Unintended Pregnancy and Inadequate Rotavirus Immunization in Peruvian Children Open Access

Abstract

Introduction: Rotavirus is the most common cause of preventable severe diarrhea affecting children aged 5 years or less in the world, including Latin America. Unintended pregnancy is associated with adverse maternal and child outcomes, including inadequate immunizations.

Objective: To estimate the association between unintended pregnancy and inadequate rotavirus immunization in Peruvian children.

Methods: We conducted a secondary data analysis of Demographic and Health Survey (DHS) data from Peru, 2012. Multivariate logistic regression was conducted to determine the association of unintended pregnancy and inadequate rotavirus immunization. Unadjusted and adjusted odds ratios and their 95% confidence intervals are reported. Interaction between unintended pregnancy and other variables was assessed using Breslow-Day test.

Results: A total of 9,620 children were born in the preceding 5 years of the survey and, of them, 175 (1.74%) had died before the time of the survey. Among 9,445 alive children at the time of the survey, 51.1% were male. In total, 5,187 children (55.6%, 95% CI 54.1 - 57) had inadequate rotavirus vaccination. Unintended pregnancy was not associated with inadequate rotavirus vaccination on unadjusted analysis. There was a significant interaction between unintended pregnancy and maternal literacy status (p=0.006). Multivariate logistic regression showed that in illiterate women, children from unintended pregnancies had 2.3 times the odds of inadequate rotavirus vaccination compared to children from intended pregnancies. Also, inadequate polio (aOR 5.93, 95%CI 3.54 - 9.92), pneumococcal (aOR 6.28, 95%CI 5.02 - 7.86) and influenza (aOR 2.28, 95%CI 1.83 - 2.84) vaccinations, television in the household (aOR 1.35, 95%CI 1.09 - 1.67), and children whose mothers had only primary education (aOR 1.35, 95%CI 1.001 - 1.83) were independent predictors of inadequate rotavirus immunization. Breastfeeding education was associated with lower odds of inadequate rotavirus immunization (aOR 0.81 95%CI 0.67 - 0.99). There was no association between unintended pregnancy and rotavirus immunization in children of literate women.

Conclusions: Our findings indicate that literacy is an important factor that could mitigate the known adverse consequences of unintended pregnancy, particularly for child health outcomes. They also indicate that vaccination compliance may be highly interdependent when vaccinations are given in close proximity and that breastfeeding education has an impact on childhood rotavirus immunization.

Table of Contents

Introduction …………………..……………………………………………………………………………...1

Background information and literature review ..………………………………………………………2

Rotavirus burden in Latin America and Peru …………………………………………………………..3

Rotavirus vaccination in Peru ……………………………………………………………………………..5

Factors associated with non-immunization in children ……………………………………………..5

The role of unintended pregnancy ………………………………………………………………………..6

Manuscript …………………….……………………………………………………………………………….7

Introduction ……………………………………………………………………………………………………8

Methods …………………………………………………………………………………………………………9

Results ………………………………………………………………………………………………………….13

Discussion ……………………………………………………………………………………………………..15

Conclusion …………………………………………………………………………………………………….19

Tables ….………………………………………………………………………………………………….…...20

References ……………………………………………………………………………………………………..26

Summary, Public Health Implications, Possible Future Directions ……………………………….32

Appendices

DHS data release ………………………………………………………………………………………………34

Emory IRB approval …………………………………………………………………………………………..35

Immunization data collection tool, DHS 2012 Peru, Spanish ……………………………………….36

About this Master's Thesis

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School	Rollins School of Public Health
Department	Executive Masters of Public Health
Degree	MPH
Submission	Master's Thesis
Language	English
Research Field	Health Sciences, Public Health Health Sciences, Medicine and Surgery Health Sciences, Epidemiology
Keyword	unintended pregnancy immunization rotavirus
Committee Chair / Thesis Advisor	Kancherla, Vijaya , Emory University
Committee Members	Blas, Magaly, UPCH

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