SOCIO-ECONOMIC DETERMINANTS OF SUCESSIVE POLIO AND PENTAVALENT VACCINES UTILISATION AMONG UNDER FIVE CHILDREN IN GHANA

Abstract

Objective: This study was conducted to investigate the factors that influence the utilization of the successive doses of polio and pentavalent vaccines among underfive children
in Ghana.
Method: The study used data from a cross-sectional survey in the form of the 2014
Ghana Demographic and Health Survey which was carried out between early September
and mid-December, 2014. The Probit model was the empirical estimation technique.
Results: Among other findings, the study revealed that the region of residence influenced
the utilization of the initial and successive doses of both polio and pentavalent vaccines.
Also, rising birth order of the child was revealed to negatively influence the utilization of
all the doses of the polio and pentavalent vaccines. In addition, rising age of the household head was found to decrease the utilization of the third dose of the polio vaccine and
the second and third doses of the pentavalent vaccine. Single mothers were also revealed
to be less likely to utilize the third dose of both vaccines for their children. Moreover,
employed mothers were found to be more likely to utilize all the subsequent doses of
both the pentavalent and polio vaccines for their children while mothers with secondary
education were more likely to utilize both the second and third doses of the polio vaccine
as well as the third dose of the pentavalent vaccine for their children as compared with
their uneducated counterparts.
Conclusion: The study therefore concludes that public sensitization programs on childhood immunization with regional focus and ethnic rulers’ partnerships, targeting of
older household heads, uneducated, unemployed, and single mothers as well as women
empowerment through employment and education are effective tools in ensuring Child
health utilization (immunization) in Ghana.

Full text

eJManager
AMERICAN JOURNAL OF PREVENTIVE MEDICINE AND PUBLIC HEALTH, 2018
VOL 2, NO. 1, PAGES 18–29
10.5455/ajpmph.20171129072443
ORIGINAL RESEARCH Open Access
Socio-economic determinants of successive polio and pentavalent vaccines ulizaon
among under-ve children in Ghana
Mustapha Immurana, Arabi U
Department of Economics, Mangalore University, India
ABSTRACT
Objecve: This study was conducted to invesgate the factors that inuence the uliza-
on of the successive doses of polio and pentavalent vaccines among underve children
in Ghana.
Method: The study used data from a cross-seconal survey in the form of the 2014
Ghana Demographic and Health Survey which was carried out between early September
and mid-December, 2014. The Probit model was the empirical esmaon technique.
Results: Among other ndings, the study revealed that the region of residence inuenced
the ulizaon of the inial and successive doses of both polio and pentavalent vaccines.
Also, rising birth order of the child was revealed to negavely inuence the ulizaon of
all the doses of the polio and pentavalent vaccines. In addion, rising age of the house-
hold head was found to decrease the ulizaon of the third dose of the polio vaccine and
the second and third doses of the pentavalent vaccine. Single mothers were also revealed
to be less likely to ulize the third dose of both vaccines for their children. Moreover,
employed mothers were found to be more likely to ulize all the subsequent doses of
both the pentavalent and polio vaccines for their children while mothers with secondary
educaon were more likely to ulize both the second and third doses of the polio vaccine
as well as the third dose of the pentavalent vaccine for their children as compared with
their uneducated counterparts.
Conclusion: The study therefore concludes that public sensizaon programs on child-
hood immunizaon with regional focus and ethnic rulers’ partnerships, targeng of
older household heads, uneducated, unemployed, and single mothers as well as women
empowerment through employment and educaon are eecve tools in ensuring Child
health ulizaon (immunizaon) in Ghana.
ARTICLE HISTORY
Received November 29, 2017
Accepted December 30, 2017
Published December 30, 2017
KEYWORDS
Child health; immunizaon;
subsequent or successive
doses; polio vaccine; pen-
tavalent vaccine; Ghana
Introducon
Globally, among the dangerous killers of children
are polio and whooping cough (pertussis). How-
ever, one of the most effective ways of preventing
        
through immunization. Hence utilizing all the rec-
ommended vaccines for children, and subsequent
or successive doses if any is very important for
child survival. It is therefore not surprising that in
various countries, efforts made toward reducing
the mortality of children have among other factors
been made via encouraging the utilization of all rec-
ommended vaccines for children.
Polio is a viral disease which can take just hours
to paralyze the entire body by attacking the nervous
system. It normally pounds on children who are less

two hundred polio infections leads to irremediable
paralysis with 5%–10% of those paralyzed dying
when there is an immobility of their breathing mus-
cles. However, via stupendous campaigns, there has
been a drastic reduction in the cases of polio globally
and hence making over ten million people today freely
walking [1]. Whooping cough, on the other hand, is
also a major cause of infant mortality [2]. According
to the World Health Organization (WHO) [2], in 2008,
Contact Mustapha Immurana mustaphaimmurana@gmail.com Department of Economics, Mangalore University, India.
© EJManager. This is an open access arcle licensed under the terms of the Creave Commons Aribuon Non-Commercial License (hp://
creavecommons.org/licenses/by-nc/3.0/) which permits unrestricted, noncommercial use, distribuon and reproducon in any medium, provided
the work is properly cited.

