Background
Methods
Protocol, eligibility criteria, information sources and search
Study selection, data collection and data items
Risk of bias
Summary measures and synthesis of results
Publication bias
Results
Study selection
Study range and characteristics
Reference | Country | Study setting | Study design | Study period | Population | Children’s age | Vaccine type | Maternal education parameter | Quality |
---|---|---|---|---|---|---|---|---|---|
Al-Sheikh et al. 1999a [17] | Iraq | Urban | Cross-sectional | 1989–1994 | 341 families (186 urban), 662 children (326 urban) | 0–2 years | BCG, DPT-OPV(3), measles, MMR, DPT-OPV(1st booster) | Illiterate; Reads and writes; Primary; Intermediate; Secondary; Institute; College; Postgraduate | Weak |
Al-Sheikh et al. 1999b [17] | Iraq | Rural | Cross-sectional | 1989–1994 | 341 families (155 rural), 662 children (336 rural) | 0–2 years | Completion of BCG, DPT-OPV(3), measles, MMR, DPT-OPV(1st booster) | Illiterate; Reads and writes; Primary; Intermediate; Secondary; Institute; College; Postgraduate | |
Animaw et al., 2014 [24] | Ethiopia | Region | Cross-sectional | March 2013 | 630 children | 12–23 months | 1 dose BCG, 3 doses Polio, 3 doses Pentavalant, 3 doses PCV, 1 dose Measles | None; Primary school; High school | Moderate |
Antai 2009 [4] | Nigeria | National | Cross-sectional | 2003 | Interviews from 3725 women aged 15 to 49 years with 6029 live born children | 12 months and older | BCG, Polio (3), DPT (3) and Measles vaccinations | No education; Primary; Secondary or higher | Moderate |
Antai 2012 [20] | Nigeria | National | Cross-sectional | 2008 | 24,910 women aged 15–49 years with live-born children within 5 years before the survey | 12 months to 5 years | 8 childhood vaccinations in the EPI – BCG, DPT 3 doses, OPV 3 doses, and measles vaccine | No education; Primary school; Secondary school or higher | Moderate |
Bbaale et al. 2013 [25] | Uganda | National | Cross-sectional | 2006 | 7591 children | 12–36 months | Full vaccination, BCG, DPT, Polio, Measles vaccinations | None, primary, secondary, post-secondary | Moderate |
Branco et al. 2014 [26] | Brazil | Urban | Cross-sectional | January 2010 | 282 children | 12–59 months | 1 dose BCG, 3 doses Hep B, 3 doses DTP-Hib, 3 doses OPV, 2 doses Rotavirus, 1 dose Yellow fever, 1 dose MMR | 0–8 years of schooling; >8 years of schooling | Moderate |
Brenner et al. 2001 [27] | USA | Urban | Cohort | August 1995 to September 1996 | 369 singleton births from 3 hospitals from low-income, inner-city patients | Cohort followed until 7 months | UTD at 7 months if had received 3 DTP, 3 HIB, and 2 polio vaccinations | <12 years; ≥12 years | Strong |
Calhoun et al. 2014 [28] | Kenya | Region | Cross-sectional | June–July 2003 | 244 children | 12–23 months | 3 doses Polio, 1 dose BCG, 1 dose Measles, 3 doses DPT or pentavalent | Years of schooling: 0–8, 8 or more | Moderate |
Chhabra et al. 2007 [29] | India | Urban | Cross-sectional | October 2003 to January 2004 | 693 children | 24–47 months | BCG, DPT and OPV (3 primary and booster), measles and MMR | Nil; 1–8 years; >8 years | Moderate |
