Do Maternal Living Arrangements Influence the Vaccination Status of Children Age 12–23 Months? A Data Analysis of Demographic Health Surveys 2010–11 from Zimbabwe

<div><p>Introduction</p><p>Although vaccination is an effective intervention to reduce childhood mortality and morbidity, reasons for incomplete vaccination, including maternal living arrangements, have been marginally explored. This study aims at assessing whether maternal living arrangements are associated with vaccination status of children aged 12–23 months in Zimbabwe. It also explores other variables that may be associated with having children not fully vaccinated.</p><p>Materials and Methods</p><p>A cross-sectional analysis was performed on the DHS-VI done in Zimbabwe in 2010–2011 (response rate 93%). Incomplete vaccination of children (outcome), was defined as not having received one dose of BCG and measles, 3 doses of polio and DPT/Pentavalent. Maternal living arrangements (main exposure), and other exposure variables were analysed. Survey logistic regression was used to calculate crude and adjusted OR for exposures against the outcome.</p><p>Results</p><p>The dataset included 1,031 children aged 12–23 months. 65.8% of children were fully vaccinated. 65.7% of the mothers were married and cohabitating with a partner, 20.3% were married/partnered but living separately and 14% were not married. Maternal living arrangements were not associated with the vaccination status of children both in crude and adjusted analysis. Factors associated with poorer vaccination status of the children included: no tetanus vaccination for mothers during pregnancy (adjusted OR = 2.1, 95%CI 1.5;3.0), child living away from mother (adjusted OR = 1.5, 95%CI 1.2;1.8), mother’s education (adjusted OR = 0.6, 95%CI 0.4;0.9), high number of children living in the household (adjusted OR = 1.5, 95%CI 1.1;2.2), child age (adjusted OR = 0.7, 95%CI 0.5;0.9).</p><p>Discussion</p><p>Maternal living arrangements were not associated with vaccination status of Zimbabwean children. Other factors, such as the mother’s health-seeking behaviour and education were major factors associated with the children’s vaccination status. Given the results of this study, it is strongly recommended that the vaccination coverage is increased by improving access to antenatal care and education for the parents.</p></div

Crude and adjusted association between different mother-related variables and the child not being fully vaccinated.

<p>This is Table 5 legend</p><p>*OR adjusted for the other variables in the table</p><p>§p-value from Wald Test.</p><p>Measure of effect expressed as Odds Ratio (OR) from survey-accounted logistic regression.</p

Percentage distribution of mother-level variables and percentages of fully vaccinated children for each variable’s level.

<p>This is Table 2 legend</p><p>Frequencies are unweighted (N = 1031, unless otherwise indicated), percentages and their 95%CI are weighted.</p><p>*weighted percentages accounting survey design</p><p>§p-values from Pearson Test.</p><p>Percentage distribution of mother-level variables and percentages of fully vaccinated children for each variable’s level.</p

Conceptual hierarchical framework of risk factors for not being fully vaccinated in Zimbabwe.

<p>Arrows indicate potential relationships/influence between factors and final outcome.</p

Crude and adjusted association between different household-related variables and the child not being fully vaccinated.

<p>This is Table 6 legend</p><p>*OR adjusted for the other variables in the table</p><p>§p-value from Wald Test.</p><p>Measure of effect expressed as Odds Ratio (OR) from survey-accounted logistic regression.</p

Percentage distribution of children aged 12–23 months and percentage fully vaccinated by selected background characteristics.

<p>This is the Table 1 legend.</p><p>Frequencies are unweighted (N = 1031, unless otherwise indicated), percentages and their 95%CI are weighted. The table includes vaccination status for each antigen.</p><p>*weighted percentages accounting survey design</p><p>§p-values from Pearson Test</p><p>¤Complete course of vaccination for either DPT or Pentavalent were considered since the country was facing a transition (phasing out DPT while introducing Pentavalent) at the time of the DHS survey.</p><p>†A “Fully vaccinated” child has received at least the following doses: 1 dose of BCG, 3 doses of Polio, 3 doses of either DPT or Pentavalent, 1 dose of Measles.</p><p>Percentage distribution of children aged 12–23 months and percentage fully vaccinated by selected background characteristics.</p

Crude (as per Tables 4, 5, and 6) and adjusted OR between different variables and the child not being fully vaccinated.

<p>This is Table 7 legend</p><p>*OR adjusted for the other variables in the table</p><p>§p-value from Wald Test.</p><p>OR from survey-accounted logistic regression.</p

Reported reasons for incomplete vaccination calendar (N = 115 at the 1^st survey, N = 81 at the 2^nd survey)

<p>Reported reasons for incomplete vaccination calendar (N = 115 at the 1^st survey, N = 81 at the 2^nd survey)</p

Vaccination Coverage Cluster Surveys in Middle Dreib – Akkar, Lebanon: Comparison of Vaccination Coverage in Children Aged 12-59 Months Pre- and Post-Vaccination Campaign

<div><p>Introduction</p><p>With the high proportion of refugee population throughout Lebanon and continuous population movement, it is sensible to believe that, in particular vulnerable areas, vaccination coverage may not be at an optimal level. Therefore, we assessed the vaccination coverage in children under 5 in a district of the Akkar governorate before and after a vaccination campaign. During the vaccination campaign, conducted in August 2015, 2,509 children were vaccinated.</p><p>Materials and Methods</p><p>We conducted a pre- and post-vaccination campaign coverage surveys adapting the WHO EPI cluster survey to the Lebanese MoPH vaccination calendar. Percentages of coverage for each dose of each vaccine were calculated for both surveys. Factors associated with complete vaccination were explored.</p><p>Results</p><p>Comparing the pre- with the post-campaign surveys, coverage for polio vaccine increased from 51.9% to 84.3%, for Pentavalent from 49.0% to 71.9%, for MMR from 36.2% to 61.0%, while the percentage of children with fully updated vaccination calendar increased from 32.9% to 53.8%. While Lebanese children were found to be better covered for some antigens compared to Syrians at the first survey, this difference disappeared at the post-campaign survey. Awareness and logistic obstacles were the primary reported causes of not complete vaccination in both surveys.</p><p>Discussion</p><p>Vaccination campaigns remain a quick and effective approach to increase vaccination coverage in crisis-affected areas. However, campaigns cannot be considered as a replacement of routine vaccination services to maintain a good level of coverage.</p></div

Percentage of fully vaccinated children aged 12–59 months for each vaccine and with a complete vaccination calendar, by selected background characteristics and overall at the post-campaign survey

<p>Percentage of fully vaccinated children aged 12–59 months for each vaccine and with a complete vaccination calendar, by selected background characteristics and overall <u>at the post-campaign survey</u></p