Rapidly Modifiable Factors Associated with Full Vaccination Status among Children in Niamey, Niger: A Cross-Sectional, Random Cluster Household Survey

"Strengthened communication interventions may be effective in improving both the acceptability of health services and low vaccination coverage."

In Niger, there is a relatively high rate of initial access to vaccination. As accessibility and availability of services are not problematic, acceptability becomes the issue. In the field, officials frequently attribute the high vaccination drop-out rate on the lack of maternal education - a factor that can be changed but only with time. However, low-income countries need to identify interventions that would have a more immediate and equitable effect on increasing vaccine acceptability and uptake. This study aimed to identify rapidly modifiable factors associated with full vaccination status among children in Niamey, Niger.

A cross-sectional, random cluster household survey was conducted in October 2016 in Niamey's five health districts. Data on vaccination coverage and socioeconomic household characteristics were collected. Logistic regression analysis was conducted with data on 445 mothers and their children aged 12-23 months.

Only 38% of children were fully vaccinated. Of 146 mothers who were unable to read and write, 101 (69.2%) did not have fully vaccinated children. More than half (n = 96, 52.8%) of 182 mothers who had completed both primary and secondary schools did not have a fully vaccinated child. Children whose mothers were uneducated were disadvantaged by 16.5% in terms of full vaccination status, compared to those whose mothers received secondary education. Children in the economically poorest quintile compared to those in the richest quintile were disadvantaged by 19.7% in terms of full vaccination status.

With regard to what the study deems "modifiable factors", mothers who were satisfied with their health worker's attitude and had correct vaccination calendar knowledge (adjusted odds ratio [aOR] 5.32, 95% confidence interval [CI] 2.05-13.82) were more likely to have fully vaccinated children. Implications:

• A previous study found that economically poor mothers felt they were treated poorly by health workers. Thus, "modifying health worker attitudes may be vital to improving healthcare utilization among poor mothers. More economically disadvantaged children could be fully vaccinated if sympathetic health workers communicated with mothers better."
• In the present study, maternal knowledge of the vaccination calendar was assessed through a simple and direct question with a binary response. Such a question could be added to household and vaccination coverage surveys. "In this way, maternal knowledge of the vaccination calendar could predict whether the mother will bring back her child for further vaccination. If the knowledge is insufficient, communication interventions could be implemented to modify this independent variable rapidly. Communication could improve the correct knowledge of the vaccination schedule, such as the time intervals between appointments. Mothers might be nudged to come for timely vaccination."

In conclusion: "A higher rate of full vaccination among children could be achieved by relatively short-term modifiable factors."