Danis et al. 2010 [18] | Greece | National | Cross-sectional | Academic year 2004–2005 | 3609 parent/ guardian-child pairs 3434 pairs in the final analysis. Children in first year of Greek grammar school | 6–7 years (Mean age 6.76 years) | 5 doses of DTP vaccine, 5 doses of poliomyelitis vaccine, 2 doses of MMR vaccine, 3 doses of HBV vaccine and full vaccination for Hib | <9 years; 9–11 years; 12 years (high school); College/ university graduate | Moderate |
Elliott et al. 2006a [30] | India | Rural | Cross-sectional | September 2003 | 470 families | 9 months | BCG, OPV (4), DPT (3) and measles | Illiterate; Literate | Weak |
Elliott et al. 2006b [30] | India | Rural | Cross-sectional | September 2003 | 470 families | 18 months | BCG, OPV (5), DPT (4) and measles | Illiterate; Literate | |
Elliott et al. 2006c [30] | India | Rural | Cross-sectional | September 2003 | 470 families | 6 years | BCG, OPV (5), DPT (4), measles and DT | Illiterate; Literate | |
Fatiregun et al. 2012 [31] | Nigeria | Region | Cross-sectional | 2007 | 540 interviews, 525 respondents mothers of children | 12–23 months | BCG, dose of measles, three doses (1,2,3) of DPT, four doses (0–3) of OPV | Primary/ secondary; Post secondary | Moderate |
Fatiregun et al. 2013 [32] | Nigeria | Region | Cross-sectional | 2006 | 1178 mothers | 12–23 months | BCG, 4 doses OPV, 3 doses DPT, 3 doses Hetaptitis B | Tertiary education; Secondary education; Primary education; None | Moderate |
Huq et al. 2008 [33] | Bangladesh | National | Cross-sectional | 1999–2000 | 755 children | 12–23 months | BCG and measles vaccinations and all 3 doses of the DPT and polio vaccines | Below primary; Secondary; Higher secondary | Moderate |
Jahn et al. 2008 [34] | Malawi | Rural | Cross-sectional | 21st August 2002 to 22nd July 2004 | 5418 children | Under 5 years old | BCG, OPV3, DPT3 and measles vaccine before their 1st birthday | <5 years primary; Primary 5 + years; Sec./tert. | Moderate |
Kidane et al. 2003 [35] | Ethiopia | Region | Cross-sectional | 2000 | 220 households | 12–23 months | BCG, measles, 3 doses of DPT/OPV | Illiterate; Literate | Weak |
Koumaré et al. 2009 [36] | Mali | Region | Cross-sectional | July 2006 | 750 children | 12–23 months | BCG, DTCP1, DTCP2, and DTCP3 and measles | Mother not educated; Mother educated | Weak |
Kumar et al. 2010 [37] | India | Hospital/ Urban | Cross-sectional | April to July 2007 | 325 children (148 males, 177 females) admitted to paediatrics ward at a tertiary care hospital | 12–60 months | BCG, 3 doses of DPT/OPV and measles | ≤primary; >primary | Weak |
Luman et al. 2003 [38] | USA | National | Cross-sectional | July 2000– June 2001 | 21,212 children | 19 to 35 months | 4 doses of DPT vaccine, 3 doses of poliovirus vaccine, 1 dose of MMR vaccine, 3 or 4 doses of Hib vaccine, and 3 doses of HBV vaccine (the 4:3:1:3:3 series). | <High school; High school; >High school; College graduate | Moderate |
