ArticleBMJ open2022
Association between childhood immunisation coverage and proximity to health facilities in rural settings: a cross-sectional analysis of Service Provision Assessment 2013-2014 facility data and Demographic and Health Survey 2015-2016 individual data in Malawi.
Article in BMJ open, 2022. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 11 papers.
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Who cites it
11 citing papers in PubMed, 14 citations in OpenAlex.
- Factors Associated with Immunization Status Among Myanmar Migrant Children in Northern Thailand: A Community-Based Cross-Sectional Study.Medical sciences (Basel, Switzerland) · 2026Article
- Health system and caregiver related factors influencing measles vaccination uptake: perspectives of Chadibe village, Botswana.BMC infectious diseases · 2025Article
- Advancing Inequality Monitoring in Immunization: Reflecting on 10 Years of WHO Contributions.Vaccines · 2025Article
- Mapping and quantifying travel time to define health facility catchment areas in Blantyre city in Malawi.Communications medicine · 2025Article
- Characteristics of Studies Focusing on Vaccine Series Completion Among Children Aged 12-23 Months in Sub-Saharan Africa: A Scoping Review.Children (Basel, Switzerland) · 2025Review
- Socio-demographic disparities in basic under-two immunization coverage: insights from the 2016 Malawi demographic and health survey.BMC public health · 2025Article
- Spatial distribution of effective coverage of child immunisation in Ethiopia.BMJ public health · 2025Article
- Spatial co-distribution of tuberculosis prevalence and low BCG vaccination coverage in Ethiopia.Scientific reports · 2024Article
- Examining inequalities in spatial access to national health insurance fund contracted facilities in Kenya.International journal for equity in health · 2024Article
- Assessing Vaccination Delivery Strategies for Zero-Dose and Under-Immunized Children in the Fragile Context of Somalia.Vaccines · 2024Article
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Authors and funding
9 authors at 2 institutions in 5 countries.
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Abstract
objectivesDespite significant progress in childhood vaccination coverage globally, substantial inequality remains. Remote rural populations are recognised as a priority group for immunisation service equity. We aimed to link facility and individual data to examine the relationship between distance to services and immunisation coverage empirically, specifically using a rural population. DESIGN AND
settingRetrospective cross-sectional analysis of facility data from the 2013-2014 Malawi Service Provision Assessment and individual data from the 2015-2016 Malawi Demographic and Health Survey, linking children to facilities within a 5 km radius. We examined associations between proximity to health facilities and vaccination receipt via bivariate comparisons and logistic regression models.
participants2740 children aged 12-23 months living in rural areas. OUTCOME MEASURES: Immunisation coverage for the six vaccines included in the Malawi Expanded Programme on Immunization schedule for children under 1 year at time of study, as well as two composite vaccination indicators (receipt of basic vaccines and receipt of all recommended vaccines), zero-dose pentavalent coverage, and pentavalent dropout.
findings72% (706/977) of facilities offered childhood vaccination services. Among children in rural areas, 61% were proximal to (within 5 km of) a vaccine-providing facility. Proximity to a vaccine-providing health facility was associated with increased likelihood of having received the rotavirus vaccine (93% vs 88%, p=0.004) and measles vaccine (93% vs 89%, p=0.01) in bivariate tests. In adjusted comparisons, how close a child was to a health facility remained meaningfully associated with how likely they were to have received rotavirus vaccine (adjusted OR (AOR) 1.63, 95% CI 1.13 to 2.33) and measles vaccine (AOR 1.62, 95% CI 1.11 to 2.37).
conclusionProximity to health facilities was significantly associated with likelihood of receipt for some, but not all, vaccines. Our findings reiterate the vulnerability of children residing far from static vaccination services; efforts that specifically target remote rural populations living far from health facilities are warranted to ensure equitable vaccination coverage.
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