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Regional variations of childhood immunisations in Senegal: a multilevel analysis

Abstract : Objectives: To estimate geographical variations of child immunisation at the regional level in Senegal, to identify individual and contextual factors that could explain these regional discrepancies, and to measure their effects. Methods: Data come from the 2015, 2016 and 2017 Senegalese Demographic and Health Survey, a national survey targeting women aged 15-49, with a questionnaire focusing on health and reproductive issues including their children's immunisation status. We restricted the analysis to children aged 12-23 months (n = 4955) and conducted a multilevel logistic regression to assess individual and contextual factors associated with complete immunisation coverage. Results: The complete immunisation coverage rate of children was estimated at 68% and ranged from 41% in the region of Kedougou to 83% in the region of Dakar. The inter-regional variance was significantly different from zero (P = 0.006) in the empty multilevel model. It decreased by more than half (57 %) after adjusting for individual factors but remained significantly different from zero (P = 0.010). Regional variations of complete immunisation rates drastically decreased and were no longer statistically significant (P = 0.343) after adjusting for the following regional factors: population density, density of hospitals, literacy rate and proportion of health facilities with an antenatal care service. Conclusions: Regarding health policies designed to improve childhood immunisation and to reduce related inequalities, our results highlight the need to take into account both individual and contextual factors, with a focus on rural and deprived areas where children are at higher risk of incomplete immunisation.
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https://hal-amu.archives-ouvertes.fr/hal-03160963
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Submitted on : Friday, March 5, 2021 - 4:11:05 PM
Last modification on : Friday, April 9, 2021 - 3:14:28 AM

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Sébastien Cortaredona, Rokhaya Diop, Valérie Seror, Luis Sagaon-Teyssier, Patrick Peretti‐watel. Regional variations of childhood immunisations in Senegal: a multilevel analysis. Tropical Medicine & International Health, John Wiley & Sons Ltd, 2020, 25 (9), pp.1122-1130. ⟨10.1111/tmi.13455⟩. ⟨hal-03160963⟩

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