Mohamud et al. 2014 [39] | Ethiopia | Region | Cross-sectional | 10 April 2011–5 May 2011 | 582 households | 12–23 months | 1 dose BCG, 1 dose Measles, 3 doses pent/OPV before 1 year of age | Illiterate; Literate | Moderate |
Odusanya et al. 2008 [40] | Nigeria | Rural | Cross-sectional | September 2006 | 339 mothers and children | 12–23 months | BCG, 3 doses of OPV & DTP, 3 doses of HBV and measles vaccine | None/ primary; Secondary/ university | Moderate |
Okoro et al. 2014 [41] | Nigeria | Region | Cross-sectional | May to December | 168 children | 6 months – 5 years | Full schedule (not specified) | No formal education; Primary; Secondary; Post-secondary; University | Moderate |
Pati et al. 2011 [42] | USA | Urban | Cohort | June 15th 2005 to August 6th 2006 | 506 Medicaid-eligible mother-infant dyads | Cohort followed until 7 months | UTD at 7 months if received 3 HepB, 2 polio, at least 2 Hib, 3 PCV7 and 3 DTaP containing vaccines | Less than high school; High school; More than high school | Moderate |
Phukan et al. 2008 [43] | India | Region | Cross-sectional | June and July 2003 | 616 children | 12–23 months | 6 EPI vaccines in time | Illiterate; Primary; Middle; Higher | Weak |
Robert et al. 2014a [44] | Belgium | Region | Cross-sectional | 2012 | 519 children | 18–24 months | Hexavalent, pneumococcal, MMR, meningococcal C | Maximum secondary level; Higher than secondary level | Moderate |
Robert et al. 2014b [44] | Belgium | Region | Cross-sectional | 2012 | 538 children | 18–24 months | Hexavalent, pneumococcal, MMR, meningococcal C | Maximum secondary level; Higher than secondary level | |
Rossi et al. 2015 [45] | Zimbabwe | National | Cross-sectional | 2010–2011 | 1031 children | 12–23 months | 1 dose BCG, 1 dose Measles, 3 doses of Polio, 3 doses DPT/Pentavalent | No education or primary; Secondary or higher | Moderate |
Schoeps et al. 2013 [46] | Burkina Faso | Region | Cross-sectional | September 2008 – December 2009 | 1665 children | 12–23 months | BCG, Oral Polio, Pentavalent, yellow fever, measles | Any; None | Moderate |
Setse et al. 2006 [47] | Zambia | Hospital/ Urban | Cross-sectional | January 1998 and October 2000 | 473 children hospitalised with measles- 372 in subgroup analysis | 4 and 60 months | BCG and completed the series of DTP and OPV vaccines. | Less than 7 years; 7 years; Greater than 7 years | Moderate |
Sia et al. 2009 [5] | Burkina Faso | Rural | Cross-sectional | 1998 | 805 children | 12–23 months | BCG, measles, yellow fever vaccines and 3 doses of DTP and OPV | No schooling; Primary or secondary school | Moderate |
Singh et al. 2000 [48] | India | National | Cross-sectional | June–October 1999 | 18,783 children | 12–23 months | BCG, DPT, OPV, Measles | Illiterate; Primary; Middle; Higher secondary; Graduate | Weak |
Singh et al. 2001 [49] | India | Region | Cross-sectional | June–October 1999 | 6171 children | 12–32 months | BCG, DPT, OPV, Measles | Illiterate; Primary Middle; Higher secondary; Graduate | Weak |
Som et al. 2010 [50] | India | Region | Cross-sectional | 2002 to 2004 | 1279 children | 12–35 months | BCG, 3 injections of DPT, 3 doses of polio (excluding polio 0) and 1 of measles | Can’t read and write; Can read and write | Moderate |