www.ajpmph.com 19
Socio-economic determinants of successive polio and pentavalent vaccines
the cases of whooping cough were about 16 million
leading to the death of about 1,095 children. However,
global vaccination against whooping cough according
to the WHO [2] was able to prevent around 687,000
mortalities in 2008. Given the deadly nature of polio
and whooping cough, it is recommended that chil-
dren utilize all the four doses of the polio vaccine and
all the three doses of the pentavalent vaccine which

infections in the case of Ghana.
According to the 2014 Ghana Health Service
Report, Ghana has attained and still maintain
the status of polio-free since 2008 [3]. However,
the 2014 Ghana Demographic and Health Sur-
vey (GDHS) report indicates that there have been
reductions in the coverage or up-take of subsequent
or successive doses of the polio and pentavalent
vaccines among children in Ghana [4]. Thus, the
success chalked with regard to polio eradication
in Ghana remains being greatly threatened by the
fall in the uptake or coverage of subsequent doses
   
the uptake or coverage of subsequent doses of the
pentavalent vaccines, they serve as dangers to Gha-
na’s efforts toward achieving the sustainable devel-

most 25 deaths per thousand live births by 2030.
-
 -
tion of the subsequent doses of the polio and pen-
tavalent vaccines among children in Ghana which
helped bring to light the reasons for falling uptake
of these vaccines and hence how to tackle them.
The main theoretical basis of the work was the
demand for health as postulated by [5] where there
is a derived demand for health and hence the intake
of vaccines by children would translate into a bet-
ter health which in itself is a form of human capital
investment. Since children are not old enough, deci-
sions on vaccines utilization depend on the expected
utility of care givers or mothers. In Ghana, studies
such as [6–9] have been done on vaccine utilization
or immunization. However, to the best of the authors’
knowledge, no study has been done on the socio-eco-
-
sequent doses of the polio and pentavalent vaccines
among children in Ghana, and hence making this
study timely, unique, and worthwhile.
Methods
The 2014 GDHS (the most recent nationally repre-
sentative survey on health and demography carried
out by the Ghana Statistical Service and other part-
ners from early September to Mid-December, 2014)
was the main source of data for the study. The data,
which was a cross-sectional survey, contained infor-
mation with regard to the immunizations status of
children born in the 5 years preceding the survey as
well as other maternal (mothers), socio-economic,
demographic, and geographic information.
As mothers or care givers are assumed to uti-
lize a particular vaccine for the child based on their
expected utility, it means they may choose to uti-
lize a vaccine for the child or not. Thus, each dose
of both the polio and pentavalent vaccines was a
dependent variable and hence treated as 1 if uti-
lized (if a dose was marked on a child’s card, or
date of vaccine utilization was found on the card or
if care giver/mother provided a verbal report that
a vaccine has been offered to a child), and 0 if not
utilized for the child. Given the dichotomous nature
of the dependent variables, the study employed
the binary probit regression model. In this study,
all don’t know responses were treated as missing
values and the categorical independent variables
were treated as dummy variables. The authors wish
to state that wealth status, mother’s marital status,
and religion were transformed (recoded) from how
they were coded in the original data to their current
state as used in this study. According to [10], mar-
ginal effects are one of the well-known approaches
to providing more meaning to variables in nonlin-
ear models like the probit model and hence the
study reported the average marginal effects (AME)
of the variables. However, before the probit regres-
sions which are multivariate analyses, bivariate


and the various categorical independent variables
   2 test. All analyzes were done
using stata 11 software.
Results
Bivariate analyses
The results of the bivariate analyses in Tables 1–3

the various regions, religions, and ethnic groups with
regard to the utilization of all the vaccines and their
  

between the utilization of Polio O, 1, and 2 vaccines
for children and mother’s educational level, per-
mission, and distance to seek self-medical help by


20 Am J Prev Med Public Health • 2018 • Vol 2 • Issue 1
Mustapha Immurana, Arabi U
Table 1. Bivariate analyses of Polio O, 1, and 2 vaccines ulizaon among children in Ghana.
Variable Polio O (%) χ2Polio 1 (%) χ2Polio 2 (%) χ2
No Yes No Ye s No Yes
Region 404.3917*** 54.0131*** 113.4261***
Western 20.11 79.89 7.47 92.53 23.49 76.51
Central 20.45 79.55 4.90 95.10 11.71 88.29
Greater Accra 4.03 95.97 5.82 94.18 13.20 86.80
Volta 28.60 71.40 6.11 93.89 13.10 86.90
Eastern 34.63 65.37 9.14 90.86 15.76 84.24
Ashan 22.54 77.46 8.77 91.23 14.67 85.33
Brong Ahafo 25.96 74.04 3.50 96.50 7.64 92.36
Northern 44.35 55.65 11.56 88.44 22.05 77.95
Upper East 9.55 90.45 4.87 95.13 10.49 89.51
Upper West 17.89 82.11 8.84 91.16 11.37 88.63
Residence 171.7934*** 0.3961 0.9961
Urban 15.00 85.00 7.01 92.99 14.16 85.84
Rural 30.35 69.65 7.46 92.54 15.13 84.87
Religion 95.3695*** 11.2535*** 9.7037***
Chrisan 22.15 77.85 7.01 92.99 14.52 85.48
Islam 23.91 76.09 6.65 93.35 13.58 86.42
Tradional 42.38 57.62 11.06 88.94 19.42 80.58
Ethnicity 257.1307*** 50.7213*** 70.7207***
Akan 21.28 78.72 6.58 93.42 14.98 85.02
Ga/Dangme 17.67 82.33 6.02 93.98 12.05 87.95
Ewe 21.90 78.10 6.28 93.72 13.53 86.47
Guan 25.00 75.00 4.69 95.31 17.19 82.81
Mole-Dagbani 20.82 79.18 7.29 92.71 12.40 87.60
Grusi 17.37 82.63 3.81 96.19 8.47 91.53
Gurma 51.27 48.73 14.13 85.87 25.36 74.64
Mande 27.06 72.94 2.35 97.65 7.06 92.94
Other 32.38 67.62 9.52 90.48 17.14 82.86
Mother’s
educaon
191.9880*** 11.4064*** 7.9899**
Uneducated 33.96 66.04 8.42 91.58 15.86 84.14
Primary 24.46 75.54 8.15 91.85 15.87 84.13
Secondary 17.72 82.28 5.91 94.09 13.61 86.39
Higher 5.66 94.34 7.08 92.92 10.85 89.15
Mother’s
insurance
70.7856*** 0.0876 0.0004
Uninsured 31.52 68.48 7.44 92.56 14.76 85.24
Insured 21.05 78.95 7.22 92.78 14.74 85.26
Marital status 13.4628*** 0.2658 16.0457***
Single 27.20 72.80 7.54 92.46 17.42 82.58
Married 22.75 77.25 7.16 92.84 13.40 86.60
Mother’s
employment
1.1451 32.4392*** 49.1958***
Unemployed 23.06 76.94 11.14 88.86 21.24 78.76
Employed 24.57 75.43 6.26 93.74 13.04 86.96
Permission to
seek medical
care/help by
mother
3.0875* 4.8294** 4.9081**
Big problem 28.00 72.00 10.13 89.87 18.67 81.33
Not a big
problem
23.97 76.03 7.08 92.92 14.47 85.53
Money to seek
medical care/help
by mother
102.9609*** 15.9141*** 0.9063
Big problem 30.24 69.76 8.71 91.29 15.21 84.79
Not a big
problem
18.60 81.40 5.94 94.06 14.31 85.69
(Connued)

