Starting then stopping: a nationwide register-based study on the magnitude, predictors, and urban-rural patterns of under-vaccination variation across health centers in The Gambia
Objectives Six million children were under-vaccinated in 2022. Our study aimed to 1) quantify the magnitude of under-vaccination variation between health facilities, 2) assess to which extent individual and health center level factors contributed to the variation, 3) identify individual and health f...
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| Format: | Article |
| Language: | English |
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Taylor & Francis Group
2024-12-01
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| Series: | Global Health Action |
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| Online Access: | http://dx.doi.org/10.1080/16549716.2024.2348788 |
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| author | Alieu Sowe Fredinah Namatovu Bai Cham Per E. Gustafsson |
| author_facet | Alieu Sowe Fredinah Namatovu Bai Cham Per E. Gustafsson |
| author_sort | Alieu Sowe |
| collection | DOAJ |
| description | Objectives Six million children were under-vaccinated in 2022. Our study aimed to 1) quantify the magnitude of under-vaccination variation between health facilities, 2) assess to which extent individual and health center level factors contributed to the variation, 3) identify individual and health facility factors associated with under-vaccination, and 4), explore rural vs. urban health facility variations. Methods We used data from 61,839 children from The Gambia national routine vaccination register. We cross tabulated under-vaccination status across study variables and fitted two-level random intercept multilevel logistic regression models to measure variance, contribution to the variance, and factors associated with the variance and under-vaccination. Results We found that 7% of the prevalence of under-vaccination was due to variation between health facilities. Thirty-seven percent of the variation was explained by individual and health center variables. The variables explained 36% of the variance in urban and 19% in rural areas. Children who were not vaccinated at 4 months or with delayed history, due for vaccination in the rainy season, and health facilities with very small or large population to health worker ratios had higher under-vaccination odds. Conclusion Our study indicates that one of the pathways to improving vaccination coverage is addressing factors driving under-vaccination inequities between health facilities through urban-rural differentiated strategies. |
| format | Article |
| id | doaj-art-6e79d666757f4123a944f415e21d1a47 |
| institution | Kabale University |
| issn | 1654-9880 |
| language | English |
| publishDate | 2024-12-01 |
| publisher | Taylor & Francis Group |
| record_format | Article |
| series | Global Health Action |
| spelling | doaj-art-6e79d666757f4123a944f415e21d1a472025-02-05T12:46:13ZengTaylor & Francis GroupGlobal Health Action1654-98802024-12-0117110.1080/16549716.2024.23487882348788Starting then stopping: a nationwide register-based study on the magnitude, predictors, and urban-rural patterns of under-vaccination variation across health centers in The GambiaAlieu Sowe0Fredinah Namatovu1Bai Cham2Per E. Gustafsson3Umeå UniversityUmeå UniversityMedical Research Council Unit The Gambia at the London School of Hygiene and Tropical MedicineUmeå UniversityObjectives Six million children were under-vaccinated in 2022. Our study aimed to 1) quantify the magnitude of under-vaccination variation between health facilities, 2) assess to which extent individual and health center level factors contributed to the variation, 3) identify individual and health facility factors associated with under-vaccination, and 4), explore rural vs. urban health facility variations. Methods We used data from 61,839 children from The Gambia national routine vaccination register. We cross tabulated under-vaccination status across study variables and fitted two-level random intercept multilevel logistic regression models to measure variance, contribution to the variance, and factors associated with the variance and under-vaccination. Results We found that 7% of the prevalence of under-vaccination was due to variation between health facilities. Thirty-seven percent of the variation was explained by individual and health center variables. The variables explained 36% of the variance in urban and 19% in rural areas. Children who were not vaccinated at 4 months or with delayed history, due for vaccination in the rainy season, and health facilities with very small or large population to health worker ratios had higher under-vaccination odds. Conclusion Our study indicates that one of the pathways to improving vaccination coverage is addressing factors driving under-vaccination inequities between health facilities through urban-rural differentiated strategies.http://dx.doi.org/10.1080/16549716.2024.2348788vaccinationcoverageunder immunizedinequalityequity |
| spellingShingle | Alieu Sowe Fredinah Namatovu Bai Cham Per E. Gustafsson Starting then stopping: a nationwide register-based study on the magnitude, predictors, and urban-rural patterns of under-vaccination variation across health centers in The Gambia Global Health Action vaccination coverage under immunized inequality equity |
| title | Starting then stopping: a nationwide register-based study on the magnitude, predictors, and urban-rural patterns of under-vaccination variation across health centers in The Gambia |
| title_full | Starting then stopping: a nationwide register-based study on the magnitude, predictors, and urban-rural patterns of under-vaccination variation across health centers in The Gambia |
| title_fullStr | Starting then stopping: a nationwide register-based study on the magnitude, predictors, and urban-rural patterns of under-vaccination variation across health centers in The Gambia |
| title_full_unstemmed | Starting then stopping: a nationwide register-based study on the magnitude, predictors, and urban-rural patterns of under-vaccination variation across health centers in The Gambia |
| title_short | Starting then stopping: a nationwide register-based study on the magnitude, predictors, and urban-rural patterns of under-vaccination variation across health centers in The Gambia |
| title_sort | starting then stopping a nationwide register based study on the magnitude predictors and urban rural patterns of under vaccination variation across health centers in the gambia |
| topic | vaccination coverage under immunized inequality equity |
| url | http://dx.doi.org/10.1080/16549716.2024.2348788 |
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