Streatfield et al. 1990 [51] | Indonesia | Rural | Cross-sectional | 1989 | 519 mother-child dyads | Under the age of 5 years | DPT, BCG, and anti-polio | Not literate; Some primary; Complete primary; Secondary school | Weak |
Thang et al. 2007 [52] | Vietnam | National | Cross-sectional | 2002 | 468 children | 11–23 months | BCG vaccination 3 doses of DPT vaccine; at least 3 doses of polio vaccine; and 1 dose of measles vaccine | Illiterate; Lower primary; Completed primary; Completed secondary; Completed high school + | Moderate |
Torun et al. 2006 [53] | Turkey | Region | Cross-sectional | 2005 | Parents of 221 children | 9 month-6 years of age | <18 months completely vaccinated if had 1 dose of BCG, 3 doses of HBV, OPV and DPT and 1 dose of Measles vaccine. >18 months completely vaccinated if had booster doses for OPV and DPT vaccines | Illiterate; Graduated primary school; Graduated secondary school or higher education | Moderate |
Waters et al. 2004a [54] | Cameroon | National | Cross-sectional | 1998 | 2123 children | Younger than 3 years | By 6 weeks- 1st dose of DPT and the 2nd dose of polio vaccine; By 10 weeks- 2nd dose of DPT and the 3rd dose of polio vaccine; By 14 weeks- 3rd DPT dose; By 9 months- measles vaccine | Less than primary school; Primary school; Secondary education; Higher education | Moderate |
Waters et al. 2004b [54] | Cameroon | National | Cross-sectional | 2000 | 3582 children | Younger than 5 years | Less than primary school; Primary school Secondary education or higher education | ||
Yadav et al. 2004 [55] | India | Regional | Cross-sectional | June–October 1999 | 1481 children | 12–23 months | BCG, DPT3, OPV3, Measles | Illiterate; Primary; Middle; Hr. Secondary; Graduate | Weak |
Reference | Maternal education parameter | # children whose mothers had education level | # children who have received full vaccination schedule | % children who received full vaccination schedule (1 d.p.) | cOR for vaccination (2 d.p.) |
---|---|---|---|---|---|
Al-Sheikh et al. 1999a [17] | Illiterate | 27 | 22 | 81.5 | 1 |
Reads and writes | 69 | 41 | 59.4 | 0.33 | |
Primary | 78 | 42 | 53.8 | 0.27 | |
Intermediate | 32 | 22 | 68.8 | 0.5 | |
Secondary | 53 | 29 | 54.7 | 0.27 | |
Institute | 43 | 27 | 62.8 | 0.38 | |
College | 23 | 12 | 52.2 | 0.25 | |
Postgraduate | 1 | 1 | 100 | / | |
Al-Sheikh et al. 1999b [17] | Illiterate | 143 | 34 | 23.8 | 1 |
Reads and writes | 121 | 34 | 28.1 | 1.25 | |
Primary | 50 | 10 | 20 | 0.8 | |
Intermediate | 5 | 2 | 40 | 2.14 | |
Secondary | 7 | 5 | 71.4 | 8.01 | |
Institute | 6 | 4 | 66.7 | 6.41 | |
College | 4 | 4 | 100 | / | |
Postgraduate | 0 | / | / | / | |
Animaw et al. 2014 [24] | None | 262 | 150 | 57.3 | 1.00 |
Primary | 252 | 211 | 83.8 | 3.84 | |
High school | 116 | 100 | 86.2 | 4.66 | |
Antai 2009 [4] | No education | 2155 | 169 | 7.8 | 1 |
Primary | 805 | 142 | 17.6 | 2.52 | |
Secondary or higher | 771 | 194 | 25.2 | 3.95 | |
Antai 2012 [20] | No education | 12,265 | 722 | 5.9 | 1 |
Primary school | 5724 | 1159 | 20.2 | 4.06 | |
