Morbidity benefit conferred by childhood immunisation in relation to maternal HIV status: a meta-analysis of demographic and health surveys

Figures & data

Table 1. Year of DHS survey and socio-economic characteristics of 27 study countries in sub-Saharan Africa.

Country	Year of survey	GDP per capita	HDI	Adult literacy rate	Health expenditure	Antiretroviral drug coverage during PMTCT	HIV prevalence (adult female)	Households using an improved water source	Households with improved, non-shared toilet facilities	Households with smoking in the household daily
Angola	2016	3110.8	0.533	66	179.4	44	2.2	45.9	32.2	13.1
Burkina Faso	2010	649.7	0.402	34.6	35.2	83	1.1	23	15.2	n/a
Burundi	2011	285.7	0.404	61.6	21.6	84	1.3	23.4	31.4	27.3
Cameroon	2011	1032.6	0.518	71.3	58.7	74	5.1	28.4	35.9	n/a
Chad	2015	664.3	0.396	22.3	37.1	63	1.6	44.5	6.6	12.8
Congo DR	2014	444.5	0.435	77	19.1	70	1	51	18.4	23
Cote d’Ivoire	2012	1526.2	0.474	43.9	88.4	73	3.5	20.9	18	21.8
Ethiopia	2003	706.8	0.448	39	26.6	69	1.3	38.4	6.8	7.1
Gabon	2012	7179.3	0.697	82.3	321.3	76	5.3	6.2	33.7	20.2
Gambia	2013	473.2	0.452	42	30.7	69	2	8.1	37	24
Ghana	2014	1513.5	0.579	71.5	57.9	56	2.1	10.2	13.6	9.3
Guinea	2012	508.1	0.414	32	37.3	43	1.9	25.1	19	22.8
Kenya	2009	1455.4	0.555	78.7	77.7	80	6.9	35.5	22.7	n/a
Lesotho	2014	998.1	0.497	76.6	105.1	66	29.8	16.4	47.1	16.3
Liberia	2013	455.4	0.427	42.9	46.3	70	2	27.3	14.2	12.7
Malawi	2016	300.8	0.476	62.1	29	84	11.2	12.7	51.8	12.1
Mali	2013	780.5	0.442	33.1	47.8	35	1.2	34	22	17.1
Namibia	2012	4140.5	0.64	88.3	499	96	16.6	10.4	33.5	n/a
Niger	2013	363.2	0.353	15.5	24.4	52	0.5	32.9	9.3	n/a
Rwanda	2015	702.8	0.498	68.3	52.5	82	3.8	27	54.1	14.6
Sao T&P	2009	1756.1	0.574	90.1	165.6	n/a	n/a	5.8	30.4	n/a
Senegal	2011	958.1	0.494	42.8	49.5	55	0.6	19.5	41.1	28.6
Sierra Leone	2013	496	0.42	32.4	85.9	87	2	39.1	9.6	37.6
Swaziland	2007	2775.2	0.541	83.1	247.9	95	34.7	29.9	9.3	n/a
Togo	2014	578.5	0.487	63.8	33.9	86	2.7	35.8	12.2	13.5
Zambia	2014	1178.4	0.579	83	85.9	83	14.5	34.5	25.4	n/a
Zimbabwe	2015	1008.6	0.516	88.7	57.7	93	16.1	21.8	37	10.8

GDP: gross domestic product, HDI: human development index, n/a: not available).

GDP – Low-income economies are defined as those with a GDP per capita of $1,025 or less; lower middle-income economies: $1,026 – $4,035; upper middle-income economies: $4,036 – $12,475;

high-income economies: ≥ $12,476. HDI – low: < 0.549; medium: 0.550 – 0.770.

(Source: Demographic and Health Surveys, World Bank, Joint United Nations Programme on HIV/AIDS, United Nations Development Programme.

Table 2. No of cases and percentages of symptoms of acute respiratory infections and episodes of diarrhoea among the children with respect to DTP3 vaccination in 27 countries in sub-Saharan Africa.

	Symptoms of acute respiratory infections				Episodes of diarrhea
	DTP3 non-uptake		DTP3 uptake		DTP3 non-uptake		DTP3 uptake
Country	No of cases	Percent (%)	No of cases	Percent (%)	No of cases	Percent (%)	No of cases	Percent (%)
Angola	164	6	92	8	417	16	264	23
Burkina Faso	60	47	231	40	175	13	865	16
Burundi	133	79	908	79	85	20	812	26
Cameroon	267	56	470	45	329	20	559	18
Chad	381	58	154	57	759	19	274	19
Congo DR	566	42	513	37	765	18	685	16
Cote d’Ivoire	132	49	163	41	260	19	361	19
Ethiopia	786	60	417	59	1069	16	492	14
Gabon	344	42	206	40	431	19	202	16
Gambia	65	71	236	62	133	17	513	19
Ghana	32	49	149	47	40	6	293	14
Guinea	259	68	168	61	314	17	229	16
Kenya	88	49	258	50	123	18	323	17
Lesotho	16	27	117	36	25	9	137	12
Liberia	205	48	256	49	374	26	427	23
Malawi	60	11	354	14	80	15	762	29
Mali	57	45	92	41	153	7	249	9
Namibia	153	51	198	44	281	13	478	15
Niger	46	39	210	43	63	15	328	20
Rwanda	20	38	382	42	14	5	424	12
Sao T&P	30	57	175	53	40	13	184	13
Senegal	115	65	366	60	213	21	603	20
Sierra Leone	176	66	437	62	137	10	410	12
Swaziland	45	54	308	54	41	12	287	15
Togo	103	54	373	53	102	14	431	17
Zambia	151	33	680	30	272	12	1679	18
Zimbabwe	69	9	240	10	113	15	574	24

Table 3. No of cases and percentages of symptoms of acute respiratory infections and episodes of diarrhoea among the children with uptake of DTP3 and maternal HIV status in 27 countries in sub-Saharan Africa.

