Objective To examine the impact of maternal healthcare (MHC) utilisation on routine immunisation coverage of children in Nigeria. Design Individual level cross-sectional study using bivariate and multivariable logistic regression analyses to examine the association between MHC utilisation and routine immunisation coverage of children. Setting Nigeria Demographic and Health Survey 2013. Participants 5506 women aged 15–49 years with children aged 12–23 months born in the 5 years preceding the survey. Primary outcome measures Fully immunised children and not fully immunised children. Results The percentage of children fully immunised with basic routine childhood vaccines by the age of 12 months was 25.8%. Antenatal care (ANC) attendance irrespective of the number of visits (adjusted OR (AOR) 1–3 visits 2.4, 95% CI 1.79 to 3.27; AOR 4–7 visits 3.2, 95% CI 2.52 to 4.13; AOR ≥ 8 visits 3.5, 95% CI 2.64 to 4.50), skilled birth attendance (SBA) (AOR 1.9, 95% CI 1.65 to 2.35); and maternal postnatal care (PNC) (AOR 1.7, 95% CI 1.46 to 2.06) had positive effects on the child being fully immunised after adjusting for covariates (except for each other, ie, ANC, SBA and PNC). Further analyses (adjusting stepwise for each MHC service) showed a mediation effect that led to the effect of PNC not being significant. Conclusions The percentage of fully immunised children in Nigeria was very low. ANC attendance, SBA and maternal PNC attendance had positive impact on the child being fully immunised. The findings suggest that strategies aimed at maximising MHC utilisation in Nigeria could be effective in achieving the national coverage target of at least 80% for routine immunisation of children.
BACKGROUND: Routine childhood immunisation is one of the most important life-saving public health interventions. However, many children still have inadequate access to these vaccines and millions remain (partially) unvaccinated globally. As the COVID-19 pandemic disrupted health systems worldwide, its effects on immunisation have become apparent. This study aimed to estimate routine immunisation coverage among children under two in Sierra Leone and to identify factors associated with incomplete immunisation during the COVID-19 pandemic. METHODS: A cross-sectional household survey was conducted in three districts in Sierra Leone: Bombali, Tonkolili and Port Loko. A three-stage cluster sampling method was followed to enrol children aged 10-23 months. Information regarding immunisation status was based on vaccination cards or caretaker's recall. Using WHO's definition, a fully immunised child received one BCG dose, three oral polio vaccine doses, three pentavalent vaccine doses and one measles-containing vaccine dose. Following the national schedule, full immunisation status can be achieved at 9 months of age. Data were weighted to reflect the survey's sampling design. Associations between incomplete immunisation and sociodemographic characteristics were assessed through multivariable logistic regression. RESULTS: A total of 720 children were enrolled between November and December 2021. Full vaccination coverage was estimated at 65.8% (95% CI 60.3%-71.0%). Coverage estimates were highest for vaccines administered at birth and decreased with doses administered subsequently. Adjusting for age, the lowest estimated coverage was 40.7% (95% CI 34.5%-47.2%) for the second dose of the measles-containing vaccine. Factors found to be associated with incomplete immunisation status were: living in Port Loko district (aOR = 3.47, 95% CI = 2.00-6.06; p-value < 0.001), the interviewed caretaker being Muslim (aOR = 1.94, 95% CI = 1.25-3.02; p-value = 0.015) and the interviewed caretaker being male (aOR = 1.93, 95% CI = 1.03-3.59, p-value = 0.039). CONCLUSION: Though full immunisation coverage at district level improved compared with pre-pandemic district estimates from 2019, around one in three surveyed children had missed at least one basic routine vaccination and over half of eligible children had not received the recommended two doses of a measles-containing vaccine. These findings highlight the need to strengthen health systems to improve vaccination uptake in Sierra Leone, and to further explore barriers that may jeopardise equitable access to these life-saving interventions.
Myrte Wassenaar, Augustin Eric Fombah, Haily Chen et al.
