Institutional mistrust and child vaccination coverage in Africa

IntroductionDespite considerable improvements in vaccination coverage over the last decade, half of the world’s unvaccinated and undervaccinated children are located in Africa. The role of institutional trust in explaining vaccination gaps has been highlighted in several qualitative reports but so f...

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Bibliographic Details
Published in:BMJ global health 2021-04, Vol.6 (4), p.e004595
Main Authors: Stoop, Nik, Hirvonen, Kalle, Maystadt, Jean-Francois
Format: Article
Language:English
Subjects:
Africa - epidemiology
Caregivers
Child
Children & youth
Global health
Humans
Immunization
Local government
Local population
Low income groups
Measles
Mortality
Original Research
Parents & parenting
Principal components analysis
Tetanus
Trust
Vaccination
Vaccination Coverage
Vaccines
Variables
Whooping cough
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Summary:IntroductionDespite considerable improvements in vaccination coverage over the last decade, half of the world’s unvaccinated and undervaccinated children are located in Africa. The role of institutional trust in explaining vaccination gaps has been highlighted in several qualitative reports but so far has only been quantified in a small number of high-income countries.MethodsWe matched information on child vaccination status from the Demographic Health Surveys with information on institutional trust from the Afrobarometer surveys at the subnational level. A total of 166 953 children from 41 surveys administered in 22 African countries covering 216 subnational regions were used. Based on a principal component analysis, we constructed an institutional mistrust index that combined the level of mistrust in the head of state, parliament, electoral system, courts and local government. Associations between institutional mistrust and child vaccination uptake were assessed with multivariable fixed effects logistic regressions that controlled for time-invariant subnational region characteristics and various child, caregiver, household and community characteristics.ResultsA 1 SD increase in the institutional mistrust index was associated with a 10% (95% CI of ORs: 1.03 to 1.18) increase in the likelihood that a child had not received any of eight basic vaccines and with a 6% decrease in the likelihood a child had received all of the basic vaccines (95% CI: 0.92 to 0.97). Institutional mistrust was negatively associated with the likelihood that a child had received each of the eight basic vaccinations (p
ISSN:2059-7908
2059-7908
DOI:10.1136/bmjgh-2020-004595