Factors associated with vaccination coverage in children &lt; 5 years in Angola

Oliveira, Manuel Falcão Saturnino de; Martinez, Edson Zangiacomi; Rocha, Juan Stuardo Yazlle

doi:10.1590/S0034-8910.2014048005284

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Sumário

Original Articles • Rev. Saúde Pública 48 (6) • Dec 2014 • https://doi.org/10.1590/S0034-8910.2014048005284 copy

Factors associated with vaccination coverage in children < 5 years in Angola

Authorship SCIMAGO INSTITUTIONS RANKINGS

OBJECTIVE

To analyze vaccination coverage and factors associated with a complete immunization scheme in children < 5 years old.

METHODS

This cross-sectional household census survey evaluated 1,209 children < 5 years old living in Bom Jesus, Angola, in 2010. Data were obtained from interviews, questionnaires, child immunization histories, and maternal health histories. The statistical analysis used generalized linear models, in which the dependent variable followed a binary distribution (vaccinated, unvaccinated) and the association function was logarithmic and had the children’s individual, familial, and socioeconomic factors as independent variables.

RESULTS

Vaccination coverage was 37.0%, higher in children < 1 year (55.0%) and heterogeneous across neighborhoods; 52.0% of children of both sexes had no immunization records. The prevalence rate of vaccination significantly varied according to child age, mother’s level of education, family size, ownership of household appliances, and destination of domestic waste.

CONCLUSIONS

Vulnerable groups with vaccination coverage below recommended levels continue to be present. Some factors indicate inequalities that represent barriers to full immunization, indicating the need to implement more equitable policies. The knowledge of these factors contributes to planning immunization promotion measures that focus on the most vulnerable groups.

Immunization Coverage; Socioeconomic Factors; Integrated Management of Childhood Illness; Child Health; Health Inequalities; Health Surveys

Households	n	%
Urban zone	901	56.5
Rural zone	695	3.5
Traditional housing	1,443	90.4
Brick/Concrete housing	153	9.6
Number of divisions
1 to 2	1,063	67.6
3 to 7	504	32.6
≥ 8	29	1.8
With electricity	815	51.1
Without electricity	781	48.9
With potable water	573	35.9
Without potable water	1,023	64.1
With public waste collection service	602	37.7
Without public waste collection service	994	62.3
Owned house	1,297	81.3
Rented house	299	19.7
With appliances	1,092	68.4
Without appliances	504	31.6
Population
Urban area	4,255	62.6
Rural area	2,539	37.4
Men	3,342	49.2
Women	3,452	50.8
15 to 29 years	4,886	71.9
≥ 30 years	1,908	28.1
Kimbundu ethnicity	4,483	66.0
Umbundu ethnicity	2,258	33.2
Kikongo and others	53	0.8
< 5 years old
≤ 1 month	54	4.5
2 to 11 months	250	20.7
12 to 59 months	905	74.9
Urban zone	846	70.0
Rural zone	363	30.0
Male	583	48.2
Female	626	51.8
Kimbundu ethnicity	802	66.3
Umbundu ethnicity	391	32.4
Kikongo and others	16	1.3
Birth order
1	287	23.7
2 to 4	704	58.3
> 5	218	18.0
Presence of birth certificate
Yes	225	18.6
No	984	81.4
Number of children
≤ 4	939	77.7
> 4	270	22.3
Head of household’s salary (minimum wage equivalents)
≤ 5	704	58.2
> 5	505	41.8

Variable	Total	n	%	PR_raw	95%CI	PR_adjusted	95%CI^a
Order
> 4	219	68	31.1	1		1
≤ 4	990	372	37.6	1.21	0.97;1.51	0.95	0.64;1.39
Birth certificate
Yes	222	75	33.8	1		1
No	980	362	36.9	1.09	0.88;1.35	1.00	0.81;1.24
Age (years)
> 1	849	247	29.1	1		1
≤ 1	360	193	53.6	1.84	1.59;2.13	1.78	1.53;2.07
Knowledge of immunization programs
No	258	75	29.1	1		1
Yes	951	365	38.4	1.32	1.06;1.64	1.32	1.07;1.63

