Factors associated with non- and under-vaccination among children aged 12–23 months in Malawi. A multinomial analysis of the population-based sample

Abstract

Background: Non- and under-vaccination among children in Malawi have received little attention. Between 2010 and 2016, the proportion of children who received full immunization before their first birthday dropped from 81% to 76% in Malawi. This signifies that a certain fraction of children are either non-vaccinated or under-vaccinated. Thus, the present study attempted to examine the predictors of non- and under-vaccination among children aged 12–23 months in Malawi. Methods: Cross-sectional data obtained from the Malawi Demographic and Health Survey 2015–16 were utilized. The percentage of children aged 12–23 months who were non-vaccinated, under-vaccinated, or fully vaccinated with 1 dose of Bacillus Calmette–Guérin, 3 doses of oral polio vaccine, 3 doses of pentavalent, 2 doses of rotavirus vaccine, 3 doses of pneumococcal vaccine and 1 dose of measles-containing vaccine were calculated. The odds of being non-vaccinated and under-vaccinated compared to full vaccination relative to various sociodemographic factors were assessed using a multivariable multinomial logistic regression with logit link function which accounted for survey design. Results: Of 3111 children aged 12–23 months, 72% were fully vaccinated, 26% were under-vaccinated, and about 2% were non-vaccinated. The multinomial logistic regression showed that children from the poorest households, and children who did not have postnatal care within two months had increased odds of being under-vaccinated. On the other hand, children who had no health card or whose card was lost had increased odds of being both non- and under-vaccinated. Additionally, children from the northern region and who resided in households with either none or one under-five child had reduced odds of being non-vaccinated and under-vaccinated, respectively. Conclusions: Women from the poorest households and those who are not attending PNC should be targeted when designing interventions that aim at improving childhood vaccination in order to reduce the barriers they face in accessing vaccination services.