Migration and child immunization in Nigeria: individual- and community-level contexts.
BACKGROUND
Vaccine-preventable diseases are responsible for severe rates of morbidity and mortality in Africa. Despite the availability of appropriate vaccines for routine use on infants, vaccine-preventable diseases are highly endemic throughout sub-Saharan Africa. Widespread disparities in the coverage of immunization programmes persist between and within rural and urban areas, regions and communities in Nigeria. This study assessed the individual- and community-level explanatory factors associated with child immunization differentials between migrant and non-migrant groups.


METHODS
The proportion of children that received each of the eight vaccines in the routine immunization schedule in Nigeria was estimated. Multilevel multivariable regression analysis was performed using a nationally representative sample of 6029 children from 2735 mothers aged 15-49 years and nested within 365 communities. Odds ratios with 95% confidence intervals were used to express measures of association between the characteristics. Variance partition coefficients and Wald statistic i.e. the ratio of the estimate to its standard error were used to express measures of variation.


RESULTS
Individual- and community contexts are strongly associated with the likelihood of receiving full immunization among migrant groups. The likelihood of full immunization was higher for children of rural non-migrant mothers compared to children of rural-urban migrant mothers. Findings provide support for the traditional migration perspectives, and show that individual-level characteristics, such as, migrant disruption (migration itself), selectivity (demographic and socio-economic characteristics), and adaptation (health care utilization), as well as community-level characteristics (region of residence, and proportion of mothers who had hospital delivery) are important in explaining the differentials in full immunization among the children.


CONCLUSIONS
Migration is an important determinant of child immunization uptake. This study stresses the need for community-level efforts at increasing female education, measures aimed at alleviating poverty for residents in urban and remote rural areas, and improving the equitable distribution of maternal and child health services.
Antai
Diddy
D
Division of Epidemiology, Institute of Environmental Medicine, Karolinska Institute, Stockholm, Sweden. theangelstrust.nigeria@gmail.com
D000293:Adolescent; D000328:Adult; D002648:Child; D003153:Community Health Services / Q000706:statistics & numerical data*; D004641:Emigration and Immigration / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D007115:Immunization Schedule; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009549:Nigeria; D012959:Socioeconomic Factors; D014171:Transients and Migrants / Q000706:statistics & numerical data*; D014611:Vaccination / Q000706:statistics & numerical data*; D055815:Young Adult