Peer-reviewed article
Determinants of Parental Immunization Decisions in Africa: Poverty, Education, Healthcare Access, and Community Awareness - A Systematic Review
Kofi Acquah, Kobina Andoh Acquah ·
Summary
Written by AI, not yet AICS's view · claude-sonnet-5This systematic review looked at 27 studies from across Africa to understand why some children do not get vaccinated. It found that poverty, low maternal education, poor access to healthcare, and lack of community awareness are all linked to lower immunisation rates. These factors also interact with and reinforce each other. The authors conclude that improving vaccination coverage requires tackling several of these issues together rather than one at a time.
Key points
- Children from poorer households had 1.8 to 4.2 times lower odds of being immunised.
- Maternal education showed the strongest link to immunisation, with odds ratios of 1.9 to 5.6.
- Healthcare access was associated with odds ratios of 1.6 to 3.8.
- Community awareness had a smaller but significant association, with odds ratios of 1.3 to 1.7.
- The four factors interact with one another, strengthening their combined effect on immunisation decisions.
Limitations
The review does not specify which African countries or age groups were covered, and as a synthesis of existing observational studies it cannot show that these factors cause low immunisation, only that they are associated with it.
Abstract
The rate of immunization in children remains very low in many countries in Africa. The reason for this is identified as poverty, lack of education among mothers, unavailability of healthcare, and lack of community education. However, until now, there does not exist any review in the literature that evaluates the combined effect of these four factors as determinants of childhood immunisation in Africa. Hence, the current systematic review undertaken herein aims to investigate the influence of the previously mentioned determinants of childhood immunisation. In order to accomplish this, a systematic search was carried out in the following databases: PubMed/MEDLINE, Scopus, Web of Science, Google Scholar, African Journals Online. The result of the search was the selection of articles mentioning any number of determinants presented and providing results on childhood immunization. Twenty-seven articles met the inclusion criteria. Poor children had 1.8-4.2 times lower immunization odds. Maternal education had the strongest effect (OR: 1.9-5.6). There were also other significant variables in terms of health care access (OR: 1.6-3.8) and community awareness (OR: 1.3-1.7). Interactions among determinants strengthened their impacts. Poverty, maternal education, healthcare access, and community awareness have an association between one another, whereby these factors act as determinants of immunization decisions in Africa. Hence, there is a need for different/intersectoral approaches based on various determinants to enhance immunization coverage.