BMC Public Health. 2010 Mar 9;10:116.
Migration and child immunization in Nigeria: individual- and community-level contexts.
Antai D. Division of Epidemiology, Institute of Environmental Medicine, Karolinska Institute, Stockholm, Sweden. firstname.lastname@example.org
BACKGROUND: Vaccine-preventable diseases are responsible for severe rates of morbidity and mortality in Africa. Despite the availability of appropriate vaccines for routine use on infants, vaccine-preventable diseases are highly endemic throughout sub-Saharan Africa. Widespread disparities in the coverage of immunization programmes persist between and within rural and urban areas, regions and communities in Nigeria. This study assessed the individual- and community-level explanatory factors associated with child immunization differentials between migrant and non-migrant groups.
METHODS: The proportion of children that received each of the eight vaccines in the routine immunization schedule in Nigeria was estimated. Multilevel multivariable regression analysis was performed using a nationally representative sample of 6029 children from 2735 mothers aged 15-49 years and nested within 365 communities. Odds ratios with 95% confidence intervals were used to express measures of association between the characteristics. Variance partition coefficients and Wald statistic i.e. the ratio of the estimate to its standard error were used to express measures of variation.
RESULTS: Individual- and community contexts are strongly associated with the likelihood of receiving full immunization among migrant groups. The likelihood of full immunization was higher for children of rural non-migrant mothers compared to children of rural-urban migrant mothers. Findings provide support for the traditional migration perspectives, and show that individual-level characteristics, such as, migrant disruption (migration itself), selectivity (demographic and socio-economic characteristics), and adaptation (health care utilization), as well as community-level characteristics (region of residence, and proportion of mothers who had hospital delivery) are important in explaining the differentials in full immunization among the children.
CONCLUSION: Migration is an important determinant of child immunization uptake. This study stresses the need for community-level efforts at increasing female education, measures aimed at alleviating poverty for residents in urban and remote rural areas, and improving the equitable distribution of maternal and child health services.
Arch Pediatr Adolesc Med. 2010 Mar;164(3):243-9.
Association between child immunization and availability of health infrastructure in slums in India.
Ghei K, Agarwal S, Subramanyam MA, Subramanian SV.
Department of Society, Human Development, and Health, Harvard School of Public Health, 677 Huntington Ave., Boston, MA 02115, USA.
Arch Pediatr Adolesc Med. 2010 Mar;164(3):294-6.
OBJECTIVE: To examine the association between presence of an urban health center (UHC) in proximity to a slum and immunization status of slum children in a city in India.
DESIGN: Cross-sectional study.
SETTING: Slums of Agra, India.
PARTICIPANTS: Data were obtained from a baseline survey conducted by the US Agency for International Development Environmental Health Project in 2005 in slums in Agra. The study population consisted of 1728 children aged 10 to 23 months. Information about children’s immunization was obtained from interviews with mothers aged 15 to 44 years. Main Exposure Availability and proximity to a UHC that provides immunization services.
MAIN OUTCOME MEASURES: Immunization status of children, which was measured as “complete” if the child had received 1 dose of BCG vaccine, 3 doses each of diphtheria, pertussis, and tetanus and oral polio vaccines, and 1 dose of measles vaccine; “partial” if any 1 or more vaccines were missing; and “not” if no vaccine was received. Adjusted relative risk ratios compared children receiving complete or partial immunization with those not immunized.
RESULTS: Adjusted models showed that presence of a UHC within 2 km of a slum was associated with more than twice the likelihood of children being completely (relative risk ratio, 2.03; 95% confidence interval, 1.12-3.66) or partially (relative risk ratio, 2.33; 95% confidence interval, 1.55-3.50) immunized.
CONCLUSIONS: We found that presence of a UHC was positively associated with immunization status of children in slums. These results suggest a need for greater public attention to expand coverage of slums through UHCs.