Measles is a highly contagious, yet vaccine preventable, viral infection, with a case fatality rate of up to 10%. Globally, an estimated 10 million cases and 164,000 deaths from measles occurred in 2008. Measles vaccination is a cost-effective intervention for averting measles infection. Vaccination for measles has been part of the World Health Organization’s (WHO) recommended immunization series since the inception of Expanded Programme on Immunization (EPI) in 1974. Routine measles vaccination coverage was selected as the third indicator of progress towards the Millennium Development Goal (MDG 4), of reducing under-five mortality rates by two-thirds by 2015, compared with 1990 baseline data.
According to the WHO, by 2008, measles vaccination coverage was 83% globally among children aged 12–23 months old. Nearly 700 million children aged between 9 months to 14 years living in high-risk countries, were vaccinated against the disease between 2000 to 2008, and globally measles deaths declined by 78% during this period, indicating that the global measles vaccination campaign successfully averted over 3.6 million deaths [1–3]. The lowest rates were in the South-East Asian (75%) and African (73%) regions. In low-income countries, 76% of children aged 12–23 months had received measles vaccination .
However, measles continues to be a major public health problem among children in developing nations, with measles deaths predominantly occurring among children aged below five years. Children living in developing countries with low income and poor health infrastructure are at the highest risk of measles-related morbidity and mortality. Most of the world’s measles-related deaths occur in nations with the lowest measles vaccine uptake [4, 5].
In 2008 two-thirds of the 22.7 million children who missed receiving measles vaccine in lived in India, Nigeria, China, Democratic Republic of Congo, Pakistan, Ethiopia and Indonesia . In India although the measles vaccination uptake increased to 70% in 2008, measles mortality is high, with about 300 children estimated to be dying from measles-related complications every day.
The major factors influencing measles and other childhood vaccinations operate at five different levels; (1) Intra-personal – Individual child’s characteristics; (2) Inter-personal – parental and household factors; (3) Community – community characteristics and service delivery factors; (4) Institutional: international coordination of vaccination efforts (5) Public policy – quality, coverage and enforcement of policies . This study focuses on the interpersonal factors influencing vaccination, Our findings have implications for the other four levels which influence childhood vaccination.
Variables such as maternal education and occupation and household’s economic status, have consistently been shown to influence measles vaccination at an interpersonal level in developing countries [7–9]. However, much of this research has focused on the role of maternal education status, despite the patriarchal nature of most nations with low measles vaccination uptake. The few studies on the impact of paternal education on vaccination uptake were largely based on small samples in limited settings. For example, a study based on a 2006 survey of slum children in Bangladesh showed that paternal occupation significantly influenced vaccination uptake, with children with fathers in a business or service occupation being 1.059 times and 1.107 times more likely to vaccinate their children, relative to children whose fathers were labourers . A recent study from Pakistan found that while maternal education status was influential in improving child nutritional outcomes, father’s education was a more important factor in one-off type health decisions such as receiving vaccination, in comparison to day-today decisions related to nutrition .
A study based on data from the 1992 Indian National Family and Health Survey found that, in rural areas, children with literate fathers were more likely to be vaccinated, even if the mothers are illiterate . The positive influence of high paternal education status on measles vaccination uptake in developed nations was also demonstrated in a state-wide study of 1003 children aged 2 in Ohio, United States .
This paper analyses the probability of a child being vaccinated against measles, specifically focusing on the influence of paternal education status at different levels of maternal education. The key variable of interest is the likelihood that a child aged under 5 years has been vaccinated for measles.