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Factors associated with completion of childhood immunization in Malawi: a multilevel analysis of the 2015–16 Malawi demographic and health survey
Authors: Peter Austin Morton Ntenda, Owen Nkoka, Andrè Wendindonde Nana, Precious Majoni, Thomas Gabriel Mhone, Tinashe Tizifa, Edward Tisungane Mwenyenkulu, Jane Flora Kazambwe, Nuntiput Putthanachote, and Mfundi President Stam Motsa
Source: Transactions of the Royal Society of Tropical Medicine and Hygiene, Published online 29 April 2019; DOI: 10.1093/trstmh/trz029
Topic(s): Child health
Country: Africa
Published: APR 2019
Abstract: Background Between 2010 and 2015, the percentage of children 12–23 months of age who received full immunization in Malawi decreased from 81% to 76%, prompting us to investigate the factors associated with completion of childhood immunization in Malawi. Methods Using data from the 2015–16 Malawi Demographic and Health Survey, generalized linear mixed models were applied on 3145 children 12–23 months of age nested within 850 communities. Complete immunization was defined as the child having received a Bacillus Calmette-Guerin, three doses of pentavalent vaccine, four doses of oral polio vaccine, three doses of pneumococcal vaccine, two doses of rotavirus vaccine and one dose of measles vaccine before their first birthday. Results Adjusted multilevel regression showed that children born to mothers with either none or one antenatal care visit (adjusted odds ratio [aOR] 0.56 [95% confidence interval {CI} 0.32 to 0.93]) and whose mothers had no card or no longer had a vaccination card (aOR 0.06 [95% CI 0.04 to 0.07]) were less likely to receive complete immunization. In addition, children from the poorest households (aOR 0.60 [95% CI 0.40 to 0.92]) and who resided in communities with a medium (aOR 0.73 [95% CI 0.53 to 0.98]) or high percentage (aOR 0.73 [95% CI 0.53 to 0.99]) of households that perceived the distance to the nearest health facility as a big problem had reduced odds of achieving complete immunization. Furthermore, the findings showed evidence of clustering effects of childhood complete immunization at the community level. Conclusions Our findings show that a series of sociodemographic, health and contextual factors are associated with the completion of childhood vaccination. Therefore interventions that aim at increasing the completion of childhood immunization in Malawi should not only address individual needs, but should also consider contextual factors and the communities addressed in this study. Keywords: complete immunization, contextual factors, Malawi, multilevel analysis, sociodemographic Topic: child, demography, health surveys, immunization, malawi, mothers, vaccination, contextual factors, immunization, childhood, community, multilevel analysis