www.ajpmph.com 21
Socio-economic determinants of successive polio and pentavalent vaccines
Table 2. Bivariate analyses of Polio 3 and Pentavalent 1 and 2 vaccines ulizaon among children in Ghana.
Variable Polio 3 (%) χ2Pentavalent 1 (%) χ2Pentavalent 2 (%) χ2
No Yes No Ye s No Yes
Region 100.3708*** 61.4757*** 83.9664***
Western 33.99 66.01 8.09 91.91 13.67 86.33
Central 28.32 71.68 4.90 95.10 9.28 90.72
Greater Accra 26.85 73.15 7.40 92.60 12.56 87.44
Volta 24.02 75.98 9.27 90.73 13.25 86.75
Eastern 27.43 72.57 9.16 90.84 15.20 84.80
Ashan 25.04 74.96 6.08 93.92 11.27 88.73
Brong Ahafo 18.95 81.05 3.98 96.02 6.53 93.47
Northern 35.04 64.96 12.99 87.01 20.38 79.62
Upper East 20.79 79.21 5.25 94.75 9.01 90.99
Upper West 17.05 82.95 8.02 91.98 12.03 87.97
Residence 0.7931 4.1189** 0.9520
Urban 26.93 73.07 6.81 93.19 12.08 87.92
Rural 25.86 74.14 8.29 91.71 12.97 87.03
Religion 20.3783*** 12.1997*** 17.3101***
Chrisan 26.47 73.53 7.41 92.59 12.00 88.00
Islam 22.63 77.37 7.00 93.00 12.22 87.78
Tradional 33.40 66.60 11.74 88.26 18.66 81.34
Ethnicity 108.3538*** 77.0531*** 79.4193***
Akan 27.95 72.05 6.22 93.78 11.23 88.77
Ga/Dangme 22.49 77.51 8.06 91.94 12.10 87.90
Ewe 24.64 75.36 7.32 92.68 12.52 87.48
Guan 29.69 70.31 4.69 95.31 8.59 91.41
Mole-Dagbani 21.19 78.81 7.29 92.71 11.65 88.35
Grusi 19.49 80.51 5.56 94.44 8.97 91.03
Gurma 40.94 59.06 16.15 83.85 23.41 76.59
Mande 8.24 91.76 1.19 98.81 3.57 96.43
Other 30.48 69.52 14.29 85.71 20.00 80.00
Variable Polio O (%) χ2Polio 1 (%) χ2Polio 2 (%) χ2
No Yes No Ye s No Yes
Distance to seek
medical care/help
by mother
102.8444*** 11.8707*** 4.1444**
Big problem 32.79 67.21 9.04 90.96 16.17 83.83
Not a big
problem
20.29 79.71 6.47 93.53 14.09 85.91
Partner’s
educaon
192.5856*** 14.8946*** 3.9718
Uneducated 35.37 64.63 8.84 91.16 15.52 84.48
Primary 25.52 74.48 7.66 92.34 14.19 85.81
Secondary 19.75 80.25 5.72 94.28 13.46 86.54
Higher 9.01 90.99 6.68 93.32 12.93 87.07
Sex of household
head
3.7733* 0.3774 1.0639
Male 24.85 75.15 7.40 92.60 14.48 85.52
Female 22.22 77.78 6.90 93.10 15.63 84.37
Sex of child 1.4935 0.1402 0.9748
Male 24.91 75.09 7.41 92.59 15.20 84.80
Female 23.51 76.49 7.15 92.85 14.26 85.74
Wealth status 244.2292*** 5.7551** 2.4056
Non-rich 29.76 70.24 7.80 92.20 15.20 84.80
Rich 9.69 90.31 5.93 94.07 13.55 86.45
Source: Authors computaon from the 2014 GDHS.
Note: *, **, and *** showing signicant dierences at 10%, 5%, and 1%, respecvely, within the predictors and Polio 0, 1, and 2
ulizaon among children in Ghana. Tradional in this study means tradional/spiritualist/no religion.
Table 1. Bivariate analyses of Polio O, 1, and 2 vaccines ulizaon among children in Ghana. (Connued)
(Connued)

