Paediatrics Health Outcomes in Sub-Saharan Africa: A Multi-Country Assessment of Antecedence of Childhood Vaccination Decision-Making.

BackgroundVaccination is a cost-effective intervention preventing causes of 48% of deaths among children Under-5 in sub-Saharan Africa. However, one in five African children still has not completed basic vaccination, and over six million children have not received a single dose of the Diphtheria, Tetanus and Pertussis vaccine, resulting in over half a million deaths annually. This study aims to understand the key factors influencing pediatrics health (vaccination) decision-making in sub-Saharan Africa. MethodsA cross-sectional design using a multi-stage stratified sampling approach was used. Data were collected from 2,451 households with children Under-5 in three countries and analyzed using R. Correlation analysis was used to understand the associations between variables, while regression analysis was used to control for covariates and identify influences on one another. ResultsThe findings show that beliefs in gender disparity, misinformation, and masculinity can undermine childhood vaccination outcomes. A childs gender (r = -0.33-0.40, p < 0.01) and misinformation (r = -0.38-0.54, p < 0.01) impact vaccination intentions and behavior. Meanwhile, positive attitudes (r = 0.36-0.49, p < 0.01), trust (r = 0.17-0.34, p < 0.01) and peer influence (r = 0.27-0.33, p < 0.01) significantly improve uptake. However, regressions show that male caregivers had weaker attitudes ({beta} = -0.31, p < 0.001), stronger beliefs about misinformation ({beta} = 0.33, p < 0.001) and lower vaccination intentions ({beta} = -0.12, p < 0.001). Country comparisons reveal that Kenyan and Malawian children are 3.6 (OR = 3.64, p < 0.001) and 13 (OR = 13.13, p < 0.001) times more likely to be vaccinated than Nigerian children, respectively. Furthermore, masculinity had a significant effect on men, Muslims and polygamous households. ConclusionTo address low vaccination uptake in sub-Saharan Africa, context-sensitive strategies are required that incorporate gender norms, counter misinformation, and engage fathers.