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Background: Child vaccination is an instrument for saving millions of lives. Only one in twenty children has access to childhood vaccination in hard to reach areas in developing countries. Although studies have been done on childhood vaccination, factors associated with access and continuum were not considered in Ethiopia. Therefore, this study aimed to identify the factors associated with the access and continuum of childhood vaccination in the emerging regions of Ethiopia based on the 2016 EDHS datasets. Methods: The two-stage stratified sampling technique was used for the survey carried out on 642 mothers of children aged 12-23 months. Access is the provision of services in shorter waiting times and flexibly at all times and alternative methods of communication. Accordingly, continuum of care reflects the extent to which a series of discrete health care events are being experienced by people coherently and interconnected over time. As a result, access and continuum of childhood vaccination are determined using pentavalent-1 and measles vaccination status of children, respectively. A binary logistic regression model was fitted to identify the factors associated with access and continuum of the vaccination. Results: Overall, 25.1% of children aged 12-23 months received all of the recommended childhood vaccines. Sixty-two percent of children accessed and 46.9% had continuum of childhood vaccination in the emerging regions of Ethiopia. Pentavalent_1 to 3 and BCG to measles dropout rates were 33.42 and 17.53%, respectively. Mothers’ formal education (AOR = 1.99; 95%CI: 1.20, 3.31), ANC (AOR = 4.13; 95%CI: 2.75,6.19), health facility delivery of last birth (AOR = 1.58; 95%CI: 1.19, 2.82), rich wealth (AOR = 1.57; 95%CI: 1.19, 3.14) and average child birth weight (AOR = 1.67; 95%CI: 1.03, 2.72) were positively associated with childhood access to vaccination. On the other hand, mothers’ ANC attendance (AOR = 3.68; 95%CI: 2.48, 5.47) and rich wealth (AOR = 2.07; 95%CI: 1.15, 3.71) were positively associated with the continuum of the services. On the contrary, children with rural resident mothers (AOR = 0.33; 95%CI: 0.14, 0.76) and small birth weight (AOR = 0.51; 95%CI: 0.33, 0.81) were negatively associated to the access and continuum of childhood vaccination, respectively. Conclusion: Childhood vaccination status was low in the emerging regions of Ethiopia. Variables such as maternal education, birth weight of children, ANC, health facility delivery and wealth were associated with the access and continuum of the vaccination. Therefore, empowering women with education and strengthening maternal healthcare services might enhance childhood vaccination. In addition, the government needs to design a compensation mechanism for the cost relating to childhood vaccination to improve the access and continuum of the service.
The 2016 Ethiopian Demographic and Health Survey (EDHS) was conducted in the nine national regional states and the two city administrations. The regions classified as emerging, Afar, Benishangul-Gumz, Gambella and Somali, are characterized by scattered pastoralists and semi-pastoralist societies suffering from extreme poverty. Absence of clear and detailed regulations, basic infrastructures and services are also their common chrematistics [14, 15]. On the other hand, developed regions such as Amhara, Oromia, Southern Nations, Nationalities and Peoples (SNNP), Tigray and the city administrations, such as Addis Ababa, Dire Dawa and Harari regions are relatively more densely populated [15]. Ethiopia is one of the Sub-Saharan countries found in the horn of Africa with a total population of 73.5 million. The total population of the four emerging regions was 6926, 933, with the largest in Somali (4,445,219) and the least in Gambella (307,096). Similarly, the total number of children 0–4 years was 449,699 in Somali and 42,044 in Gambella [16]. The sampling frame used for the 2016 EDHS was the 2007 Population and Housing Census (PHC) of the Central Statistical Agency report of Ethiopia [16]. The sample for the 2016 EDHS was designed to provide estimates of the key indicators of the country as a whole, separately for urban and rural areas, and for each of the nine regions and the two city administrations. The sample was stratified and selected in two stages and each region was stratified into urban and rural areas. Samples of the Enumeration Areas (EAs) were selected independently in each stratum of two stages. Implicit stratification and proportional allocation were used at each lower administrative level. In the first stage, EAs in urban and rural areas were selected with probability proportional to the EA size (based on the 2007 PHC) and with independent selection in each sampling stratum. A household listing operation was carried out in all of the selected EAs in 2015. The resulting lists of households served as sampling frames for the selection of households in the second stage. Segmentation was