22 Am J Prev Med Public Health • 2018 • Vol 2 • Issue 1
Mustapha Immurana, Arabi U
Table 2. Bivariate analyses of Polio 3 and Pentavalent 1 and 2 vaccines ulizaon among children in Ghana. (Connued)
Variable Polio 3 (%) χ2Pentavalent 1 (%) χ2Pentavalent 2 (%) χ2
No Yes No Ye s No Yes
Mother’s
educaon
2.8767 15.4284*** 15.9535***
Uneducated 26.94 73.06 9.45 90.55 14.67 85.33
Primary 27.49 72.51 7.56 92.44 13.29 86.71
Secondary 25.35 74.65 6.23 93.77 10.68 89.32
Higher 24.06 75.94 8.49 91.51 11.32 88.68
Mother’s
insurance
6.6802*** 0.0001 0.3265
Uninsured 28.59 71.41 7.71 92.29 12.24 87.76
Insured 25.28 74.72 7.70 92.30 12.79 87.21
Marital status 42.4187*** 3.1730* 7.1256***
Single 31.69 68.31 8.60 91.40 14.29 85.71
Married 23.57 76.43 7.25 92.75 11.78 88.22
Mother’s
employment
21.3126*** 25.8363*** 38.2778***
Unemployed 31.61 68.39 11.26 88.74 18.01 81.99
Employed 24.90 75.10 6.78 93.22 11.22 88.78
Permission to
seek medical
care/help by
mother
3.0588* 7.1261*** 5.8097**
Big problem 30.13 69.87 11.26 88.74 16.62 83.38
Not a big
problem
26.02 73.98 7.45 92.55 12.33 87.67
Money to seek
medical care/help
by mother
0.0597 19.0402*** 7.4441***
Big problem 26.14 73.86 9.31 90.69 13.87 86.13
Not a big
problem
26.43 73.57 6.19 93.81 11.44 88.56
Distance to seek
medical care/help
by mother
0.2646 13.3490*** 6.9752***
Big problem 26.74 73.26 9.62 90.38 14.35 85.65
Not a big
problem
26.09 73.91 6.82 93.18 11.82 88.18
Partner’s
educaon
2.2669 17.0489*** 16.0171***
Uneducated 26.78 73.22 9.50 90.50 14.86 85.14
Primary 24.88 75.12 7.34 92.66 12.44 87.56
Secondary 24.75 75.25 6.03 93.97 10.72 89.28
Higher 25.00 75.00 7.97 92.03 10.99 89.01
Sex of household
head
7.0385*** 3.5892* 1.9859
Male 25.43 74.57 8.07 91.93 12.96 87.04
Female 29.12 70.88 6.47 93.53 11.48 88.52
Sex of child 0.0965 2.6251 2.5432
Male 26.46 73.54 8.26 91.74 13.30 86.70
Female 26.10 73.90 7.10 92.90 11.88 88.12
Wealth status 2.3407 9.8979*** 4.0561**
Non-rich 25.73 74.27 8.39 91.61 13.17 86.83
Rich 27.75 72.25 5.87 94.13 11.16 88.84
Source: Authors computaon from the 2014 GDHS.
Note: *, **, and *** showing signicant dierence at 10%, 5% and 1% respecvely within the predictors and Polio 3, Pentavalent 1 and
2 vaccine ulizaon among children in Ghana. Tradional in this study means tradional/spiritualist/no religion.

www.ajpmph.com 23
Socio-economic determinants of successive polio and pentavalent vaccines
between the utilization of Polio 3 and Pentavalent
1 and 2 vaccines for children and Marital Status of
mother, mother’s employment, and permission to
seek medical help by mother in Table 2. Also, the
utilization of Pentavalent 1 and 2 doses in Table 2
-
cation, partner’s education, distance, and money to
seek medical help by mother. In addition, the utiliza-
tion of Pentavalent 3 dose was found to have signif-
icant relationships with mother’s education, moth-
er’s employment, marital status, partner’s education
and permission, distance and money to seek medical
help by mother as shown in Table 3. Moreover, the
distribution of the various vaccines among the vari-
ables can also be seen in Table 3.
Mulvariate analyses
Since these bivariate analyses were done for each
categorical independent variable and hence did not
control for other variables that may determine the
utilization of a particular vaccine and subsequent
doses, the study adopted the multivariate analyses
while controlling the other factors.
It must be stated that when children are said
to have utilized or not utilized a vaccine in these
Table 3. Bivariate analyses of Pentavalent 3 vaccine
Ulizaon among children in Ghana.
Variable Pentavalent 3 (%) χ2
No Yes
Region 135.1370***
Western 29.86 70.14
Central 18.39 81.61
Greater Accra 20.85 79.15
Volta 22.74 77.26
Eastern 25.73 74.27
Ashan 19.68 80.32
Brong Ahafo 14.97 85.03
Northern 33.85 66.15
Upper East 16.89 83.11
Upper West 15.40 84.60
Residence 0.4816
Urban 21.96 78.04
Rural 22.75 77.25
Religion 19.9368***
Chrisan 21.99 78.01
Islam 20.64 79.36
Tradional 30.40 69.60
Ethnicity 115.6395***
Akan 22.31 77.69
Ga/Dangme 19.76 80.24
Ewe 21.30 78.70
Guan 20.31 79.69
Mole-Dagbani 19.14 80.86
Grusi 15.81 84.19
Gurma 38.66 61.34
Mande 5.95 94.05
Other 28.57 71.43
Partner’s
educaon
16.1336***
Uneducated 25.06 74.94
Primary 20.57 79.43
Secondary 19.99 80.01
Higher 19.83 80.17
Mother’s
educaon
14.3677***
Uneducated 24.91 75.09
Primary 23.20 76.80
Secondary 20.18 79.82
Higher 20.28 79.72
Mother’s
insurance
1.8612
Uninsured 23.59 76.41
Insured 21.93 78.07
Marital status 33.9034***
Single 27.03 72.97
Married 20.13 79.87
Mother’s
employment
36.1802***
Unemployed 29.00 71.00
Employed 20.71 79.29
Permission to
seek medical
care/help by
mother
3.8688**
Big problem 26.54 73.46
Not a big
problem
22.14 77.86
Variable Pentavalent 3 (%) χ2
No Yes
Money to seek
medical care/help
by mother
5.9893**
Big problem 23.85 76.15
Not a big
problem
21.11 78.89
Distance to seek
medical care/help
by mother
9.6743***
Big problem 25.00 75.00
Not a big
problem
21.26 78.74
Sex of child 0.0268
Male 22.52 77.48
Female 22.34 77.66
Wealth status 0.2310
Non-rich 22.60 77.40
Rich 22.00 78.00
Sex of household
head
0.9475
Male 22.13 77.87
Female 23.42 76.58
Source: Authors computaon from the 2014 GDHS.
Note: **, and *** showing signicant dierence at 5% and 1%,
respecvely, within the predictor and Pentavalent 3 vaccine
ulizaon among children in Ghana. Tradional in this study
means tradional/spiritualist/no religion.
Table 3. Bivariate analyses of Pentavalent 3 vaccine
Ulizaon among children in Ghana. (Connued)
(Connued)

