Family structure and full vaccination coverage among children aged 12-23 months in West Africa: Analysis of the interaction effects of maternal education

Childhood vaccination is affected by many maternal socio-economic and family characteristics but these often change over time such that the pattern of relationship needs to be reappraised periodically. In this study, we investigated the influence of family structure and interaction effects of maternal education on full vaccination coverage in the West Africa. Random effects logistic regression was applied to the most recent demographic and health survey data on children aged 12-23 months in six countries. Main explanatory variable was sex of household head and family type. Children living in female-headed households (FHHS) were less likely to be fully vaccinated in five out of six countries [Liberia (OR=0.77), Mali (OR=0.64), Senegal (OR=0.80), Sierra Leone and Togo (OR=0.85)]. Polygyny was negatively associated with full vaccination in three countries [Liberia 9OR=0.79), Mali (OR=0.88), Togo (OR=0.80)]. Interaction effects showed that secondary/higher education enhanced better vaccination coverage among children in FHHs in five countries. Children of single mothers and polygynous women with secondary/higher education recorded higher likelihood of full vaccination. There was a moderate association between family structure and childhood vaccination but the relationship was modified by maternal education which either mitigated the negative influence or amplified the positive effect of family characteristics. Immunization advocacy and awareness programmes may need to target under-five mothers without formal education and those living in female-headed households and polygynous families.