Factors associated with completion of childhood immunization in Malawi: a multilevel analysis of the 2015-16 Malawi demographic and health survey

Ntenda, P. A. M., Nkoka, O., Nana, A. W., Majoni, P., Mhone, T. G., Tizifa, T., Mwenyenkulu, E. T., Kazambwe, J. F., Putthanachote, N. and Motsa, M. P. S. (2019) Factors associated with completion of childhood immunization in Malawi: a multilevel analysis of the 2015-16 Malawi demographic and health survey. Transactions of the Royal Society of Tropical Medicine and Hygiene, 113(9), pp. 534-544. (doi: 10.1093/trstmh/trz029) (PMID:31034078)

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.

• Item Type: Articles
• Status: Published
• Refereed: Yes
• Glasgow Author(s) Enlighten ID: Nkoka, Dr Owen
• Authors: Ntenda, P. A. M., Nkoka, O., Nana, A. W., Majoni, P., Mhone, T. G., Tizifa, T., Mwenyenkulu, E. T., Kazambwe, J. F., Putthanachote, N., and Motsa, M. P. S.
• College/School: College of Medical Veterinary and Life Sciences > School of Health & Wellbeing > Robertson Centre
• Journal Name: Transactions of the Royal Society of Tropical Medicine and Hygiene
• Publisher: Oxford University Press
• ISSN: 0035-9203
• ISSN (Online): 1878-3503
• Published Online: 29 April 2019
• Copyright Holders: Copyright © 2019 Oxford University Press
• First Published: First published in Transactions of the Royal Society of Tropical Medicine and Hygiene 113(9):534-544
• Publisher Policy: Reproduced in accordance with the copyright policy of the publisher