Peer-reviewed article
Systematic review of social determinants of childhood immunisation in low- and middle-income countries and equity impact analysis of childhood vaccination coverage in Nigeria
Sarah V Williams, Tanimola Makanjuola Akande, Kaja Abbas ·
Summary
Written by AI, not yet AICS's view · claude-haiku-4-5-20251001This study identifies the social and economic factors that create inequities in childhood vaccination coverage in Nigeria. Using data from 6,059 children aged 12-23 months, researchers found that only 31% of children received basic vaccines, with 19% receiving no vaccines at all. Key barriers included poverty, lack of maternal education, young maternal age, no antenatal care, and home birth rather than facility birth. The study recommends targeted approaches to reach the most disadvantaged children.
Key points
- Only 31% of children aged 12-23 months in Nigeria had received basic vaccination coverage, with 19% receiving no vaccines at all
- Children from the wealthiest households were 3.2 times more likely to be vaccinated than those from the poorest households
- Mothers with 4+ antenatal care visits were 2.87 times more likely to have their children vaccinated compared to those with no antenatal care
- Maternal education and age were significant factors: children of mothers aged 35-49 years were 2.25 times more likely to be vaccinated than those with mothers aged 15-19 years
- Children of Fulani ethnicity had lower vaccination odds compared to Igbo children, indicating ethnic disparities in immunisation coverage
Limitations
The analysis is cross-sectional, so it cannot establish causation between the identified determinants and vaccination coverage. The study does not evaluate an intervention or provide information about barriers at the health system level or specific implementation challenges in vaccine delivery.
Abstract
BACKGROUND: Nigeria has a high proportion of the world's underimmunised children. We estimated the inequities in childhood immunisation coverage associated with socioeconomic, geographic, maternal, child, and healthcare characteristics among children aged 12-23 months in Nigeria using a social determinants of health perspective. METHODS: We conducted a systematic review to identify the social determinants of childhood immunisation associated with inequities in vaccination coverage among low- and middle-income countries. Using the 2018 Nigeria Demographic and Health Survey (DHS), we conducted multiple logistic regression to estimate the association between basic childhood vaccination coverage (1-dose BCG, 3-dose DTP-HepB-Hib (diphtheria, tetanus, pertussis, hepatitis B and Haemophilus influenzae type B), 3-dose polio, and 1-dose measles) and socioeconomic, geographic, maternal, child, and healthcare characteristics in Nigeria. RESULTS: From the systematic review, we identified the key determinants of immunisation to be household wealth, religion, and ethnicity for socioeconomic characteristics; region and place of residence for geographic characteristics; maternal age at birth, maternal education, and household head status for maternal characteristics; sex of child and birth order for child characteristics; and antenatal care and birth setting for healthcare characteristics. Based of the 2018 Nigeria DHS analysis of 6,059 children aged 12-23 months, we estimated that basic vaccination coverage was 31% (95% CI: 29-33) among children aged 12-23 months, whilst 19% (95% CI:18-21) of them were zero-dose children who had received none of the basic vaccines. After controlling for background characteristics, there was a significant increase in the odds of basic vaccination by household wealth (AOR: 3.21 (2.06, 5.00), p < 0.001) for the wealthiest quintile compared to the poorest quintile, antenatal care of four or more antenatal care visits compared to no antenatal care (AOR: 2.87 (2.21, 3.72), p < 0.001), delivery in a health facility compared to home births (AOR 1.32 (1.08, 1.61), p = 0.006), relatively older maternal age of 35-49 years compared to 15-19 years (AOR: 2.25 (1.46, 3.49), p < 0.001), and maternal education of secondary or higher education compared to no formal education (AOR: 1.79 (1.39, 2.31), p < 0.001). Children of Fulani ethnicity in comparison to children of Igbo ethnicity had lower odds of receiving basic vaccinations (AOR: 0.51 (0.26, 0.97), p = 0.039). CONCLUSIONS: Basic vaccination coverage is below target levels for all groups. Children from the poorest households, of Fulani ethnicity, who were born in home settings, and with young mothers with no formal education nor antenatal care, were associated with lower odds of basic vaccination in Nigeria. We recommend a proportionate universalism approach for addressing the immunisation barriers in the National Programme on Immunization of Nigeria.