24 Am J Prev Med Public Health • 2018 • Vol 2 • Issue 1
Mustapha Immurana, Arabi U
analyses, it must be kept in mind that it was done
on their behalf by care givers or mothers.

East and Greater Accra regions were 8% more
likely to have received the Polio 0 vaccine as com-
pared to their counterparts in the reference region
      
from the Central, Western, Eastern, Brong Ahafo
,Volta, Ashanti, and Northern regions were on
average 5%, 6%, 20%, 9%, 14%, 11%, and 15%,
respectively, less probable to have received the

region. Also, children from the Christian faith and
urban areas were 4% more likely to have received
the Polio 0 vaccine as compared to those from
the Traditional/Spiritualist/No Religion faith and
     
that children with Akan, Ewe, Ga/Dangme, Guan,
Grusi, and Mole-Dagbani ethnicity were on the
average 14%, 18%, 16%, 16%, 15%, and 15%,
respectively, more probable to have received the
Polio 0 vaccine relative to those with other ethnic
backgrounds. Also, both mothers with primary
and secondary education, mothers with health
insurance, and married mothers were 3%, 6%, and
3% more likely to have utilized the Polio 0 vaccine
for their children as compared to the uneducated,
uninsured, and single mothers, respectively. On
average, children with mothers or caregivers who
had partners with higher and secondary educa-
tion were 9% and 5%, respectively, more proba-
ble to have utilized the Polio 0 vaccine relative to
those whose mothers had uneducated partners. In
addition, wealthy households were 9% more prob-
able to have utilized the Polio 0 vaccine for their
-
thermore, a one year increase in the ages of the
child and the mother was revealed to decrease and
increase the probability of children receiving the
Polio 0 vaccine by 2% and 0.5%, respectively. Con-
versely, on average, a unit increase in the age of the
household head and child’s birth order decreased
the probability that a child received the Polio 0
vaccine by 0.09% and 2%, respectively.
On Polio 1 utilization, children from the Cen-
       
were on average 4%, 5%, 4%, and 3%, respec-
tively, more probable to have received the Polio 1
       
region. Children from urban areas were on average
3% less likely to have utilized the Polio 1 vaccine
as compared to their rural counterparts. Also on
average, Mande ethnicity children, children with
employed mothers, and children from wealthy
households were 6%, 4%, and 2% more probable
to have received the Polio 1 vaccine as compared
with those from the other ethnic groups, those
with unemployed mothers, and those from non-
wealthy households, respectively. Moreover, a one
year increase in the ages of the child and the mother
were revealed to increase the probability of chil-
dren receiving the Polio 1 vaccine by 2% and 0.3%,
respectively. Conversely, on average, a unit increase
in child’s birth order decreased the probability that
a child received the Polio 1 vaccine by 0.8%.
On Polio 2 vaccine utilization, children from
the Brong Ahafo, Western and Northern regions
on average were, respectively, 6% more likely, 9%
less likely, and 5% less likely to have received the
        
West region. Also, Grusi ethnicity children were
7% more probable to have received the Polio 2 vac-
cine in comparison with those from the other eth-
nic groups. Mothers with secondary education and
mothers, who were employed, were revealed to be
3% and 6% more probable to utilize the Polio 2 vac-
cine for their children as compared with their uned-
ucated and unemployed counterparts, respectively.
In addition, mothers with money as a big problem
in seeking care for themselves were 2% on average
more probable to utilize the Polio 2 vaccine for their
children. Also, a unit increase in the ages of the child
and the mother were revealed to increase the prob-
ability of children receiving the Polio 2 vaccine by
3% and 0.4%, respectively. Conversely, on average,
a unit increase in the child’s birth order decreased
the probability that a child received the Polio 2 vac-
cine by 1%.
On the utilization of the Polio 3 vaccine, children
from the Central, Western, Eastern, Greater Accra,
and Northern Regions on average were 6%, 11%,
7%, 6%, and 11%, respectively, less probable to
        
      
and Ga/Dangme ethnicity were, respectively, 18%
and 9% more likely to have received the Polio 3 vac-
cine relative to those from the other ethnic groups.
In addition, on average, employed and married
mothers were 4% more likely to have utilized the
Polio 3 vaccine for their children as compared to the
unemployed and single mothers, respectively. Also,
mothers with secondary education were revealed
on average to be 4% more likely to utilize the Polio 3
vaccine for their children as compared to the uned-
ucated mothers. Mothers with monetary challenges
in seeking self-medical care/help were on average

