Peer-reviewed article
Decomposing the rural–urban gap in factors associated with childhood immunisation in sub-Saharan Africa: evidence from surveys in 23 countries
Edward Kwabena Ameyaw, Yusuf Olushola Kareem, Bright Opoku Ahinkorah, Abdul‐Aziz Seidu, Sanni Yaya ·
Summary
Written by AI, not yet AICS's view · claude-haiku-4-5-20251001This study analyzed immunisation coverage data from over 26,000 children across 23 sub-Saharan African countries to understand why rural children are less likely to be fully immunised than urban children. The research found that 52.8% of urban children were fully immunised compared to only 40.7% of rural children. Three-quarters of this rural-urban gap was explained by differences in household wealth, birth order, maternal characteristics, and distance to health facilities, with household wealth being the largest single factor.
Key points
- Urban immunisation coverage (52.8%) was substantially higher than rural coverage (40.7%) across 23 sub-Saharan African countries
- 76.5% of the rural-urban gap in full childhood immunisation was attributable to differences in child and maternal characteristics
- Household wealth accounted for 35.7% of the immunisation disparity between rural and urban settings
- First and sixth birth orders contributed 7.3% and 14.9% respectively to the disparity
- Distance to health facility accounted for 7.9% of the rural-urban immunisation gap
Limitations
This is a cross-sectional analysis from surveys conducted between 2010 and 2018, so it cannot establish causal relationships or explain temporal changes in immunisation coverage. The study identifies correlations with the rural-urban gap but cannot fully explain all factors driving the disparity, particularly contextual and programmatic barriers.
Abstract
BACKGROUND: About 31 million children in sub-Saharan Africa (SSA) suffer from immunisation preventable diseases yearly and more than half a million children die because of lack of access to immunisation. Immunisation coverage has stagnated at 72% in SSA over the past 6 years. Due to evidence that full immunisation of children may be determined by place of residence, this study aimed at investigating the rural-urban differential in full childhood immunisation in SSA. METHODS: The data used for this study consisted of 26 241 children pooled from 23 Demographic and Health Surveys conducted between 2010 and 2018 in SSA. We performed a Poisson regression analysis with robust Standard Errors (SEs) to determine the factors associated with full immunisation status for rural and urban children. Likewise, a multivariate decomposition analysis for non-linear response model was used to examine the contribution of the covariates to the observed rural and urban differential in full childhood immunisation. All analyses were performed using Stata software V.15.0 and associations with a p<0.05 were considered statistically significant. RESULTS: More than half of children in urban settings were fully immunised (52.8%) while 59.3% of rural residents were not fully immunised. In all, 76.5% of rural-urban variation in full immunisation was attributable to differences in child and maternal characteristics. Household wealth was an important component contributing to the rural-urban gap. Specifically, richest wealth status substantially accounted for immunisation disparity (35.7%). First and sixth birth orders contributed 7.3% and 14.9%, respectively, towards the disparity while 7.9% of the disparity was attributable to distance to health facility. CONCLUSION: This study has emphasised the rural-urban disparity in childhood immunisation, with children in the urban settings more likely to complete immunisation. Subregional, national and community-level interventions to obviate this disparity should target children in rural settings, those from poor households and women who have difficulties in accessing healthcare facilities due to distance.