Association between childhood immunisation coverage and proximity to health facilities in rural settings: a cross-sectional analysis of Service Provision Assessment 2013–2014 facility data and Demographic and Health Survey 2015–2016 individual data in Malawi
Objectives Despite significant progress in childhood vaccination coverage globally, substantial inequality remains. Remote rural populations are recognised as a priority group for immunisation service equity. We aimed to link facility and individual data to examine the relationship between distance...
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| Format: | Article |
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BMJ Publishing Group
2022-07-01
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| Series: | BMJ Open |
| Online Access: | https://bmjopen.bmj.com/content/12/7/e061346.full |
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| author | Ahmad Reza Hosseinpoor Nicole E Johns Mike Chisema M Carolina Danovaro-Holliday Katherine Kirkby Anne Schlotheuber Messeret Shibeshi Samir V Sodha Boston Zimba |
| author_facet | Ahmad Reza Hosseinpoor Nicole E Johns Mike Chisema M Carolina Danovaro-Holliday Katherine Kirkby Anne Schlotheuber Messeret Shibeshi Samir V Sodha Boston Zimba |
| author_sort | Ahmad Reza Hosseinpoor |
| collection | DOAJ |
| description | Objectives Despite significant progress in childhood vaccination coverage globally, substantial inequality remains. Remote rural populations are recognised as a priority group for immunisation service equity. We aimed to link facility and individual data to examine the relationship between distance to services and immunisation coverage empirically, specifically using a rural population.Design and setting Retrospective cross-sectional analysis of facility data from the 2013–2014 Malawi Service Provision Assessment and individual data from the 2015–2016 Malawi Demographic and Health Survey, linking children to facilities within a 5 km radius. We examined associations between proximity to health facilities and vaccination receipt via bivariate comparisons and logistic regression models.Participants 2740 children aged 12–23 months living in rural areas.Outcome measures Immunisation coverage for the six vaccines included in the Malawi Expanded Programme on Immunization schedule for children under 1 year at time of study, as well as two composite vaccination indicators (receipt of basic vaccines and receipt of all recommended vaccines), zero-dose pentavalent coverage, and pentavalent dropout.Findings 72% (706/977) of facilities offered childhood vaccination services. Among children in rural areas, 61% were proximal to (within 5 km of) a vaccine-providing facility. Proximity to a vaccine-providing health facility was associated with increased likelihood of having received the rotavirus vaccine (93% vs 88%, p=0.004) and measles vaccine (93% vs 89%, p=0.01) in bivariate tests. In adjusted comparisons, how close a child was to a health facility remained meaningfully associated with how likely they were to have received rotavirus vaccine (adjusted OR (AOR) 1.63, 95% CI 1.13 to 2.33) and measles vaccine (AOR 1.62, 95% CI 1.11 to 2.37).Conclusion Proximity to health facilities was significantly associated with likelihood of receipt for some, but not all, vaccines. Our findings reiterate the vulnerability of children residing far from static vaccination services; efforts that specifically target remote rural populations living far from health facilities are warranted to ensure equitable vaccination coverage. |
| format | Article |
| id | doaj-art-d1c882e2a016498ea39e952f949e264b |
| institution | Kabale University |
| issn | 2044-6055 |
| language | English |
| publishDate | 2022-07-01 |
| publisher | BMJ Publishing Group |
| record_format | Article |
| series | BMJ Open |
| spelling | doaj-art-d1c882e2a016498ea39e952f949e264b2025-01-30T15:30:09ZengBMJ Publishing GroupBMJ Open2044-60552022-07-0112710.1136/bmjopen-2022-061346Association between childhood immunisation coverage and proximity to health facilities in rural settings: a cross-sectional analysis of Service Provision Assessment 2013–2014 facility data and Demographic and Health Survey 2015–2016 individual data in MalawiAhmad Reza Hosseinpoor0Nicole E Johns1Mike Chisema2M Carolina Danovaro-Holliday3Katherine Kirkby4Anne Schlotheuber5Messeret Shibeshi6Samir V Sodha7Boston Zimba8Division of Data, Analytics and Delivery for Impact, World Health Organization, Geneva, SwitzerlandDepartment of Data and Analytics, World Health Organization, Geneve, SwitzerlandPreventive Health Services and Expanded Program on Immunization, Malawi Ministry of Health, Lilongwe, MalawiDepartment of Immunization, Vaccines, and Biologicals, World Health Organization, Geneva, SwitzerlandDepartment of Data and Analytics, World Health