www.ajpmph.com 25
Socio-economic determinants of successive polio and pentavalent vaccines
Table 4. Probit results on determinants of polio vaccine ulizaon.
Dependent variable Polio 0 Polio 1 Polio 2 Polio 3
Independent variable AME AME AME AME
Region (Ref: Upper West)
Western −0.0635413** −0.0007772 −0.0869258*** −0.1128125***
Central −0.0508547* 0.0422439** 0.0284939 −0.0592207*
Greater Accra 0.0753127** 0.004111 −0.0055787 −0.061992*
Volta −0.1415353*** 0.0388053* 0.0203142 −0.0347548
Eastern −0.1999165*** −0.0069749 −0.0171395 −0.0662922*
Ashan −0.1135889*** −0.007875 −0.0128593 −0.0388982
Brong Ahafo −0.0887736*** 0.0502628*** 0.0635363*** 0.0196296
Northern −0.1483711*** 0.0018722 −0.0487437* −0.1061035***
Upper East 0.0757231*** 0.0341849** 0.0071333 −0.0391827
Residence (Ref:Rural)
Urban 0.0429563*** −0.0276181*** −0.0193321 −0.018871
Religion (Ref: Tradional)
Chrisan 0.0400328* −0.0023167 −0.0020891 0.0077244
Islam 0.0343361 0.0134472 0.0076979 0.0365679
Ethnicity(Ref: other)
Akan 0.1367185*** 0.0173449 0.0119832 0.0227724
Ga/Dangme 0.1582876*** 0.0453598 0.0627136 0.0930583*
Ewe 0.1803711*** 0.0220394 0.0166965 0.0514449
Guan 0.1576171*** 0.0402796 −0.0165998 −0.0346003
Mole-Dagbani 0.1511283*** 0.0287557 0.0492137 0.0644409
Grusi 0.1488752*** 0.0501761 0.0711227* 0.0603181
Gurma 0.0706808 −0.0182269 −0.0520217 −0.0767681
Mande 0.0949749 0.0600826* 0.074483 0.1805152***
Mother’s educaon (Ref: Uneducated)
Primary 0.0296773* −0.0142803 −0.0070346 −0.0020568
Secondary 0.0337268* 0.0061133 0.0270586* 0.0416585**
Higher 0.0592806 −0.0262089 0.0286556 0.0468766
Mother’s insurance (Ref: Uninsured)
Insured 0.0573752*** 0.0023802 −0.0023679 0.0170871
Marital status (Ref: Single Mothers)
Married 0.0268188* −0.0076803 0.0156062 0.0433052***
Mother’s employment (Ref: Unemployed)
Employed −0.0039048 0.0376731*** 0.0591613*** 0.0441878***
Permission to seek medical care by mother
(Ref: Not a big problem)
Big Problem −0.0079161 −0.0039398 −0.002261 −0.0071927
Money to seek medical care by mother (Ref:
Not a big problem)
Big problem −0.0097535 −0.0124154 0.0222678** 0.0377548***
Distance to seek medical care by mother (Ref:
Not a big problem)
Big problem −0.014743 −0.0045649 −0.0110253 −0.0108551
Partner’s educaon (Ref: Uneducated)
Primary 0.0278112 0.0021469 −0.0055197 −0.0052049
Secondary 0.0484825*** 0.0168591 −0.0003977 0.009082
Higher 0.0856081*** 0.0026594 −0.0103177 −0.0011061
Sex of household head (Ref: Female head)
Male head −0.0092374 −0.0014763 0.0142504 0.0284064*
Sex of child (Ref: Female)
Male child −0.0075843 0.0011519 −0.0042359 −0.0045623
Wealth (Ref: Non-rich)
Rich 0.0863899*** 0.019625* 0.0019913 −0.0425306**
Mother’s age 0.0053193*** 0.0027599*** 0.0043704*** 0.0055323***
Age of household head −0.0008759* −0.0003991 −0.0006619 −0.0013488**
Birth order of child −0.0170414*** −0.0082444*** −0.0127934*** −0.0131053***
Childs age −0.0188567*** 0.018882*** 0.0330777*** 0.0214626***
N = 5,142 N = 5,140 N = 5,140 N = 5,140
Prob > χ2 = 0.0000 Prob > χ2 = 0.0000 Prob > χ2 = 0.0000 Prob > χ2 = 0.0000
Source: Authors computaon from the children’s recode le, 2014 GDHS.
Note: *P-value < 0.1, **P-value < 0.05, ***P-value < 0.01. AME: Average marginal eects. Tradional in this study means tradional/
spiritualist/no religion.

26 Am J Prev Med Public Health • 2018 • Vol 2 • Issue 1
Mustapha Immurana, Arabi U
4% more likely to have utilized the Polio 3 vaccine
for their children relative to mothers without mone-
tary challenges. Also, children with male household
heads and those from wealthy households were 3%
more likely and 4% less likely to have received the
Polio 3 vaccine relative to those with female house-
hold heads and from non-rich households respec-
tively. Also on average, a unit increase in the ages of
the child and the mother were revealed to increase
the probability of children receiving the Polio 3 vac-
cine by 2% and 0.6%, respectively. Conversely, on
average a unit increase in the child’s birth order and
the age of the household head decreased the proba-
bility that a child received the Polio 3 vaccine by 1%
and 0.1%, respectively.
The results from Table 5 showed that on aver-
age children from the Brong Ahafo Region were 3%
and more likely to have received the Pentavalent 1
      
