Inequity in access to childhood immunization in Enugu urban, Southeast Nigeria

Abstract

Background: The Nigerian National Programme on Immunization aims at increasing the immunization coverage of children under 1 year of age. However, there is still a gap between the national immunization targets and the immunization coverage rates, and data are rarely disaggregated according to socioeconomic status. As a result, there is a dearth of information about the coverage of subgroups, especially at the local level. This study determined the socioeconomic differentials in immunization coverage for children under 5 years and under 1 year in Enugu urban, Southeast Nigeria.

Methods: This was a community‑based, descriptive cross‑sectional study in Enugu urban of Southeast Nigeria. A modified 30 × 7 cluster sampling design was adopted as the sampling method to select and interview 462 mothers of 685 children under the age of 5 years on their sociodemographic and economic characteristics and immunization status of their children. Principal components analysis in STATA software was used to characterize socioeconomic inequity.

Results: Immunization coverage was as follows: Diphtheria, pertussis, tetanus third dose(DPT3), 3, 65.3%; oral polio vaccine 3, 78.0%; hepatitis B3, 65.2%; and measles, 55.8%. The full immunization rates for children 1–5 years and <1 year were 49.8% and 65.2%, respectively. The very poor, poor, and least poor socioeconomic levels significantly had a higher rate of full immunization than the poorest socioeconomic level for children aged <5 years (odds ratio [OR] 1.934, 95% confidence interval [CI] 1.513–2.820). When the 1st year of life was selected as the reference group, the immunization rates in all other age groups decreased significantly. Using the same logistic regression model for children under 1 year of age, every added month of the child’s life increased the full immunization coverage, and this was statistically significant (OR 2.752, 95% CI 2.304–3.418).

Conclusions: Full immunization coverage for children aged <1 year was lower than the national target of 95%. There are differences in immunization coverage rates between different wealth quartiles in the area with the least poor benefiting more than the poorest, thus creating equity problems. Health managers need such community‑based information about the vaccination status of their target population to plan and implement interventions that aim to improve immunization coverage in these areas.

Keywords: Immunization coverage, inequity, Nigeria, socioeconomic status