Demographic and Socioeconomic Disparities in Yellow Fever Vaccine Coverage Among Children in Chad: A Multilevel Analysis of a National Survey

Background/Objective Yellow fever is a vaccine-preventable hemorrhagic disease that causes morbidity and mortality in affected individuals. The burden of yellow fever is disproportionately borne by people in tropical regions worldwide, primarily in sub-Saharan Africa and South America. This study examined the contributions of individual- and contextual socioeconomic factors, as well as demographic and healthcare-use variables, to yellow fever vaccine coverage among children in Chad. Methods We used data from the most recent Chad Demographic and Health Survey (CDHS). Multilevel modelling techniques were applied to data on 8,039 children aged 12-59 months across 626 communities to estimate the odds ratio (OR) for receiving the yellow fever vaccine. Results Children born to mothers who were professionals had 116% higher odds of receiving the yellow fever vaccine compared to those whose mothers were not working (OR = 2.16; 95% CI, 1.04-3.18). In addition, analysis shows that the odds of receiving the yellow fever vaccine were 128% higher (OR =2.28; 95% CI, 1.80–3.24) among children from the richest households and those born in a healthcare facility (OR = 1.80; 95% CI, 1.40–2.20) than among their counterparts from poorer households and born at home. Children born to mothers with at least secondary education had 11% higher odds of receiving the yellow fever vaccine (OR = 1.11; 95% CI: 0.74–1.42) than those born to illiterate mothers. Children living in a low socioeconomic deprived community had 31% higher odds (OR =1.31; 95% CI: 1.06 to 2.08) when compared to their peers living in a highly socioeconomic deprived community. Conclusions This study indicates disparities stemming from healthcare service use and socioeconomic differentials at the individual, household, and community levels and their independent contributions to yellow fever vaccine coverage among children in Chad.