Peer-reviewed article
Regional variations of childhood immunisations in Senegal: a multilevel analysis
Sébastien Cortaredona, Rokhaya Diop, Valérie Seror, Luis Sagaon‐Teyssier, Patrick Peretti‐Watel ·
Summary
Written by AI, not yet AICS's view · claude-haiku-4-5-20251001This study analyzed childhood immunisation coverage across Senegal's regions using data from national surveys conducted between 2015 and 2017. Complete immunisation coverage averaged 68% but varied significantly by region, ranging from 41% to 83%. The researchers found that differences between regions were largely explained by individual factors (like household characteristics) and contextual factors (like population density, hospital availability, literacy rates, and access to antenatal care). The study suggests that policies to improve immunisation coverage should target rural and disadvantaged areas.
Key points
- Complete immunisation coverage in Senegal was 68% overall, with substantial regional variation from 41% in Kedougou to 83% in Dakar
- Individual factors (family characteristics) explained 57% of regional variation in immunisation rates
- Regional factors including population density, hospital density, literacy rate, and availability of antenatal care services accounted for most remaining regional differences
- After adjusting for regional contextual factors, geographical variation was no longer statistically significant
- Children in rural and deprived areas face higher risk of incomplete immunisation
Limitations
The study uses cross-sectional survey data and cannot establish causal relationships between contextual factors and immunisation coverage. The analysis is limited to children aged 12-23 months and relies on maternal recall of immunisation status.
Abstract
OBJECTIVES: To estimate geographical variations of child immunisation at the regional level in Senegal, to identify individual and contextual factors that could explain these regional discrepancies, and to measure their effects. METHODS: Data come from the 2015, 2016 and 2017 Senegalese Demographic and Health Survey, a national survey targeting women aged 15-49, with a questionnaire focusing on health and reproductive issues including their children's immunisation status. We restricted the analysis to children aged 12-23 months (n = 4955) and conducted a multilevel logistic regression to assess individual and contextual factors associated with complete immunisation coverage. RESULTS: The complete immunisation coverage rate of children was estimated at 68% and ranged from 41% in the region of Kedougou to 83% in the region of Dakar. The inter-regional variance was significantly different from zero (P = 0.006) in the empty multilevel model. It decreased by more than half (57 %) after adjusting for individual factors but remained significantly different from zero (P = 0.010). Regional variations of complete immunisation rates drastically decreased and were no longer statistically significant (P = 0.343) after adjusting for the following regional factors: population density, density of hospitals, literacy rate and proportion of health facilities with an antenatal care service. CONCLUSIONS: Regarding health policies designed to improve childhood immunisation and to reduce related inequalities, our results highlight the need to take into account both individual and contextual factors, with a focus on rural and deprived areas where children are at higher risk of incomplete immunisation.