West region. Also, children from Ga/Dangme,
Akan, Ewe, Mole-Dagbani, Guan, Mande, and Grusi
ethnicity were 8%, 6%, 8%, 7%, 9%, 12%, and 7%,
respectively, more probable to have received the
Pentavalent 1 vaccine relative to those from the
other ethnic backgrounds (reference category).
Employed mothers on average were revealed to be
3% more likely to have utilized the Pentavalent 1
vaccine for their children relative to their unem-

to receive medical care for mothers were revealed
on average to reduce by 2% the likelihood of chil-

a 1 year increase in the ages of the child and the
mother were revealed to increase the probability
of children receiving the Pentavalent 1 vaccine
by 2% and 0.2% respectively. The probability of
receiving the Pentavalent 1 vaccine by children,
on average, decreased by 0.5% with a unit rise in
child’s birth order.
On Pentavalent 2 utilization as observed under
Pentavalent 1, children from the Brong Ahafo
Region on average were 6% more probable to have
received the Pentavalent 2 vaccine relative to those
  -
dren with Ga/Dangme, Mole-Dagbani, Guan, and
Mande ethnic backgrounds were 8%, 7%, 10%, and
13%, respectively, more probable to have received
the Pentavalent 2 vaccine as compared to those
from the other ethnic groups. Employed mothers on
average were revealed to be 4% more likely to have
utilized the Pentavalent 2 vaccine for their children
relative to their unemployed counterparts. In addi-
tion, a one year increase in the ages of the child and
the mother were revealed to increase the probabil-
ity of children receiving the Pentavalent 2 vaccine
by 3% and 0.3%, respectively. Conversely, on aver-
age, a unit increase in the age of the household head
and child’s birth order decreased the probability
that a child received the Pentavalent 2 vaccine by
0.1% and 0.6%, respectively.
With regard to the utilization of the Pentavalent
3 vaccine children from the Greater Accra, West-
ern, Eastern, Volta, and Northern regions were 6%,
12%, 9%, 6%, and 12%, respectively, less likely to
have utilized relative to their counterparts in the
 
Mande and Ga/Dangme ethnicity were 19% and
9%, respectively, more probable to have utilized/
received the pentavalent 3 vaccine as compared to
children from the other ethnic groups. Moreover,
mothers with secondary education on average were
4% more likely to have utilized the Pentavalent 3
vaccine for their children as compared to their
uneducated counterparts. In addition, employed
and married mothers were revealed to be 5% and
4% more likely to have utilized the Pentavalent 3
vaccine for their children as compared to their
unemployed and single counterparts, respectively.
Also, the results showed that wealthy households
were 3% less probable to have utilized the Pen-
tavalent 3 vaccine for children relative to the non-
wealthy households. In addition, a 1 year increase in
the ages of the child and the mother were revealed
to increase the probability of children receiving the
Pentavalent 3 vaccine by 3% and 0.5%, respectively.
On the contrary, on average, a unit increase in the
age of the household head and child’s birth order
decreased the probability that a child received the
Pentavalent 3 vaccine by 0.1% and 1%, respectively.
Discussion

utilization of vaccines as Children from the Western,
Central, Ashanti, Volta; Brong Ahafo, Eastern, and
Northern regions were less likely to have received
the Polio 0 vaccine. Children from the Northern and
Western regions were less likely to have utilized the
Polio 2 vaccine and those from the Greater Accra,
Volta, and Eastern, Western, and Northern regions
were found to be less likely to have received the Pen-
tavalent 3 vaccine as compared to those from the
      -
ern, Greater Accra, Central, Northern, and Eastern
regions were less likely to have received the Polio
3 vaccines. Thus, strengthening the regional health

www.ajpmph.com 27
Socio-economic determinants of successive polio and pentavalent vaccines
Table 5. Probit results on determinants of pentavalent vaccine ulizaon.
Dependent variable Pentavalent 1 Pentavalent 2 Pentavalent 3
Independent variable AME AME AME
Region (Ref: Upper West)
Western −0.0252266 −0.0205289 −0.1195291***
Central 0.0259051 0.0299087 −0.0016329
Greater Accra −0.0319816 −0.0238996 −0.0597628*
Volta −0.0163995 −0.0023776 −0.0603368*
Eastern −0.0184202 −0.0304261 −0.0872715***
Ashan 0.0057379 0.002453 −0.0279651
Brong Ahafo 0.0318413* 0.0562767*** 0.0196533
Northern −0.01814 −0.0376709 −0.1167992***
Upper East 0.0180724 0.023816 −0.0360347
Residence (Ref: Rural)
Urban −0.0132011 −0.0170192 −0.0132817
Religion (Ref: Tradional)
Chrisan −0.0050266 0.0028162 0.0052018
Islam 0.0130522 0.0088105 0.0159192
Ethnicity (Ref: Other)
Akan 0.0648621* 0.0442818 0.0320045
Ga/Dangme 0.0785688** 0.076869* 0.0889516*
Ewe 0.0764486** 0.0575916 0.0662363
Guan 0.0899791** 0.0950668** 0.0676413
Mole-Dagbani 0.0655368* 0.0695419* 0.0736134
Grusi 0.069918* 0.0695907 0.0760888
Gurma 0.0174555 −0.0067988 −0.0436802
Mande 0.1170151*** 0.1257305*** 0.1850583***
Mother’s educaon (Ref: Uneducated)
Primary 0.0045896 −0.0018446 0.0057554
Secondary 0.0102836 0.0222346 0.0442371**
Higher −0.0280922 −0.0126857 0.0359017
Mother’s insurance (Ref: Uninsured)
Insured 0.0014691 −0.0085962 0.0048904
Marital status (Ref: Single mothers)
Married 0.0066056 0.0158163 0.0418283***
Mother’s employment (Ref: Unemployed)
Employed 0.0290446*** 0.0421218*** 0.0521472***
Permission to seek medical care by mother (Ref: Not a big
problem)
Big problem −0.0089199 −0.0215015 −0.0070858
Money to seek medical care by mother (Ref: Not a big problem)
Big problem −0.0152867* 0.0025315 0.0095984
Distance to seek medical care by mother (Ref: Not a big problem)
Big problem −0.005866 −0.0035277 −0.0207959
Partner’s educaon (Ref: Uneducated)
Primary 0.0032462 −0.0019288 0.0097221
Secondary 0.0104285 0.0129796 0.0175112
Higher −0.014748 0.0112615 0.0088526
Sex of household head (Ref: Female head)
Male head −0.010752 −0.0114242 0.014553
Sex of child (Ref: Female)
Male child −0.0094261 −0.0075592 −0.0015375
Wealth (Ref: Non-rich)
Rich 0.018561 0.0071716 −0.0349315*
Mother’s age 0.0018747** 0.0031811*** 0.004573***
Age of household head −0.0002721 −0.0012392*** −0.0012812**
Birth order of child −0.0050974* −0.0064368* −0.0125649***
Childs age 0.020341*** 0.0313554*** 0.0332877***
N = 5,126 N = 5,126 N = 5,126
Prob > χ2 = 0.0000 Prob > χ2 = 0.0000 Prob > χ2 = 0.0000
Source: Authors computaon from the children’s recode le, 2014 GDHS.
Note: *P-value < 0.1, **P-value < 0.05, ***P-value < 0.01. AME: Average marginal eects. Tradional in this study means tradional/
spiritualist/no religion.