	Symptoms of acute respiratory infections				Episodes of diarrhea
	HIV seronegative		HIV seropositive		HIV seronegative		HIV seropositive
Country	No of cases	Percent (%)	No of cases	Percent (%)	No of cases	Percent (%)	No of cases	Percent (%)
Angola	258	23	6	29	91	8	1	5
Burkina Faso	857	16	8	16	228	40	3	50
Burundi	789	26	23	30	887	79	21	70
Cameroon	536	18	23	16	451	45	19	46
Chad	266	19	8	30	150	58	4	50
Congo DR	681	16	4	11	507	37	6	33
Cote d’Ivoire	355	19	6	10	160	42	3	30
Ethiopia	489	14	3	4	413	59	4	33
Gabon	198	16	4	8	198	40	8	36
Gambia	505	19	8	20	233	63	3	60
Ghana	290	14	3	7	144	47	5	50
Guinea	222	16	7	29	164	61	4	57
Kenya	291	17	32	22	237	50	21	51
Lesotho	105	13	32	11	92	36	25	36
Liberia	425	23	2	10	254	49	2	33
Malawi	712	30	50	25	330	14	24	12
Mali	246	9	3	11	90	41	2	40
Namibia	476	15	2	12	198	44	0	0
Niger	271	20	57	21	172	43	38	44
Rwanda	412	12	12	10	370	42	12	48
Sao T&P	183	13	1	8	175	53	n/a	n/a
Senegal	602	20	1	5	365	60	1	33
Sierra Leone	407	12	3	7	429	62	8	73
Swaziland	200	16	87	14	205	54	103	55
Togo	421	17	10	17	363	54	10	44
Zambia	1,485	18	194	17	608	30	72	27
Zimbabwe	502	24	72	20	212	10	28	8

Figure 1. Forest plot showing the prevalence of estimates of symptoms of acute respiratory infections among the children with respect to DTP3 vaccination in 27 sub-Saharan Africa countries.

Figure 2. Forest plot showing the prevalence of estimates of episodes of diarrhoea among the children with respect to DTP3 vaccination in 27 sub-Saharan Africa countries.

Figure 3. Forest plot showing the prevalence of estimates of symptoms of acute respiratory infections among the children of HIV-infected mothers with respect to DTP3 vaccination in selected sub-Saharan Africa countries.

Figure 4. Forest plot showing the prevalence of estimates of episodes of diarrhoea among the children of HIV-infected mothers with respect to DTP3 vaccination in selected sub-Saharan Africa countries.

Figure 5. Forest plot showing theprevalence of estimates of symptoms of acute respiratory infections among the children who were vaccinated with DTP3 with respect to the maternal HIV status in 27 sub-Saharan Africa countries.

Figure 6. Forest plot showing the prevalence of estimates of episodes of diarrhoea among the children who were vaccinated with DTP3 with respect to the maternal HIV status in 26 sub-Saharan Africa countries.

Figure 7. A plot showing the influence of each country on the overall pooled result for estimates of acute respiratory infections using “leave-one-country-out” sensitivity analysis.

Figure 8. A plot showing the influence of each country on the overall pooled result for estimates of diarrhoea using “leave-one-country-out” sensitivity analysis.

Table 4. Subgroup analysis and univariate meta-regression analysis results (for diarrhoea).

						Univariate meta-regression
Characteristics	No of studies	Subgroup odds ratio	95% CI	I-squared	P-value*	^#β (p-value)*	95% CI
Year of survey						0.95 (0.009)	0.91,0.99
2003–2007	2	0.98	0.61, 1.57	85.2	0.000
2008–2012	10	0.97	0.87, 1.09	70.0	0.000
2013–2016	15	0.72	0.61, 0.85	90.1	0.000
Gross domestic product per capita (US$)						0.98 (0.862)	0.75, 1.28
Low	18	0.84	0.73, 0.95	87.8	0.000
Middle	9	0.83	0.67, 0.99	88.1	0.000
Human development index						1.01 (0.950)	0.74, 1.37
Low	21	0.83	0.73, 0.93	87.6	0.000
Medium	6	0.83	0.62, 1.09	90.7	0.000
Adult literacy rate						1.00 (0.273)	0.99, 1.00
Low	11	0.95	0.85, 1.06	77.4	0.000
Average	9	0.70	0.54, 0.90	86.8	0.000
High	7	0.80	0.64, 1.02	92.4	0.000
Households using an improved water source						1.12 (0.356)	0.87, 1.44
Low	12	0.77	0.65, 0.92	87.1	0.000
Medium	15	0.87	0.76, 1.00	88.8	0.000
Households with improved, non-shared toilet facilities						0.85 (0.195)	0.67, 1.09
Low	14	0.90	0.80, 1.02	82.9	0.000
Medium	13	0.76	0.63, 0.91	89.5	0.000
Regions						0.88 (0.073)	0.76, 1.01
Western Africa	13	0.88	0.78, 0.99	76.9	0.000
Central/Eastern Africa	7	1.00	0.85, 1.17	82.5	0.000
Southern Africa	7	0.64	0.54, 0.75	75.5	0.000

* p < 0.05 ^#β- Beta coefficient.