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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
Umeå University, Faculty of Medicine, Department of Epidemiology and Global Health. Expanded Program on Immunization, Ministry of Health, Banjul, The Gambia.ORCID iD: 0000-0003-3786-3021
Umeå University, Faculty of Medicine, Department of Epidemiology and Global Health.ORCID iD: 0000-0001-5471-9043
Medical Research Council Unit The Gambia at the London School of Hygiene and Tropical Medicine, Bakau, The Gambia; School of Public Health, Georgia State University, Atlanta, GA, USA.ORCID iD: 0000-0002-1656-2126
Umeå University, Faculty of Medicine, Department of Epidemiology and Global Health.ORCID iD: 0000-0002-3972-5362
2024 (English)In: Global Health Action, ISSN 1654-9716, E-ISSN 1654-9880, Vol. 17, no 1, article id 2348788Article in journal (Refereed) Published
Abstract [en]

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.

Place, publisher, year, edition, pages
Taylor & Francis, 2024. Vol. 17, no 1, article id 2348788
Keywords [en]
Vaccination, coverage, under immunized, inequality, equity
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Research subject
Epidemiology
Identifiers
URN: urn:nbn:se:umu:diva-225727DOI: 10.1080/16549716.2024.2348788ISI: 001237706900001PubMedID: 38826143Scopus ID: 2-s2.0-85195003493OAI: oai:DiVA.org:umu-225727DiVA, id: diva2:1866234
Available from: 2024-06-06 Created: 2024-06-06 Last updated: 2024-06-10Bibliographically approved

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Sowe, AlieuNamatovu, FredinahGustafsson, Per E

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