Associations Between Selected Maternal Empowerment Domains and Routine Infant Vaccine-Series Completion in Cambodia

Abstract

Background: Childhood vaccination is a repeated behavioral process that requires caregivers to return for multiple scheduled visits. In settings where vaccines are provided free of charge and overall coverage is relatively high, remaining gaps may be more closely related to successful completion of repeated visits than to initial access alone. Different domains of maternal empowerment may therefore matter differently for routine infant vaccine-series completion.Objective: This study examined the association between selected maternal empowerment domains and routine infant vaccine-series completion in Cambodia. Methods: Data were drawn from the 2021–2022 Cambodia Demographic and Health Survey (CDHS). The analytical sample included 1,677 mother–child pairs with children aged 12–23 months. Maternal empowerment was assessed using two selected domains: economic agency and knowledge/information-related empowerment. The outcomes were completion of the three-dose DTP, OPV, and PCV infant vaccine series, as well as completion of all three infant vaccine series combined. In descriptive analysis, vaccination status was presented as zero-dose, incomplete, and complete. In regression analysis, due to small counts of zero-dose, zero-dose and incomplete were combined into the not-completed category. Binary logistic regression models were fitted in unadjusted and adjusted analyses, controlling for child characteristics, maternal background characteristics, and household socioeconomic and contextual factors. Results: In the analytical sample, the knowledge and information empowerment domain was more concentrated in the medium and high categories than the economic agency domain. Specifically, 18.17% of mothers were classified as low, 39.13% as medium, and 42.70% as high in the knowledge and information domain, compared with 25.85%, 46.89%, and 27.25%, respectively, for economic agency. Across the antigen-specific outcomes, completion was the most common vaccination status, although zero-dose and incomplete vaccination remained present. For OPV3, 7.35% of children were classified as zero-dose, 8.78% as incomplete, and 83.87% as complete; for DTP3, the corresponding proportions were 10.63%, 8.18%, and 81.18%; and for PCV3, they were 10.69%, 8.60%, and 80.70%. For the combined three-vaccine series outcome, 7.23% of children were zero-dose, 15.17% were incomplete, and 77.60% were complete. The most consistent pattern was observed for knowledge and information empowerment. Compared with children of mothers in the low group, those in the medium and high knowledge/information groups had significantly higher odds of completing OPV3, DTP3, PCV3, and all three infant vaccine series in adjusted analyses: OPV3 (medium: OR = 2.45, 95% CI: 1.46–4.12; high: OR = 3.53, 95% CI: 1.84–6.77), DTP3 (medium: OR = 2.29, 95% CI: 1.41–3.73; high: OR = 3.20, 95% CI: 1.76–5.84), PCV3 (medium: OR = 2.09, 95% CI: 1.30–3.36; high: OR = 2.95, 95% CI: 1.63–5.34), and the combined three-vaccine series outcome (medium: OR = 1.93, 95% CI: 1.24–3.02; high: OR = 2.60, 95% CI: 1.49–4.52). By contrast, economic agency showed a generally positive direction, but its associations were weaker and were not statistically significant in adjusted analyses. Conclusions: Among the retained maternal empowerment domains, knowledge and information empowerment was most consistently associated with routine infant vaccine-series completion in Cambodia. These findings suggest that, even in a context where routine childhood vaccines are provided free of charge, successful completion of repeated infant vaccination visits may also depend on mothers’ ability to access, understand, and use immunization-related information in ways that support continued use of vaccination services. Efforts to improve childhood vaccination outcomes in Cambodia may therefore benefit from strengthening communication, reminders, and follow-up support for repeated vaccination visits.