BACKGROUND: Child healthcare services such as diphtheria-tetanus-pertussis (DPT3) vaccination are known to reduce childhood mortality and morbidity. However, inequalities in access to these services in developing countries continue to constrain global efforts aimed at improving child health. This study examines the impact and equity effect of a community-based primary healthcare programme known as the Ghana Essential Health Intervention Programme (GEHIP) on improving the uptake of childhood DPT3 immunisation coverage in a remote rural region of Ghana. METHODS: Using baseline and end-line household survey data collected from mothers, the effect of GEHIP's community-based healthcare programme on DPT3 immunisation coverage is evaluated using difference-in-differences multivariate logistic regression models. Household wealth index and maternal educational attainment were used as equity measures. RESULTS: At end-line, both intervention and comparison districts recorded increases in DPT3 immunisation coverage although intervention districts had a relatively higher coverage than comparison districts (90% versus 88%). While children resident in intervention areas had slightly higher rates than children resident in comparison areas, regression results show that this difference was not statistically significant (DiD = 0.038, p-value = 0.102). There were also no significant equity disparities in the coverage of DPT3 vaccination for both household wealth index and maternal educational attainment. CONCLUSION: DPT3 vaccination coverage in both study arms met the global vaccine action plan targets. However, because estimated effects are not significantly higher among treatment area children than among comparison districts counterparts, no equity/inequity effects of the community-based healthcare programme on DPT 3 coverage is evident.
Edmund Wedam Kanmiki, Abdullah Al Mamun, James F. Phillips et al.
Data from the 2016-17 Multiple Indicator Cluster Survey from Nigeria are used to study the relationship between child stature, mother's years of education, and indicators of early childhood development (ECD). The relationships are contrasted between two empirical approaches: the conventional approach whereby control variables are selected in an ad-hoc manner, and the double machine-learning (DML) approach that employs data-driven methods to select controls from a much wider set of variables and thus reducing potential omitted variable bias. Overall, the analysis confirms that maternal education and the incidence of chronic malnutrition have a significant direct effect on measures of early childhood development. The point estimates based on the ad-hoc specification tend to be larger in absolute value than those based on the DML specification. Frequently, the point estimates based on the ad-hoc specification fall inside the confidence interval of the DML point estimates, suggesting that in these cases the omitted variable bias is not serious enough to prevent making causal inferences based on the ad-hoc specification. However, there are instances where the omitted variable bias is sufficiently large for the ad hoc specification to yield a statistically significant relationship when in fact the more robust DML specification suggests there is none. The DML approach also reveals a more complex picture that highlights the role of context. In rural areas, mother's education affects early childhood development both directly and indirectly through its impact on the nutritional status of both older and younger children. In contrast, in urban areas, where the average level of maternal education is much higher, increases in a mother's education have only a direct effect on child ECD measures but no indirect effect through child nutrition. Thus, DML provides a practical and feasible approach to reducing threats to internal validity for robust inferences and policy design based on observational data.
Abstract Background Child vaccination is recognised as a mechanism to improve child survival and health by reducing child deaths. However, there are significant inequalities in the coverage of different childhood vaccinations in both urban and rural areas. In this article, we examine the inequalities between rural and urban areas in the vaccination of children in Togo. Methods Using data from the 2017 MICS6 Survey, we examine the probability that a child aged 12–59 months will receive the required vaccinations and break down the sources of inequalities in immunisation coverage between rural and urban areas. This is done using the Oaxaca-Blinder decomposition technique, which identifies the sources and factors that explain differences in outcomes between groups. Results Analysis of the results shows that the characteristics of the child, the mother and the household influence the immunization status of the child. For example, children in rural areas are more likely to complete the required vaccinations. We find that a pro urban advantage in characteristics is observed. Conclusion There is also a need to specifically target vulnerable children in urban areas, in order to maintain the focus on women's empowerment and to pay special attention to children from poor households.
