populations and refugees. A sample of 3,646 children aged 12–35 months were selected using a cluster sampling approach. Vaccination dropout was estimated as the proportion of children who did not get the subsequent vaccine among those who received the first vaccine. A generalized estimating equation was used to assess determinants of the dropout rate and findings were presented using an adjusted odds ratio with 95% confidence interval. Concentration curve and index were used to estimate wealth related inequality of vaccination dropout.ResultsA total of 3,646 caregivers of children participated in the study with a response rate of 97.7%. The BCG to Penta-3 (52.5%), BCG to MCV-2 (57.4%), and Penta-1 to Penta-3 (43.9%) dropouts were all high. The highest Penta-1 to Penta-3 dropout rate was found in developing regions (60.1%) and the lowest was in urban slums (11.2%). Caregivers who were working outside their homes [AOR (95% CI) = 3.67 (1.24–10.86)], who had no postnatal care follow-up visits [AOR (95%CI) = 1.66 (1.15–2.39)], who did not receive a service from a skilled birth attendant [AOR (95%CI) = 1.64 (1.21–2.27)], who were older than 45 years [AOR (95% CI) = 12.49 (3.87–40.33)], and who were less gender empowered [AOR (95%CI) = 1.63 (1.24–2.15)] had increased odds of Penta-1 to Penta-3 dropout. The odds of dropout for children from poor caregivers was nearly two times higher compared to their wealthy counterparts [AOR (95%CI) = 1.87 (1.38–2.52)].ConclusionVaccination dropout estimates were high among children residing in remote and underserved settings. Poor wealth quintile, advanced maternal age, low women empowerment, and limited utilization of maternity care services contributed to vaccination dropout.

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Section: Discussionsupporting

confidence: 89%

“…Our finding is consistent with studies conducted in Nigeria, Benin, and the Democratic Republic of the Congo. Using a nationally representative data, Ataguba et al stated that existing immunization coverage disparities disproportionately benefited the rich ( 37 , 38 , 52 , 53 ).…”

Section: Discussionmentioning

confidence: 99%

Vaccination dropout and wealth related inequality among children aged 12–35 months in remote and underserved settings of Ethiopia: a cross-sectional evaluation survey

Shiferie,

Gebremedhin,

Andargie

et al. 2023

Front. Pediatr.

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“…A 2015 systematic review found that greater household and healthcare decision-making power by women was associated with higher odds of complete childhood immunization [19]. Subsequent analyses have found similar associations in Kenya [20], Ethiopia [21], and the Democratic Republic of the Congo [22].…”

Section: Introductionmentioning

confidence: 98%

Gender-Related Inequality in Childhood Immunization Coverage: A Cross-Sectional Analysis of DTP3 Coverage and Zero-Dose DTP Prevalence in 52 Countries Using the SWPER Global Index

et al. 2022

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Gender-related barriers to immunization are key targets to improve immunization coverage and equity. We used individual-level demographic and health survey data from 52 low- and middle-income countries to examine the relationship between women’s social independence (measured by the Survey-based Women’s emPowERment (SWPER) Global Index) and childhood immunization. The primary outcome was receipt of three doses of the diphtheria-tetanus-pertussis vaccine (DTP3) among children aged 12–35 months; we secondarily examined failure to receive any doses of DTP-containing vaccines. We summarized immunization coverage indicators by social independence tertile and estimated crude and adjusted summary measures of absolute and relative inequality. We conducted all analyses at the country level using individual data; median results across the 52 examined countries are also presented. In crude comparisons, median DTP3 coverage was 12.3 (95% CI 7.9; 16.3) percentage points higher among children of women with the highest social independence compared with children of women with the lowest. Thirty countries (58%) had a difference in coverage between those with the highest and lowest social independence of at least 10 percentage points. In adjusted models, the median coverage was 7.4 (95% CI 5.0; 9.1) percentage points higher among children of women with the highest social independence. Most countries (41, 79%) had statistically significant relative inequality in DTP3 coverage by social independence. The findings suggest that greater social independence for women was associated with better childhood immunization outcomes, adding evidence in support of gender-transformative strategies to reduce childhood immunization inequities.

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“…Women empowerment and higher socioeconomic standing have a vital role in the promotion of complete immunization of children, as reflected by the study done by Lu Xinran, et al in Congo 15 . In our study, 45.6 % of cases and 64.5% of controls represented empowered mothers for the childhood vaccination.…”

Section: Discussionmentioning

confidence: 99%

“…For sample size calculation, we took 95% twosided significance level (1-alpha), and 90% power. 55% (Educated mothers with incomplete immunization) in cases and 68.6% 15 in control (un-educated mothers with incomplete immunization). A total of 434 patients were enrolled in study; 217 in the case and 217 in the control group.…”

Section: Patients and Methodmentioning

confidence: 97%

Association of Educational Status of Mothers and Incomplete Immunization in Children

Aslam

Farhan

Erum

et al. 2023

ashkmdc

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Objective: To determine the association of educational status of mothers and incomplete immunization in children presented at Tertiary Care Hospital, Karachi. Methods: This Case-control study was conducted at Pediatric department, Abbasi Shaheed Hospital, Karachi; from July 2018 to January 2019. The data were prospectively collected from 434 subjects with consent out of which 217 had an incomplete vaccination status and 217 had completed vaccination status. Case group included unvaccinated children whose mothers were uneducated (mothers were labeled un-educated who were never enrolled in school, madrasa and received primary education), whereas control group included vaccinated children whose mothers were educated (mothers were labeled educated who were enrolled in school, madrasa and received primary education).Quantitative data were presented as simple descriptive statistics giving mean and standard deviation and qualitative variables were presented as frequency and percentages. Chi-square test was applied to compare both groups and the odds ratio was calculated. Effect modifiers were controlled through stratification to see the effect of these on the outcome variable. Using post-stratification chi-square test, a p-value of ?0.05 was considered as significant. Results: A total of 434 (217 cases and 217 controls) were included in this study. The mean age was 3.27±1.79 years (case) and 3.49±1.40 years (controls). Educational status of mothers was assessed verbally. Uneducated mothers are defined as those who did not receive formal education of any level, while educated mothers are defined as those who were enrolled in school or madarsa and received primary education or more. On the basis of which the uneducated mothers in case group were 144 (66.4%) while in control group was 52 (24%).Children with incomplete immunization were 6.25 times more likely to have uneducated mothers than those with complete immunization, after controlling for the other factors. Conclusion: This study has strengthened the value of maternal education in context of complete childhood immunization because acquisition of literacy and health-seeking behavior enhance vaccine uptake for their children.

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Women’s Empowerment and Children’s Complete Vaccination in the Democratic Republic of the Congo: A Cross-Sectional Analysis

Cited by 6 publications

References 59 publications

Vaccination dropout and wealth related inequality among children aged 12–35 months in remote and underserved settings of Ethiopia: a cross-sectional evaluation survey

Vaccination dropout and wealth related inequality among children aged 12–35 months in remote and underserved settings of Ethiopia: a cross-sectional evaluation survey

Gender-Related Inequality in Childhood Immunization Coverage: A Cross-Sectional Analysis of DTP3 Coverage and Zero-Dose DTP Prevalence in 52 Countries Using the SWPER Global Index

Association of Educational Status of Mothers and Incomplete Immunization in Children

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