Coverage and determinants of COVID-19 vaccination among 36 555 Nigerian women of childbearing age: a mixed-effects analysis of nationally representative data
Jul 2026· BMJ public health· Vol 4, pp. e004858· 1 citation· 60 references
Medicine
TL;DR
Demographic, socioeconomic and environmental factors were associated with higher COVID-19 vaccination uptake among Nigerian women of reproductive age and this finding is grossly suboptimal for herd immunity.
Abstract
Abstract Introduction Even though COVID-19 has spread globally, with millions of deaths, vaccination remains low in resource-constrained settings. Uptake of COVID-19 vaccine has remained suboptimal despite its potential for protection against the disease. The objective of this study was to assess the factors associated with higher COVID-19 vaccination uptake among Nigerian women of reproductive age. Methods A sample of 36 555 women aged 15–49 years was extracted from the 2024 Nigeria Demographic and Health Survey data. The outcome variable was COVID-19 vaccination. Percentage and χ2 tests were used in univariate and bivariate analyses. In addition, self-reported COVID-19 vaccination uptake was examined using multilevel ordinal logistic regression analysis. Results Approximately 73.9% of Nigerian women received no dose of COVID-19 vaccination. Those who received one dose were 13.4%, two doses were 10.5% and >2 doses were 2.1%, respectively. The full model (model V) was selected based on model fitness selection criteria. Older women, educated, Muslims, those covered by health insurance, formerly married, employed, exposed to media, from higher household wealth, have community-level willingness for COVID-19 vaccine uptake, native of the community and living in North East/North Central/South East/South South/South West had higher odds of being in a higher COVID-19 vaccination category when compared with women aged 15–19 years, with no formal education, Christians, uninsured, single, unemployed, not exposed to media, from poorest household, no community-level willingness for COVID-19 uptake, not a native of the community and from North West, respectively. On the other hand, women having a household size >6 were less likely to be in a higher COVID-19 vaccination category when compared with those having a household size of 1–2 members. Conclusions COVID-19 vaccination was approximately one-quarter. This finding is grossly suboptimal for herd immunity. Demographic, socioeconomic and environmental factors were associated with higher COVID-19 vaccination uptake among Nigerian women of reproductive age.
Background Understanding COVID-19 vaccine uptake is particularly important in studies of inequity in vaccination access, as differences in uptake may reflect underlying social and structural inequalities. Evidence suggests that socioeconomic status is a key driver for COVID-19 vaccination uptake in Nigeria. This study examines the socioeconomic inequality in COVID-19 vaccination uptake among reproductive-age Nigerian women. Methods Data from the 2024 Nigeria Demographic and Health Survey (NDHS) was analyzed for a sample of 36,555 women of reproductive age (15–49 years). COVID-19 vaccination uptake was the outcome variable measured in this study. A socioeconomic decomposition analysis was conducted to identify the factors contributing to inequalities in COVID-19 vaccination uptake across the socioeconomic gradient. Results The least disadvantaged women had the highest COVID-19 vaccination uptake (31.6%), whereas the most disadvantaged women had the lowest COVID-19 vaccination uptake (19.2%). The concentration index curve showed that COVID-19 vaccination uptake among Nigerian women was significantly higher among the least disadvantaged group. In addition, having higher education, secondary education, being exposed to mass media, employed, covered by health insurance, being aged 30 years or older, from South West, South South and South East geopolitical zones respectively, were positive contributors to socioeconomic inequality in COVID-19 vaccination uptake. Conclusion There was low uptake rate of COVID-19 vaccination among Nigerian women, with approximately one-third of the least disadvantaged, one-quarter of the moderately disadvantaged, and one-fifth of the most disadvantaged women reported receiving a COVID-19 vaccine. This shows that the dream of achieving equitable vaccination coverage will require concerted efforts and targeted strategies that prioritize disadvantaged women, including context-specific policies aimed at reducing socioeconomic barriers to access.
High rates of COVID-19 vaccination among PLHIV on ART in Uganda are found, and lack of confidence in the safety of the vaccine was the primary barrier to uptake.
Taing N Aung, Winnie Muyindike, Susanne S. Hoeppner et al.· Vaccine· 0 citations
Targeted communication, such as risk-stacking to improve risk-awareness, harmonized eligibility criteria, and co-administration, may help overcome remaining vaccination barriers in high-risk individuals.
Lucas Grape, Wilma Persson, Adam Sergejev et al.· 0 citations
Targeted communication, such as risk-stacking to improve risk-awareness, harmonized eligibility criteria, and co-administration, may help overcome remaining vaccination barriers in high-risk individuals.
Lucas Grape, Wilma Persson, Adam Sergejev et al.· Human Vaccines & Immunothera...· 0 citations
Background HIV testing is essential for early diagnosis, treatment initiation, and achieving UNAIDS 95-95-95 targets. However, disparities in uptake remain in sub-Saharan Africa, including Malawi. Methods A cross-sectional analysis was conducted using the 2024 Malawi Demographic and Health Survey data. A total of 21,587 individuals aged 15–49 years were included. Multilevel mixed-effects logistic regression was used to identify individual- and community-level factors associated with HIV testing uptake. Results The prevalence of HIV testing was 86.1%. Higher odds of HIV testing were observed among females, older age groups, individuals with higher education, richer households, married respondents, and those from the southern region. Significant community-level variation in HIV testing uptake was also identified. Conclusion Although HIV testing uptake is high in Malawi, important sociodemographic and regional disparities persist. Targeted interventions are needed to improve equitable access to HIV testing services.
A. S. Asgai, Desalegn Mitiku Kidie, T. K. Derse et al.· Journal of the International...· 0 citations
BACKGROUND
Decline in routine childhood vaccination coverage in Canada has accelerated following the COVID-19 pandemic, increasing risks of vaccine-preventable diseases. Yet, little is known about how this affects different racial groups. This study examines racial disparities in uptake of childhood polio, meningococcal, and varicella vaccines, and the roles of health literacy and conspiracy beliefs.
METHODS
We conducted a national survey that included 2,528 Canadian parents of children aged 0-12 years. Parents reported their child's vaccination status and completed measures of health literacy and COVID-19 conspiracy beliefs. Associations between parental racial category, sociodemographic characteristics and vaccine uptake were assessed using Chi-square tests and multivariable logistic regression models.
RESULTS
Overall vaccine uptake rates were 76.8% for polio, 73.1% for meningococcal conjugate, and 76.7% for varicella. Children of racialized parents had consistently lower vaccination coverage compared with children of White parents. Lower odds of polio and meningococcal vaccination were reported among children of Arab (aOR: 0.47-0.58), Asian (aOR: 0.36-0.45), Black (aOR: 0.63-0.69), and Indigenous parents (aOR: 0.54-0.60) compared to their White counterparts. Regarding varicella vaccination, uptake was significantly lower among children of Arab (aOR: 0.54, p < 0.001) and Asian parents (aOR: 0.61, p = 0.006), but not among children of Black and indigenous parents. Higher health literacy was associated with greater vaccine uptake, whereas stronger conspiracy beliefs were associated with lower uptake across all vaccines.
CONCLUSIONS
Racial inequities in routine childhood vaccination exist in Canada in the post-COVID-19 pandemic period. Strategies aimed at culturally tailored interventions, improved health literacy, and addressing mistrust and structural inequities are needed to support equitable vaccine coverage.
Rose Darly Dalexis, I. Beogo, Yan Xu et al.· Vaccine· 0 citations
