Peer-reviewed article
The role of place of residency in childhood immunisation coverage in Nigeria: analysis of data from three DHS rounds 2003–2013
Olayinka Aderopo Obanewa, Marie‐Louise Newell ·
Summary
Written by AI, not yet AICS's view · claude-haiku-4-5-20251001This study analysed data from three Nigerian Demographic and Health Surveys (2003, 2008, 2013) to understand why childhood immunisation coverage remains low and varies by where children live. Researchers found that fully-immunised child coverage increased over the decade but remained much lower in rural areas (7.4% to 15.8%) than urban formal areas (25.6% to 45.5%) and slums (24.9% to 38.5%). Maternal education and place of delivery at health facilities were the strongest factors associated with immunisation, with the largest potential gains from improving maternal education. The study highlights that while rural gaps reflect lack of health facilities, urban disparities need further investigation.
Key points
- Fully-immunised child coverage in Nigeria roughly doubled from 2003 to 2013 but remained lowest in rural areas (15.8% vs 45.5% in urban formal areas)
- Maternal higher education was the strongest predictor of immunisation coverage across all settings, with potential to increase coverage by 38.15 percentage points in rural areas, 22.88 in urban formal, and 23.76 in slums
- Delivery at a health facility was significantly associated with immunisation in all settings, but the effect was strongest in slums (adjusted odds ratio 5.39)
- Antenatal care attendance was strongly protective; non-attendance was estimated to cause the largest reduction in immunisation coverage
- Intra-urban disparities between formal urban areas and slums remain largely unexplained and require qualitative and interventional research
Limitations
The study is observational and cannot establish causation. The analysis cannot explain why disparities exist between urban formal areas and slums despite similar facility access, and qualitative research would be needed to understand the mechanisms behind these differences.
Abstract
BACKGROUND: In 2017, about 20% of the world's children under 1 year of age with incomplete DPT vaccination lived in Nigeria. Fully-immunised child coverage (FIC), which is the percentage of children aged 12-23 months who received all doses of routine infant vaccines in their first year of life in Nigeria is low. We explored the associations between child, household, community and health system level factors and FIC, in particular focussing on urban formal and slum, and rural residence, using representative Nigeria Demographic Health Survey (NDHS) data from 2003, 2008 and 2013. METHOD: Multilevel logistic regression models were applied for quantitative analyses of NDHS 2003, 2008 and 2013 data, singly, pooled overall and stratified by rural/urban, and within urban by formal and slum. We also quantify Population Attributable Risk (PAR) of FIC. RESULTS: FIC for rural, urban formal and slum rose from 7.4, 25.6 and 24.9% respectively in 2003 to 15.8, 45.5 and 38.5% in 2013, and varied across sociodemographics. In pooled NDHS analysis, overall and stratified, final FIC adjusted odds (aOR) were: 1. Total population - delivery place (health facility vs home, aOR = 1.13, 95% CI = 0.73-1.73), maternal education (higher vs no education, aOR = 3.92, 95% CI = 1.79-8.59) and place of residence (urban vs rural, aOR = 1.69, 95% CI = 0.89-3.22). 2. Rural, urban formal and slum stratified: A.Rural - delivery place (aOR = 1.47, 95% CI = 1.12-1.94), maternal education (aOR = 4.99, 95% CI = 2.48-10.06). B.Urban formal - delivery place (aOR = 2.62, 95% CI = 1.43-4.79), maternal education level (aOR = 9.18, 95% CI = 3.05-27.64). C.Slums - delivery place (aOR = 5.39, 95% CI = 2.18-13.33), maternal education (aOR = 5.03, 95% CI = 1.52-16.65). The PAR revealed the highest percentage point increase in FIC would be achieved in all places of residence by maternal higher education: rural-38.15, urban formal-22.88 and slum 23.76, while non-attendance of antenatal care was estimated to lead to the largest reduction in FIC. CONCLUSION: Although low FIC in rural areas may be largely due to lack of health facilities and immunisation education, the intra-urban disparity is mostly unexplained, and requires further qualitative and interventional research. We show the FIC point increase that can be achieved if specific sociodemographic variable (risk) are addressed in the various communities, thus informing prioritisation of interventions.