Secondary school or higher | 6921 | 2402 | 34.7 | 8.50 | |
Bbaale et al. 2013 [25] | No education | 1824 | 967 | 53.0 | 1.00 |
Primary | 4686 | 2484 | 53.0 | 1.00 | |
Secondary | 896 | 520 | 58.0 | 1.23 | |
Post-secondary | 185 | 117 | 63.2 | 1.52 | |
Branco et al. 2014 [26] | 0–8 years of schooling | 151 | 116 | 76.8 | 1.00 |
>8 years of schooling | 130 | 117 | 90 | 2.72 | |
Brenner et al. 2001 [27] | <12 years | 145 | 55a
| 38 | 1 |
≥12 years | 179 | 77a
| 43 | 1.23 | |
Calhoun et al. 2014 [28] | 0–7 years of schooling | 132 | 35 | 26.5 | 1.00 |
≥8 years of schooling | 23 | 11 | 47.8 | 2.54 | |
Chhabra et al. 2007 [29] | Nil | 378b
| 130 | 34.4 | 1 |
1–8 years | 106b
| 51 | 48.1 | 1.77 | |
>8 years | 209b
| 106 | 50.7 | 1.96 | |
Danis et al. 2010 [18] | <9 years | 536 | 278 | 51.9 | 1 |
9–11 years | 429 | 240 | 55.9 | 1.18 | |
12 years (high school) | 1336 | 859 | 64.3 | 1.67 | |
College/ university graduate | 985 | 670 | 68 | 1.97 | |
Elliott et al. 2006a [30] | Illiterate | 332b
| 240 | 72.3 | 1 |
Literate | 139b
| 123 | 88.5 | 2.95 | |
Elliott et al. 2006b [30] | Illiterate | 318b
| 210 | 66 | 1 |
Literate | 127b
| 113 | 89 | 4.15 | |
Elliott et al. 2006c [30] | Illiterate | 139b
| 73 | 52.5 | 1 |
Literate | 49b
| 35 | 71.4 | 2.26 | |
Fatiregun et al. 2012 [31] | Primary/ secondary | 297 | 76 | 25.6 | 1 |
Post secondary | 228 | 94 | 41.2 | 2.04 | |
Fatiregun et al. 2013 [32] | None | 129 | 24 | 18.6 | 1.00 |
Primary | 468 | 128 | 27.4 | 1.65 | |
Secondary | 523 | 225 | 43.0 | 3.30 | |
Tertiary | 58 | 51 | 87.9 | 31.88 | |
Huq et al. 2008 [33] | Below primary | 485 | 307a
| 63.3 | 1 |
Secondary | 221 | 164a
| 74.2 | 1.67 | |
Higher secondary | 49 | 46a
| 93.9 | 8.92 | |
Jahn et al. 2008 [34] | <5 years primary | 237 | 140 | 59.1 | 1 |
Primary 5 + years | 1364 | 903 | 66.2 | 1.36 | |
Sec./tert. | 304 | 233 | 76.6 | 2.27 | |
Kidane et al. 2003 [35] | Illiterate | 92 | 66 | 71.7 | 1 |
Literate | 18 | 17 | 94.4 | 6.70 | |
Koumaré et al. 2009 [36] | Mother not educated | 639 | 376a
| 58.8 | 1 |
Mother educated | 111 | 73a
| 65.8 | 1.35 | |
Kumar et al. 2010 [37] | ≤primary | 223 | 12 | 5.4 | 1 |
>primary | 92 | 46 | 50.0 | 17.58 | |
Luman et al. 2003 [38] | <High school | 3157 | 2147a
| 68.0 | 1 |
High school | 7160 | 5191a
| 72.5 | 1.24 | |
>High school | 4375 | 3233a
| 73.9 | 1.33 | |
College graduate | 8698 | 6915a
| 79.5 | 1.82 | |
Mohamud et al. 2014 [39] | Illiterate | 510 | 167 | 32.7 | 1.00 |
Litterate | 72 | 46 | 63.9 | 3.63 | |
Odusanya et al. 2008 [40] | None/ primary | 107 | 57 | 53.3 | 1 |
Secondary/ university | 232 | 153 | 65.9 | 1.70 | |
Okoro et al. 2014 [41] | No formal education | 12 | 7 | 58.3 | 1.00 |
Primary | 33 | 16 | 48.5 | 0.67 | |
Secondary | 55 | 36 | 65.5 | 1.35 | |
Post-secondary | 28 | 24 | 85.7 | 4.29 | |
University | 40 | 32 | 80.0 | 2.86 | |
Pati et al. 2011 [42] | Less than high school | 159 | 63 | 39.6 | 1 |
High school | 119 | 55 | 46.2 | 1.31 | |
More than high school | 228 | 101 | 44.3 | 1.21 | |
Phukan et al. 2008 [43] | Illiterate | 132 | 50 | 37.9 | 1 |
Primary | 81 | 41 | 50.6 | 1.68 | |
