Maternal education is associated with vaccination status of infants less than 6 months in Eastern Uganda: a cohort study

Victoria Nankabirwa, Thorkild Tylleskär, James K Tumwine, Halvor Sommerfelt, Promise-ebf Study Group, Thorkild Tylleskär, Philippe Van de Perre, Eva-Charlotte Ekström, Nicolas Meda, James K Tumwine, Chipepo Kankasa, Debra Jackson, Ingunn M S Engebretsen, Lars Thore Fadnes, Eli Fjeld, Knut Fylkesnes, Jørn Klungsøyr, Anne Nordrehaug-Astrøm, Øystein Evjen Olsen, Bjarne Robberstad, Halvor Sommerfelt, Hama Diallo, Thomas Ouedrago, Jeremi Rouamba, Bernadette Traoré Germain Traoré, Emmanuel Zabsonré, Caleb Bwengye, Charles Karamagi, Victoria Nankabirwa, Jolly Nankunda, Grace Ndeezi, Margaret Wandera, Mary Katepa-Bwalya, Chafye Siuluta, Seter Siziya, Mickey Chopra, Mark Colvin, Tanya Doherty, Ameena Eooga, Lyness Matizirofa, Lungiswa Nkonki, David Sanders, Wanga Zembe, Victoria Nankabirwa, Thorkild Tylleskär, James K Tumwine, Halvor Sommerfelt, Promise-ebf Study Group, Thorkild Tylleskär, Philippe Van de Perre, Eva-Charlotte Ekström, Nicolas Meda, James K Tumwine, Chipepo Kankasa, Debra Jackson, Ingunn M S Engebretsen, Lars Thore Fadnes, Eli Fjeld, Knut Fylkesnes, Jørn Klungsøyr, Anne Nordrehaug-Astrøm, Øystein Evjen Olsen, Bjarne Robberstad, Halvor Sommerfelt, Hama Diallo, Thomas Ouedrago, Jeremi Rouamba, Bernadette Traoré Germain Traoré, Emmanuel Zabsonré, Caleb Bwengye, Charles Karamagi, Victoria Nankabirwa, Jolly Nankunda, Grace Ndeezi, Margaret Wandera, Mary Katepa-Bwalya, Chafye Siuluta, Seter Siziya, Mickey Chopra, Mark Colvin, Tanya Doherty, Ameena Eooga, Lyness Matizirofa, Lungiswa Nkonki, David Sanders, Wanga Zembe

Abstract

Background: Despite provision of free childhood vaccinations, less than half of all Ugandan infants are fully vaccinated. This study compares women with some secondary schooling to those with only primary schooling with regard to their infants' vaccination status.

Methods: A community-based prospective cohort study conducted between January 2006 and May 2008 in which 696 pregnant women were followed up to 24 weeks post partum. Information was collected on the mothers' education and vaccination status of the infants.

Results: At 24 weeks, the following vaccinations had been received: bacille Calmette-Guérin (BCG): 92%; polio-1: 91%; Diphteria-Pertussis-Tetanus-Hepatitis B-Haemophilus Influenza b (DPT-HB-Hib) 3 and polio-3: 63%. About 51% of the infants were fully vaccinated (i.e., had received all the scheduled vaccinations: BCG, polio 0, polio 1, DPT-HB-Hib1, polio 2, DPT-HB-Hib 2, polio 3 and DPT-HB-Hib 3). Only 46% of the infants whose mothers' had 5-7 years of primary education had been fully vaccinated compared to 65% of the infants whose mothers' had some secondary education. Infants whose mothers had some secondary education were less likely to miss the DPT-HB-Hib-2 vaccine (RR: 0.5, 95% CI: 0.3, 0.8), Polio-2 (RR: 0.4, 95%CI: 0.3, 0.7), polio-3 (RR: 0.5, 95%CI: 0.4, 0.7) and DPT-HB-Hib-3 (RR: 0.5, 95%CI: 0.4, 0.7). Other factors showing some association with a reduced risk of missed vaccinations were delivery at a health facility (RR = 0.8; 95%CI: 0.7, 1.0) and use of a mosquito net (RR: 0.8; 95%CI: 0.7, 1.0).

Conclusion: Infants whose mothers had a secondary education were at least 50% less likely to miss scheduled vaccinations compared to those whose mothers only had primary education. Strategies for childhood vaccinations should specifically target women with low formal education.

Figures

Figure 1
Figure 1
Maternal education and infant vaccination.
Figure 2
Figure 2
Primary vs. secondary maternal education and infant vaccination.
Figure 3
Figure 3
Percentage drop-out from the immunization schedule.

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