28 Am J Prev Med Public Health • 2018 • Vol 2 • Issue 1
Mustapha Immurana, Arabi U
directorates to undertake more behavioral change
communication activities on the essence of vaccina-
tion utilization could be a major approach toward
tackling the falling up-take of the successive doses
of the polio and pentavalent vaccines.
-
lization of vaccines as children from Grusi ethnic-
ity, on one hand, and those from Mande and Ga/
Dangme ethnicity, on another hand, were more
likely to utilize the Polio 2 and Polio 3 vaccines,
respectively, relative to those from the other ethnic
groups. This offers an opportunity for Public cam-
paign programs toward encouraging the utilization
of vaccines to have effective partnerships with rul-
ers of the various ethnic groups in addition to the
already existing translation in to local languages of
Public campaign programs on child health utiliza-
tion. In addition, Public sensitization programs on
immunization must demystify the need for all chil-
dren no matter the order of their birth to receive all
the doses of the pentavalent and polio vaccines. This
is because rising birth order was found to decrease
the utilization of not only the successive doses but
all the doses of the pentavalent and polio vaccines.
Thus, if you take for instance two children, where
one has a birth rank or order of 1 and the other is
of birth rank 2, the one with birth rank 2 would be
less probable to have received all the doses of the
pentavalent and polio vaccines. This might be that
mothers or caregivers realized some side effects
of such vaccines in their older children and hence
would not be prepared to utilize for their subse-
quent births. The same was seen in the case of ris-
ing age of the household head which was revealed
to decrease the utilization of the third dose of the
polio vaccine and the second and third doses of the
pentavalent vaccine. This could be attributed to the
sheer unwillingness on the part of some elderly
people in Ghana to accept drugs they label as “white
man’s drug.” Therefore, this calls for the targeting
of household heads especially the older ones with
regard to public sensitization programs on Child-
hood immunization.
Mothers employment has proven to be very
important with regard to the utilization of all the
subsequent doses of both the pentavalent and polio
vaccines. Thus, employed mothers were more likely
to utilize these subsequent doses for their children
as compared to their unemployed counterparts. It
is not surprising since although immunization is
offered free of charge, employed mothers can bet-
ter afford indirect costs such as transportation cost
that may be associated with reaching immunization
centers. This gives credence to women empower-
ment through employment, as a very effective tool
toward encouraging the uptake of such vaccines.
It must also be emphasized that the targeting and
encouragement of unemployed mothers could be
an urgent effective tool.
Another women empowerment tool in the form
education has proven to be vital in the utilization
of the subsequent doses of the pentavalent vaccine
and polio vaccine since mothers with secondary
education were more likely to utilize both the sec-
ond and third doses of the polio vaccine as well as
the third dose of the pentavalent vaccine for their
children as compared with their uneducated coun-
       -
cated mothers can better assimilate the essence
of these vaccines for child survival relative to their
uneducated counterparts. Thus, encouraging girl
child education up to at least the secondary level as
a long-term policy as well as sensitizing the uned-
ucated women as an urgent policy could help in
tackling the falling utilization of successive doses of
the pentavalent and polio vaccines. The social wel-
fare department must also pay so much attention to
vulnerable women like single mothers who may not
get enough support like married mothers given that
single mothers were less likely to utilize the third
doses of both the polio and pentavalent vaccines
for their children. This can be attributed to the fact
that married mothers stand a better chance of get-
ting support from their husbands relative to single
mothers.
Conclusion
The study therefore concludes that public sensiti-
zation programs on childhood immunization with
regional and ethnic centeredness, targeting of older
household heads, uneducated, unemployed, and
single mothers as well as women empowerment
through employment and education are effective
tools in ensuring Child health utilization (immuni-
zation) in Ghana.
Acknowledgement
The authors are most grateful to the DHS Pro-
gramme for providing data for the study.
Conict of Interest
None.

www.ajpmph.com 29
Socio-economic determinants of successive polio and pentavalent vaccines
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