Middle | 344 | 242 | 70.3 | 3.89 | |
Higher | 59 | 50 | 84.7 | 9.11 | |
Robert et al. 2014a [44] | Maximum secondary level | 293 | 237 | 80.8 | 1.00 |
Higher than secondary level | 214 | 177 | 82.9 | 1.13 | |
Robert et al. 2014b [44] | Maximum secondary level | 296 | 242 | 81.6 | 1.06 |
Higher than secondary level | 233 | 197 | 84.4 | 1.29 | |
Rossi et al. 2015 [45] | No education or primary | 320 | 177 | 55.2 | 1.00 |
Secondary or higher | 711 | 500 | 70.3 | 1.91 | |
Schoeps et al. 2013 [46] | None | 1435 | 250 | 17.4 | 1.00 |
Any | 230 | 57 | 24.8 | 1.56 | |
Setse et al. 2006 [47] | Less than 7 years | 137 | 92a
| 67c
| 1 |
7 years | 114 | 87a
| 76c
| 1.56 | |
Greater than 7 years | 121 | 105a
| 87c
| 3.30 | |
Sia et al. 2009 [5] | No schooling | 850 | 172a
| 20.2 | 1 |
Primary or secondary school | 48 | 18a
| 37.5 | 2.37 | |
Singh et al. 2000 [48] | Illiterate | 7337 | 3404a
| 46.4 | 1 |
Primary | 2946 | 1912a
| 64.9 | 2.14 | |
Middle | 3044 | 2143a
| 70.4 | 2.75 | |
Higher secondary | 3433 | 2705a
| 78.8 | 4.29 | |
Graduate | 2023 | 1705a
| 84.3 | 6.20 | |
Singh et al. 2001 [49] | Illiterate | 3421 | 1143a
| 33.4 | 1 |
Primary | 900 | 496a
| 55.1 | 2.45 | |
Middle | 718 | 442a
| 61.5 | 3.19 | |
Higher secondary | 580 | 416a
| 71.8 | 5.08 | |
Graduate | 552 | 442a
| 80 | 7.98 | |
Som et al. 2010 [50] | Can’t read and write | 400 | 151a
| 37.8 | 1 |
Can read and write | 879 | 538a
| 61.2 | 2.60 | |
Streatfield et al. 1990 [51] | Not literate | 78 | 35a
| 45.1 | 1 |
Some primary | 129 | 40a
| 31.1 | 0.55 | |
Complete primary | 177 | 59a
| 33.6 | 0.62 | |
Secondary school | 81 | 44a
| 54.9 | 1.48 | |
Thang et al. 2007 [52] | Illiterate | 33 | 13a
| 39.5 | 1 |
Lower primary | 74 | 37a
| 50 | 1.53 | |
Completed primary | 157 | 100a
| 63.5 | 2.66 | |
Completed secondary | 122 | 94a
| 77.4 | 5.25 | |
Completed high school + | 83 | 69 a
| 82.9 | 7.43 | |
Torun et al. 2006 [53] | Illiterate | 31b
| 15 | 48.4 | 1 |
Graduated primary school | 157b
| 141 | 89.8 | 9.4 | |
Graduated secondary school or higher education | 33b
| 31 | 93.9 | 16.53 | |
Waters et al. 2004a [54] | Less than primary school | 438 | 105a
| 24 | 1 |
Primary school | 603 | 235a
| 39 | 2.02 | |
Secondary education | 473 | 246a
| 52 | 3.43 | |
Higher education | 12 | 8a
| 67 | 6.43 | |
Waters et al. 2004b [54] | Less than primary school | 961 | 202a
| 21 | 1 |
Primary school | 1137 | 387a
| 34 | 1.94 | |
Secondary education or higher education | 840 | 403a
| 48 | 3.47 | |
Yadav et al. 2004 [55] | Illiterate | 835d
| 407a
| 48.7 | 1 |
Primary | 241 | 180a
| 74.8 | 3.13 | |
Middle | 190 | 142a
| 74.9 | 3.14 | |
Hr. Secondary | 119 | 93a
| 78.2 | 3.78 | |
Graduate | 96 | 77a
| 80.2 | 4.27 |
Data extraction
Meta-analysis
Illiteracy vs. literacy
Continent
Setting
Timing
Summary estimate of vaccine completion by maternal education level
Maternal education level | Pooled child vaccination completion (%) | 95% confidence interval | I-squared (%) |
---|---|---|---|
None | 42.8 | 35.2–50.4 | 99.7 |
Primary | 56.6 | 49.5–63.7 | 99.4 |
Secondary | 64.3 | 56.1–72.5 | 99.2 |
Tertiary | 80.2 | 75.5–85.0 | 89.3 |