done for some of the selected EAs with large households, and only one segment was selected for the survey with a probability proportional to size. Household listing was conducted only in the selected segment, that is, the 2016 EDHS cluster was either an EA or a segment of an EA. In the second stage, the selection of the households per cluster was done using systematic sampling technique. In this study, the 2016 Ethiopian demographic and health survey childhood datasets of the four emerging regions, namely Afar, Benishangul-Gumz, Gambella and Somali were used for analysis. All women aged 15–49 years and permanently lived in the area and slept in the selected households the night before the surveys were eligible [10]. Children 12–23 months are the source population and the study included 642 mothers and their children aged 12–23 months and data on both were extracted from the 2016 EDHS datasets. Potential independent variables such as socio-demographic, economic, fertility history and health service utilization were also extracted and further recoding of the selected variables was done to match and compare with other similar studies. Access and continuum of childhood vaccination were the dependent variables of the study. Socio-demographic characteristics (age, residence, religion, and marital status), and obstetric history of the women, like places of delivery, birth order, antenatal care, postnatal check-ups in 2 months after birth, number of live children, sex of children, and marital status were the independent variables. Vaccination refers to the administration of antigenic material (a vaccine) to stimulate an individual’s immune system to develop adaptive immunity to a pathogen [17] and its coverage is defined as the proportion of a given population that has been vaccinated in a given time period [18]. A fully vaccinated child was expected to receive one dose of BCG, three doses of pentavalent, Pneumococcal Conjugate (PCV), Oral Polio Vaccines (OPV), two doses of Rotavirus and one dose of measles vaccines [19]. Each vaccine had five response categories, namely “no”, “vaccination date on the card”, “reported by mothers”, “vaccination marked on card” and “do not know”. The vaccination status of children was recoded as 0 and 1 for each antigen. “No” responses were recoded as “0” and labeled “not received the vaccine”, while the other responses “vaccination date on card, reported by mothers, vaccination marked on card” were recoded together as “1” and labeled “received the vaccine”. Besides, “do not know responses” were excluded from analysis. As a result, the vaccination status of children was recoded as “0” for “not vaccinated” and “1” for “vaccinated” for each antigen on the basis of the reports of women and information on the child vaccination card. Accordingly, access and the continuum of childhood vaccination were recoded as “0” for “no” and “1” for “yes” for each child. Access is the provision of services in shorter waiting times, more flexibly, electronically, by telephone or alternative methods of communication [20]. As a result, access to childhood vaccination was determined based on pentavalent-1 vaccination status of children. Continuum of care reflects the extent to which a series of discrete health care events are being experienced by people coherently and interconnected over time [20]. Thus, continuum of childhood vaccination was measured by measles vaccination status of children. The extracted EDHS data included socio-demographic characteristics of the women, obstetric history and service utilization child-specific information for all births in the past 5 years of women in the reproductive age group. The 2016 EDHS collected information on childhood vaccination status from vaccination cards and women’s verbal reports. The interviewer copied the vaccination dates directly into the questionnaire if the cards were available. However, the interviewer asked respondents to recall the vaccines given to their children when there were no vaccination cards. The cleaned and recoded data were analyzed using STATA version 14. Descriptive statistics such as means, medians, SDs, frequencies and proportions of variables were presented using graphs, texts, and tables. Bivariable and multivariable logistic regression analyses were conducted to identify factors associated with access, utilization, and continuity of vaccination. Variables with p-values < 0.2 [21, 22] during the bivariable analyses were fitted into the multivariable logistic regression analyses. However, p-value of 0.2 did not mean that there was a 20% chance that the null hypothesis was correct [22, 23], rather variables with p-value of < 0.2 during the bivariable analyses might have a chance to be significantly associated with the outcome variable during the multivariable regression analyses. Adjusted Odds Ratio (AOR) and 95% Confidence Interval (CI) with p-value < 0.05 were used to identify variables associated with the outcome variables.
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