Abstract This paper aims to analyze the effect of inequality of opportunity on early childhood development in Togo. To achieve this objective, we use a logit model to obtain the conditional probabilities of the study circumstances. Based on these probabilities, we construct dissimilarity indices with the parametric approach and then apply Shapley decomposition using data from the Multiple Indicator Cluster Survey (MICS) conducted in Togo in 2017. The results obtained show that inequalities in opportunities slow early childhood development. The Shapley decomposition reveals that region of residence, ownership of agricultural land and mother's education contribute most to inequalities in early childhood development dimensions at 57.58%, 25.50% and 28.77%, respectively. Additionally, the return to an equal situation between children characterized by good health, better nutrition and good social and emotional cognitive development and those in poor condition is conditioned by the reallocation of 12.4% of the inequalities of the first group of children to the second group. Strengthening the coordination of agricultural activities and the provision of safe water to rural households is essential to improve the level of the early childhood development indicator. JEL Classification: D30, D63, I14, I15
Aim: This study examined the nexus between mother's education and nutritional status and their relationships with child stunting, wasting, underweight, and overweight. Methods: The data of 34,193 under-five (U-5) children from the 2018 Nigeria Demographic and Health Survey (NDHS) were analyzed using descriptive statistics, and binary and complementary log-logistic regression models. Results: The prevalence of child stunting, wasting, underweight, and overweight were 36.51%, 6.92%, 21.73%, and 2.05%, respectively. Compared to children born to mothers with at least secondary education, uneducated women's children (odds ratio (OR) = 1.55; 95% confidence interval (CI) = 1.32–1.82) and those of women with primary education (OR = 1.49; 95% CI = 1.28–1.72) were more likely to be stunted. Similarly, children born to uneducated women (OR = 1.51; 95% CI = 1.24–1.83) were more likely to be underweight than women with at least secondary education. The likelihood of child underweight (OR = 1.71; 95% CI = 1.45–2.01) and wasting (rate ratio (RR) = 1.82; 95% CI = 1.47–2.26) were higher among underweight mothers, respectively, than those with normal body mass index (BMI). The likelihood of child stunting (OR = 0.75; 95% CI = 0.67–0.84) and underweight (OR = 0.66; 95% CI = 0.57–0.77) were lower among obese/overweight mothers compared to those with normal BMI, but their children were more likely to be overweight (RR = 1.77; 95% CI = 1.27–2.48). Conclusion: Attainment of higher education by mothers should be promoted to prevent childhood nutritional imbalances, and sensitization on healthy dietary habits and lifestyles should be promoted among women, especially the overweight/obese, to reduce their risk of having overweight children.
Saheed Akinmayọwa Lawal, David Aduragbemi Okunlola, Oyelola Abdulwasiu Adegboye et al.
Maternal mental health distress has a disease burden of severe adverse effects for both mother and child. This review identified maternal mental health concerns, their impact on child growth and the current practice of maternal healthcare for both mothers and their children in Nigeria. The Population, phenomenon of Interest and Context (PICo) model was adopted to formulate the review strategy, and five databases were searched for published articles between 1999 and 2019. Databases include Scopus, PubMed, ProQuest, Applied Social Science Index and Abstracts and Web of Science. Boolean operators (AND/OR/NOT) helped to ensure rigorous use of search terms which include 'maternal', 'pre/peri/postnatal', 'mental health', 'mental illness', 'disorders', 'intervention,' 'Nigeria', 'child', 'infant growth', and 'wellbeing'. Thirty-four studies met the inclusion criteria, and extracted data were qualitatively synthesised and analysed thematically. Five themes emerged. These include (i) marital difficulties, (ii) relationship status of the mother, (iii) child's gender, (iv) mode of child delivery and (v) child growth and development. The review showed a significant paucity of literature on the impact of specific maternal mental health problems on child physical growth and cognitive development. We concluded that culturally appropriate and evidence-based psychological interventions for maternal mental health problems would benefit Nigerian indigenous mothers. Therefore, the study recommends randomised controlled trials that are culturally appropriate and cost-effective for distressed mothers with children.
Dung Ezekiel Jidong, Nusrat Husain, Tarela Juliet Ike et al.
This paper is written by authors to primarily look at ‘concepts, causes and institutional response to child labour in Ghana’. Methodologically, this paper adopted a desktop review approach which relied its sources of information mainly from secondary data and related literatures on the subject. The paper revealed that, some of the challenges of child labour are frequent illness, attempts of rape, financial difficulty and many others. It is therefore concluded that, stakeholders should continue their participation in eradicating child labour and their support, increasing enrollment and classroom attendance participation. It was in agreement that the media and other concern bodies like the Commission for Human Rights and Administrative Justice (CHRAJ), Community Based Organizations (CBOs) and traditional rulers should increase campaign and education against child labour and intensified publicity of the criminal nature of child labour. It is strongly recommended that single parents in local communities especially women should be empowered to financially and vocationally through free vocational and financial management training to provide enough avenues for single parent (women) to cater for their children’s education. Government and stakeholders should implement policies aimed at promoting classroom enrollment, classroom attendance and classroom participation. If these recommendations given are feasibly implemented, searching for every day in African and Ghanaian childhoods would be reduced if not curbed.
In contexts where child labour is pervasive, household decisions about allocating children's time between school and work involve a trade-off: current returns from child labour versus future returns from education. This paper tests for the existence of a third factor: future returns from child labour, as parents view farm work as an investment in agricultural skills. We provide evidence on each component of this trade-off in the context of rural Ghana by leveraging four waves of survey data on 5,000 households, exogenous shocks to agricultural productivity, and a vignette survey design to elicit parental beliefs.
