M. A. Rasoul Mofleh, Saber Perdes
Objective This study will analyze data from MICS 2022–2023 to explore the association between maternal and caregiver education levels and immunization coverage among children aged 12–23 months. Furthermore, it will also estimate immunization coverage at the national and provincial levels. While further identifying factors associated with incomplete immunization, it will ultimately offer recommendations to enhance immunization service quality in Afghanistan.
Study design
Cross-sectional study
Methods This study utilized the most recent data from the 2022-2023 Afghanistan Multiple Indicator Cluster Survey (MICS). The analysis focused on immunization data for 6,177 children aged 12-23 months, comprising 3,125 boys and 3,052 girls. Variables included participants' level attributes such as age, sex, and antigen-specific immunization status, as well as household-level factors, including place of residence, region, wealth status, and maternal education. Univariate logistic regression models were used to estimate unadjusted odds ratios (ORs) for the association between each predictor variable and immunization status. Multivariable logistic regression and likelihood ratio tests were conducted to compare different univariate and multivariate logistic models. A p-value <0.05 at the 95% confidence interval was considered to indicate statistical significance (Kirkwood & Sterne, 2010).
Results At the national level, 36.6% of the children aged 12-23 months who participated in the study received basic immunization. Coverage varied across provinces, ranging from 86.1% in Bamyan to 2.6% in Urozgan (2.6%). Crude coverage rates for specific antigens at 23 months were as follows: BCG (64.7%), Penta1 (63.9%), Penta2 (57.7%), Penta3 (51.3%), Polio3 (58.9%), and measles1(51.2%). Immunization coverage among children of mothers who were uneducated was only 31.2%, compared to 55.1% among those whose mothers had higher education. Spoken language had a statistically significant relationship with basic immunization (p = 0.000). After adjusting for extraneous factors such as household wealth and urbanâ??rural residence, maternal education remained a strong predictor. Adjusted ORs for mothers with a higher education (2.74, 95% CI 2.01-3.73, p = 0.000) were significantly greater than those for mothers with no education Conclusions: Our findings underscore the urgent need to invest in women's education, particularly in rural and marginalized communities where female education is scarce, as a crucial pathway to enhancing child health outcomes.