Can facility-based delivery boost infant vaccinations? The long-term effect of facility delivery in sub-Saharan Africa

Abstract

Background: In the developing world, facility-based delivery has been linked to improved outcomes for both mothers and babies in the period immediately surrounding birth. Facility-based delivery has also been linked to an increased likelihood of childhood immunisation in at least one sub-Saharan African nation, even when factors associated with facility-based delivery and immunisation are controlled. We sought to determine if such an association held true when looking across all of sub-Saharan Africa and controlling for economic development indicators as well. Methods: We collected publicly available, country-specific data from WHO, the UN, Demographic and Health Surveys, the World Bank, and the International Monetary Fund for all nations of sub-Saharan Africa and entered them into an Excel spreadsheet. Data were imported into Stata 11·0 for analysis. Correlation coefficients were calculated, and regression analysis was done to determine the relation between facility-based delivery and immunisation status in sub-Saharan Africa. A p value of 0·10 was considered significant. Findings: Facility-based delivery rates were significantly associated with the percentage of children younger than 1 years who were fully vaccinated (Pearson R 0·32, p=0·060) and vaccinated with BCG immunisation (0·44, p=0·002), but not with other immunisations. When looking at predictors of full vaccination in a multivariate regression model, facility-based delivery was associated with full vaccination (p<0·0001), even after controlling for gross national income per head, percentage of the country's population that resides in an urban setting, and percentage of the population with at least a secondary education (β coefficient 0·71, 95% CI 0·34–1·0). When looking at predictors of BCG immunisation, facility-based delivery was significantly associated with BCG vaccination (p=0·015), even after controlling for gross national income per head, percentage of the population in an urban setting, and percentage of the population with a secondary education (β coefficient 0·25, 95% CI 0·05–0·45). Interpretation: Facility-based delivery is associated with increased likelihood of BCG immunisation and full immunisation for children younger than 1 year in sub-Saharan Africa. This relation is robust enough to remain even after controlling for economic and social indicators that might be linked to both. These results suggest that the benefits of facility-based delivery go beyond the immediate survival benefit for mothers and their babies, and might serve as a gateway to further interactions with the health-care system. Funding: None.