Organization, Geneve, SwitzerlandDepartment of Data and Analytics, World Health Organization, Geneve, SwitzerlandInter-Country Support Team for East and Southern Africa, World Health Organization, Harare, ZimbabweDepartment of Immunization, Vaccines and Biologicals, World Health Organization, Geneve, SwitzerlandMalawi Country Office, World Health Organization, Lilongwe, MalawiObjectives Despite significant progress in childhood vaccination coverage globally, substantial inequality remains. Remote rural populations are recognised as a priority group for immunisation service equity. We aimed to link facility and individual data to examine the relationship between distance to services and immunisation coverage empirically, specifically using a rural population.Design and setting Retrospective cross-sectional analysis of facility data from the 2013–2014 Malawi Service Provision Assessment and individual data from the 2015–2016 Malawi Demographic and Health Survey, linking children to facilities within a 5 km radius. We examined associations between proximity to health facilities and vaccination receipt via bivariate comparisons and logistic regression models.Participants 2740 children aged 12–23 months living in rural areas.Outcome measures Immunisation coverage for the six vaccines included in the Malawi Expanded Programme on Immunization schedule for children under 1 year at time of study, as well as two composite vaccination indicators (receipt of basic vaccines and receipt of all recommended vaccines), zero-dose pentavalent coverage, and pentavalent dropout.Findings 72% (706/977) of facilities offered childhood vaccination services. Among children in rural areas, 61% were proximal to (within 5 km of) a vaccine-providing facility. Proximity to a vaccine-providing health facility was associated with increased likelihood of having received the rotavirus vaccine (93% vs 88%, p=0.004) and measles vaccine (93% vs 89%, p=0.01) in bivariate tests. In adjusted comparisons, how close a child was to a health facility remained meaningfully associated with how likely they were to have received rotavirus vaccine (adjusted OR (AOR) 1.63, 95% CI 1.13 to 2.33) and measles vaccine (AOR 1.62, 95% CI 1.11 to 2.37).Conclusion Proximity to health facilities was significantly associated with likelihood of receipt for some, but not all, vaccines. Our findings reiterate the vulnerability of children residing far from static vaccination services; efforts that specifically target remote rural populations living far from health facilities are warranted to ensure equitable vaccination coverage.https://bmjopen.bmj.com/content/12/7/e061346.full |
| spellingShingle | Ahmad Reza Hosseinpoor Nicole E Johns Mike Chisema M Carolina Danovaro-Holliday Katherine Kirkby Anne Schlotheuber Messeret Shibeshi Samir V Sodha Boston Zimba Association between childhood immunisation coverage and proximity to health facilities in rural settings: a cross-sectional analysis of Service Provision Assessment 2013–2014 facility data and Demographic and Health Survey 2015–2016 individual data in Malawi BMJ Open |
| title | Association between childhood immunisation coverage and proximity to health facilities in rural settings: a cross-sectional analysis of Service Provision Assessment 2013–2014 facility data and Demographic and Health Survey 2015–2016 individual data in Malawi |
| title_full | Association between childhood immunisation coverage and proximity to health facilities in rural settings: a cross-sectional analysis of Service Provision Assessment 2013–2014 facility data and Demographic and Health Survey 2015–2016 individual data in Malawi |
| title_fullStr | Association between childhood immunisation coverage and proximity to health facilities in rural settings: a cross-sectional analysis of Service Provision Assessment 2013–2014 facility data and Demographic and Health Survey 2015–2016 individual data in Malawi |
| title_full_unstemmed | Association between childhood immunisation coverage and proximity to health facilities in rural settings: a cross-sectional analysis of Service Provision Assessment 2013–2014 facility data and Demographic and Health Survey 2015–2016 individual data in Malawi |
| title_short | Association between childhood immunisation coverage and proximity to health facilities in rural settings: a cross-sectional analysis of Service Provision Assessment 2013–2014 facility data and Demographic and Health Survey 2015–2016 individual data in Malawi |
| title_sort | association between childhood immunisation coverage and proximity to health facilities in rural settings a cross sectional analysis of service provision assessment 2013 2014 facility data and demographic and health survey 2015 2016 individual data in malawi |
| url | https://bmjopen.bmj.com/content/12/7/e061346.full |
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