Determinants of the Uptake of the Full Dose of Diphtheria-Pertussis-Tetanus Vaccines (DPT3) in Northern Nigeria: A Multilevel Analysis

Objectives Health behaviors are influenced by an array of factors at the individual, household, community and societal levels. This paper examines the relative contribution of child's characteristics, mother's attributes, household profiles and community factors on the probability that a child will receive the full series of diphtheria-pertussis-tetanus vaccines (DPT3) as a proxy for full immunization. Methods We used data from a 2004 household survey conducted in three northern Nigeria states: Borno, Kano and Yobe. We estimated multilevel models with fixed effects specified at the individual, household and community levels, and random effects at the community level. Results Overall, only 16.0% of the children aged 12-35 months had received DPT3. The data show that a significant amount of the variation in DPT3 uptake occurs at the community level. The most significant predictors of the uptake of DPT3 are found at multiple levels and include child's place of birth, presence of an immunization card, mother's ideation, mother's decision-making power and perceived social approval of immunization. The data further show that significant community-level variations in immunization uptake remain even after individual and household factors have been considered. Conclusions The data reveal that childhood immunization is influenced by norms and unmeasured factors at the community level in addition to factors operating at the level of the individual child and the household. Strategies for improving the uptake of immunization should include culturally appropriate interventions that target multiple levels of influences. Improving parental attitudes towards immunization without addressing the issue of community norms is not likely to yield significant results.