Adedokun, Sulaimon, Uthman, Olalekan A., Adekanmbi, Victor and Wiysonge, Charles S. (2017) Incomplete childhood immunization in Nigeria : a multilevel analysis of individual and contextual factors. BMC Public Health, 17 (236). ISSN 1471-2458.

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Abstract

Background: Under-five mortality remains high in sub-Saharan Africa despite global decline. One quarter of these deaths are preventable through interventions such as immunization. The aim of this study was to examine the independent effects of individual-, community- and state-level factors on incomplete childhood immunization in Nigeria, which is one of the 10 countries where most of the incompletely immunised children in the world live.
Methods: The study was based on secondary analyses of cross-sectional data from the 2013 Nigeria Demographic and Health Survey (DHS). Multilevel multivariable logistic regression models were applied to the data on 5,754 children aged 12–23 months who were fully immunized or not (level 1), nested within 896 communities (level 2) from 37 states (level 3).
Results: More than three-quarter of the children (76.3%) were not completely immunized. About 83% of children of young mothers (15–24 years) and 94% of those whose mothers are illiterate did not receive full immunization. In the fully adjusted model, the chances of not being fully immunized reduced for children whose mothers attended antenatal clinic (adjusted odds ratio [aOR] = 0.49; 95% credible interval [CrI] = 0.39–0.60), delivered in health facility (aOR = 0.62; 95% CrI = 0.51–0.74) and lived in urban area (aOR = 0.66; 95% CrI = 0.50–0.82). Children whose mothers had difficulty getting to health facility (aOR = 1.28; 95% CrI = 1.02–1.57) and lived in socioeconomically disadvantaged communities (aOR = 2.93; 95% CrI = 1.60–4.71) and states (aOR = 2.69; 955 CrI =1.37–4.73) were more likely to be incompletely immunized.
Conclusions: This study has revealed that the risk of children being incompletely immunized in Nigeria was influenced by not only individual factors but also community- and state-level factors. Interventions to improve child immunization uptake should take into consideration these contextual characteristics.

Item Type:	Journal Article
Subjects:	R Medicine > RA Public aspects of medicine > RA0421 Public health. Hygiene. Preventive Medicine
Divisions:	Faculty of Science, Engineering and Medicine > Medicine > Warwick Medical School > Health Sciences Faculty of Science, Engineering and Medicine > Medicine > Warwick Medical School > Health Sciences > Population, Evidence & Technologies (PET) Faculty of Science, Engineering and Medicine > Medicine > Warwick Medical School
Library of Congress Subject Headings (LCSH):	Immunization of children, Immunization of children--Nigeria
Journal or Publication Title:	BMC Public Health
Publisher:	BioMed Central Ltd.
ISSN:	1471-2458
Official Date:	8 March 2017
Dates:	Date Event 8 March 2017 Published 15 February 2017 Accepted 29 June 2016 Submitted
Volume:	17
Number:	236
Status:	Peer Reviewed
Publication Status:	Published
Access rights to Published version:	Open Access (Creative Commons)
Date of first compliant deposit:	9 March 2017
Date of first compliant Open Access:	10 March 2017
Funder:	Warwick Medical School, Wellcome Trust (London, England), Carnegie Corporation of New York, Styrelsen för Internationellt Utvecklingssamarbete (SIDA)
Grant number:	087547/Z/08/Z (Wellcome Trust), B 8606.R02 (Carnegie), 54100029 (SIDA)

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