Variable	Total	Vaccinated	%	PR_raw	95%CI	PR_adjusted	95%CI^a
Family size
2 to 3	121	56	46.3	1.40	1.11;1.76	1.34	1.05;1.71
4 to 5	489	186	38.0	1.15	0.96;1.37	1.06	0.86;1.29
≥ 6	599	198	33.1		1		1
Head of household
Mother	112	37	33.0		1		1
Father or other	1,097	403	36.7	1.11	0.82;1.50	1.07	0.80;1.44
Age of the mother (years)
15 to 29	754	300	39.9	1.31	1.09;1.56	1.21	0.98;1.48
≥ 30	455	139	30.6		1		1
Mother works as housewife
Yes	644	244	37.9	1.09	0.92;1.29	1.00	0.83;1.18
No	565	196	34.7		1		1
Level of education of the mother (years)
Illiterate	206	68	33.0		1		1
≤ 4	594	209	35.2	1.07	0.84;1.35	1.07	0.84;1.35
> 4	409	163	39.9	1.21	0.94;1.54	1.12	0.87;1.44
Mother’s language
Kimbundo	802	305	38.0	1.15	0.95;1.37	1.15	0.96;1.38
Others	407	135	33.2		1		1
Number of children
≤ 4	940	361	38.4	1.31	1.05;1.62	1.07	0.82;1.41
> 4	269	79	29.4		1		1

Variable	Total	n	%	PR_raw	95%CI	PR_adjusted	95%CI^a
Area
Urban	266	83	31.2	1		1
Rural	943	357	37.9	1.21	0.97;1.51	1.19	0.95;1.47
Head of household’s salary (minimum wage equivalents)
≤ 5	954	345	36.2	1		1
> 5	255	95	37.2	1.03	0.84;1.25	0.97	0.80;1.19
Head of household’s education (years)
Illiterate	99	30	30.3	1		1
≤ 4	398	126	31.7	1.04	0.75;1.45	0.99	0.71;1.36
> 4	712	284	39.9	1.32	0.97;1.78	1.30	0.96;1.76
Owned house
Yes	938	347	37.0	1.08	0.88;1.31	1.09	0.90;1.33
No	271	93	34.3	1		1
Appliances
Radio	115	50	43.5	1.40	1.02;1.91	1.45	1.05;1.99
TV	273	85	31.1	1		1
Radio and TV	653	253	38.7	1.24	0.99;1.55	1.14	0.91;1.43
Radio, TV, and others	166	52	31.3	1.00	0.74;1.35	0.97	0.69;1.36
None	2	0		–		–
Water treatment method
Boiling	20	9	45.0	1.73	0.89;3.36	1.47	0.77;2.80
Chemical treatment	36	10	27.8	1.07	0.51;2.21	0.99	0.49;2.02
Never treat water	1,080	402	37.2	1.43	0.97;2.10	1.42	0.96;2.10
Sometimes treat water	73	19	26.0	1		1
Lighting
Public	772	287	37.2	1.07	0.84;1.36	1.03	0.77;1.37
Generator	209	73	34.9	1.01	0.74;1.36	0.91	0.65;1.27
Lamp	156	54	34.6	1		1
Others	72	26	36.1	1.04	0.70;1.55	0.99	0.68;1.45
Waste disposal
Public collection	109	50	45.9	1.97	1.11;3.48	2.26	1.26;4.07
Burning	43	10	23.3	1		1
Burying	242	100	41.3	1.78	1.02;3.09	1.99	1.12;3.54
Others	815	280	34.4	1.48	0.86;2.53	1.71	0.97;3.00

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[1] Correspondence
: Manuel Falcão Saturnino de Oliveira. Rua Visconde de Inhaúma, 757 apto. 41 Centro. 14010-100 Ribeirão Preto, SP, Brasil. E-mail: manuelsat@usp.br