Association between maternal literacy and child vaccination in Ethiopia and southeastern India and the moderating role of health workers: a multilevel regression analysis of the Young Lives study

Figures & data

Table 1. Descriptive characteristics of child samples across Ethiopia and India in 2006.

		Ethiopia		India
Variable	Categories	Total: N(%)	Completed 4 vaccinations: N(%)	Total: N(%)	Completed 4 vaccinations: N(%)
Maternal literacy	Illiterate	740 (64.0)	636 (85.9)	885 (60.8)	841 (95.0)
	Literate	417 (36.0)	397 (95.2)	570 (39.2)	543 (95.2)
Paternal literacy	Illiterate	485 (41.9)	406 (83.7)	572 (39.3)	541 (94.6)
	Literate	672 (58.1)	627 (93.3)	883 (60.7)	843 (95.5)
Maternal age	30 ≦	572 (49.4)	514 (89.9)	1152 (79.2)	1097 (95.2)
	30 >	585 (50.6)	519 (88.7)	303 (20.8)	287 (94.7)
Gender of child	Male	617 (53.3)	555 (90.0)	770 (52.9)	728 (94.5)
	Female	540 (46.7)	478 (88.5)	685 (47.1)	656 (95.8)
Sibling status*	With Sibling	865 (74.8)	762 (88.1)	639 (43.9)	612 (95.8)
	Only child	292 (25.2)	271 (92.8)	816 (56.1)	772 (94.6)
Wealth	Poorest	225 (19.4)	208 (92.4)	309 (19.3)	282 (91.3)
	Poor	221 (19.1)	204 (92.3)	288 (19.8)	271 (94.1)
	Middle	234 (20.2)	206 (88.0)	287 (19.7)	281 (97.9)
	Wealthy	237 (20.5)	207 (87.3)	293 (20.1)	284 (96.9)
	Wealthiest	240 (20.7)	208 (86.7)	278 (19.1)	266 (95.7)
Type of residence	Rural	733 (63.4)	644 (87.9)	362 (75.1)	320 (88.4)
	Urban	424 (36.6)	389 (91.7)	1093 (24.9)	1064 (97.3)
Region	(Ethiopia)
	Addis Ababa	198 (17.1)	195 (98.5)
	Amhara	272 (23.5)	250 (91.9)
	Oromia regional state	220 (19.0)	192 (87.3)
	Southern Nations, Nationalities, and Peoples’ region	312 (27.0)	242 (77.6)
	Tigray	155 (13.4)	154 (99.4)
	(India)
	Coastal Andhra			492 (33.8)	472 (95.9)
	Rayalaseema			459 (31.6)	450 (98.0)
	Telangana			504 (34.6)	462 (95.9)
Existence of a state-run health center in community	No	841 (72.7)	761 (90.5)	1228 (84.4)	1161 (94.5)
	Yes	316 (27.3)	272 (86.1)	227 (15.6)	223 (98.2)
Existence of community	No	423 (36.6)	363 (85.8)	710 (48.8)	664 (93.5)
health workers in community	Yes	734 (63.4)	670 (91.3)	745 (51.2)	720 (96.6)
Total		1,157 (100)		1,455 (100)

*At the time of the first round of the survey.

Table 2. Results from multilevel logistic models of the association between maternal literacy and child completion of four vaccinations in Ethiopia.

		Adjusted odds ratios (95% Confidence interval)
	Null	1–1^a	1–2^b	2–1^c	2–2^d	3–1^e	3–2^f
Fixed effect
Maternal literacy (ref = illiterate)
Literate		**2.54 (1.35–4.75)	*2.27 (1.18–4.39)	*2.19 (1.13–4.24)	*2.36 (1.07–5.20)	*2.30 (1.19–4.47)	**4.84 (1.75–13.36)
Paternal literacy (ref = illiterate)
Literate			1.32 (0.81–2.13)	1.31 (0.81–2.12)	1.30 (0.80–2.11)	1.31 (0.81–2.12)	1.28 (0.79–2.08)
Presence of state-run health center (ref = none)
Yes				0.69 (0.30–1.61)	0.74 (0.30–1.83)
Maternal literacy * Presencexistence of a state-run health center					0.80 (0.23–2.79)
Presence of community health workers (ref = none)
Yes						1.34 (0.58–3.12)	1.80 (0.72–4.46)
Maternal literacy * Presence of community health workers							*0.29 (0.09–0.96)
Random effect
Community variation (Standard error)	1.378 (0.575)	0.282 (0.199)	0.285 (0.199)	0.284 (0.216)	0.295 (0.221)	0.299 (0.212)	0.331 (0.222)
Intraclass correlation	29.5	7.9	8.0	7.9	8.2	8.3	9.1

^aModel 1–1: adjusted for only maternal literacy.

^bModel 1–2: added paternal literacy to model 1–1.

^cModel 2–1: added presence of health center to model 1–2.

^dModel 2–2: added the interaction term of maternal literacy and presence of health center to model 2–1.

^eModel 3–1 : added presence of health workers to model 1–2.

^fModel 3–2: added the interaction term of maternal literacy and presence of health workers to model 3–1.

► All models were additionallyadjusted for maternal age, gender of child, sibling status, wealth level, type of residence, and region.

*p < 0.05; **p < 0.01; ***p < 0.001; ****p < 0.0001

Table 3. Results from multilevel logistic models of the association between maternal literacy and child completion of four vaccinations in India.

		Adjusted odds ratios (95% Confidence interval)
	Null	1–1^a	1–2^b	2–1^c	2–2^d	3–1^e	3–2^f
Fixed effect
Maternal literacy (ref = illiterate)
Literate		1.84 (0.96–3.51)	1.73 (0.89–3.39)	1.67 (0.85–3.28)	1.46 (0.73–2.90)	1.74 (0.89–3.41)	^†2.26 (0.98–5.19)
Paternal literacy (ref = illiterate)
Literate			1.24 (0.67–2.29)	1.22 (0.66–2.24)	1.24 (0.68–2.29)	1.24 (0.67–2.29)	1.25 (0.68–2.30)
Presence of a state-run health center (ref = none)
Yes				**6.60 (1.57–27.70)	*3.09 (0.62–15.38)
Maternal literacy * Presence of a state-run health center					5.55 (0.48–63.62)
Presence of community health workers (ref = none)
Yes						1.07 (0.43–2.63)	1.33 (0.49–3.58)
Maternal literacy * Presence of community health workers							0.51 (0.15–1.76)
Random effect
Community variation (Standard error)	1.655 (0.470)	1.176 (0.242)	1.159 (0.421)	0.784 (0.378)	0.765 (0.374)	1.204 (0.437)	1.227 (0.442)
Intraclass correlation	33.5	26.3	26.0	19.2	18.9	26.8	27.2

^aModel 1–1: adjusted for only maternal literacy.

^bModel 1–2: added paternal literacy to model 1–1.

^cModel 2–1: added presence of health center to model 1–2.

^dModel 2–2: added the interaction term of maternal literacy and presence of health center to model 2–1.

^eModel 3–1 : added presence of health workers to model 1–2.

^fModel 3–2: added the interaction term of maternal literacy and presence of health workers to model 3–1.

► All models were additionally adjusted for maternal age, gender of child, sibling status, wealth level, type of residence, and region.

*p < 0.05; **p < 0.01; ***p < 0.001; ****p < 0.0001.

Figure 1. Differential effect of maternal literacy on the child immunization status according to the presence of community health workers in Ethiopia.