What are the individual child and parental factors that lead to delay of the first immunization in Jos University Teaching Hospital (JUTH), Nigeria?

Nantok Dami studied on the Master of Public Health programme at ScHARR from 2012 to 2013. Nantok's main reason for doing the MPH was to develop his research skills, in particular how to do a systematic review, write a research proposal and conduct research.
Nantok is now back working at the University of Jos in Nigeria, where he  lectures in community health. He has recently been appointed as the Project Director in the Centre for Addiction Treatment and Research in Vom. The project is a collaboration between the Jos University Teaching Hospital and Vom Christian Hospital. Nantok believes that completing the MPH course has helped him to achieve this dream.

The title of Nantok's research project was 'What are the individual child and parental factors that lead to delay of the first immunization in Jos University Teaching Hospital (JUTH), Nigeria?'

Introduction: It is estimated that over two million Vaccine Preventable Deaths (VPDs) still occur in Sub-Saharan Africa every year. Nigeria’s immunization coverage has been on the decline. According to the National Demographic Health Survey (NDHS) report of 2008, immunization coverage in Nigeria is only 23%. This is far below the universal target of 90%. Studies have shown that delay to the first immunization is the strongest predictor to this poor coverage.    

Objectives: This study attempts to identify the prevalence of delay at first immunization, the demographic child and parental factors associated with the delay, and to estimate statistically the strength of relationship this factors and immunization delay.

Methods: A retrospective, cohort study design was adopted for this study. Data on 1488 children, aged between 0 to 12 months from the Family Health Clinic (FHC) database, a Primary Health Care (PHC) database which is representative of children in the Jos University Teaching Hospital in Nigeria as used. Prevalence of delay and odds ratio were analysed using Logistic Regression while the hazard ratio was analysed using Cox Regression.

Results: Prevalence of delay of the first immunization is 32.8%. Odds of delay at the univariate level is significantly associated with higher birth order (OR 0.86, 95% CI 0.836 to .994), home delivery (OR 1.664, 95% CI 1.323 to 2.092), poor prenatal care history (OR 1.392, 95% CI 1.005 to 1.928), religion (Islam) (OR 1.986, 95% CI 1.514 to 2.605), lower SES (OR 0.495 95% CI 0.335 to 0.732), and educational level (none formal OR 0.179, 95% CI 0.440 to 0.731), (primary OR 0.478, 95% CI 0.322 to 0.757). During the multivariate analysis, odds of delay of the first immunization was significantly associated with mother’s religion Islam) (OR 1.517, 95% CI 1.097 to 2.098), higher birth order (OR 0.922, 95% CI 0.867 to 0.981), and poor prenatal care history (OR 1.411, 95% CI 1.005 to 1.962). The hazard ratio at the univariate level demonstrated significant association in these predictors: home delivery (RR 1.243, 95% CI 1.140 to 1.387), level of education (no education RR 0.532, 95% CI 0.274 to 1.030), (primary, RR 0.703, 95% CI 0.576 to 0.857), religion (Islam) (RR 1.450, 95% CI 1.288 to1.633), lower SES (RR 0.756, 95% CI 0.638 to 0.897), higher birth order (RR 0.998, 95% CI 0.998 to 0.999). Adjusting for all variables, only religion (Islam) (RR 1.314, 95% CI of 1.135 to 1.521) was significantly associated with the delay.

Conclusion: After adjusting for all variables, the predictors of delay of the first immunization include: being born to a mother who practices Islam, higher birth order, and poor prenatal care history. Mother’s religion remained the strongest predictor of the delay of the first immunization.