Non-uptake of Childhood Vaccination among the Children of HIV-infected Mothers in Sub-Saharan Africa: A Multilevel Analysis

Several individual-, community-, and country-level factors influence the association between maternal HIV status and childhood vaccination coverage in sub-Saharan Africa. For example, studies have found that children born to HIV-infected mothers are less likely to get all basic vaccinations according to schedule due to mothers' avoidance of community health facilities owing to stigma and discrimination. The aim of the present study was to develop and test models for non-uptake of 3 doses of diphtheria-tetanus-pertussis containing vaccines (DTP3) among children of women living with HIV in sub-Saharan Africa.

A total of 5,537 children aged 12-23 months within 2,841 communities and from 27 countries in sub-Saharan Africa were involved in this study. The surveys were conducted between 2003 and 2016 in the included countries, with the years 2013 and 2014 having 5 surveys each. About one-fourth of the children of HIV-infected mothers did not receive DTP3 prior to the survey.

Multivariable logistic regression models were used to assess the relationship between individual and contextual factors associated with non-uptake of DTP3 among the children. At the individual level, the odds of non-uptake of DTP3 decreased with formal education, increasing age, and access to media. The full model shows that the odds of non-uptake of DTP3 are increased among unemployed women, those living in communities with high illiteracy rate, and those living in countries with low adult literacy level. For a child who moved to another country or community with a higher probability of DTP3 non-uptake, the median increase for the odds of DTP3 non-uptake would be 2.24% and 1.22%, respectively, for country and community. This implies that HIV exposed children from the same communities were inclined to have similar vaccination status and are subjected to similar contextual characteristics within the communities.

Expanding on the findings, the researchers explain:

• The inability of unemployed and economically poorer mothers to source funds for transport to health centres for scheduled vaccinations may be a vital reason for the non-uptake of the vaccines.
• The low likelihood of the younger HIV-infected mother, possibly having her first child, to take her child for vaccination may be the result of lack of information concerning the importance of immunisation. Along these lines, the probability of a child of an HIV-positive mother not taking her child for DTP3 is reduced in women with any form of formal education compared to their uneducated counterparts.

According to the researchers, public health interventions should be designed specifically for women living with HIV who are young mothers, unemployed women, and those without formal education. Interventions that provide parents, caregivers, and other community members with information on the benefit of immunisation may improve childhood vaccination coverage. The remedial interventions should also focus on HIV-infected women who are resident in communities with a high illiteracy rate. The findings show that access to media reduces non-uptake; multimedia interventions have been proven to be effective and useful for childhood immunisation programmes in sub-Saharan African countries and could be specially adapted for HIV-exposed and -infected children.