Second Dose Measles Vaccination Utilization and Associated Factors in Jabitehnan District, Northwest Ethiopia

Dose-Response, Volume 21, No. 1, Year 2023

Interpretation

Background: Herd immunity against measles is essential to interrupt measles transmission, and this can only be attained by reaching at least 95% coverage for each of the 2 doses of measles vaccine provided in infancy and early childhood age group. It is important to provide everyone with 2 doses of the measles vaccine in order to effectively safeguard the population. Despite this, little is known about the second dosage of the measles vaccine utilization status and the factors that affect it. Therefore, this study aimed to assess second dose of measles vaccination utilization and its associated factors among children aged 24–35 months in Jabitehnan district, 2020. Methods: A community-based cross-sectional study design was conducted at Jabitehnan District, Northwest Ethiopia, from September 1st, 2020 to October 1st, 2020. Systematic random sampling technique was used to select 845 mothers/caregivers who had children aged 24–35 months. Both bi-variable and multivariable logistic regression was fitted to identify the determinant factors of second dose measles vaccination utilization. Finally, the statistical significant variables were declared by using 95% CI and P value less than.05 in the multivariable logistic regression analysis. The Hosmer and Lemeshow test was used to check the model’s fit to the data, and the variance inflation factor was used to assess multi-collinearity. Results: The overall second dose of measles vaccination utilization was 48.1%, (95% CI: 44.7-51.6). Mothers with primary school education (AOR = 1.91, 95% CI: 1.15-3.17), information about MCV2 (AOR = 6.53, 95% CI: 4.22-10.08), distance from vaccination site (AOR = 3.56, 95% CI: 2.46-5.14), knowledge about immunization (AOR = 1.935, 95% CI: 1.29-2.90), and favorable attitude about immunization (AOR = 5.19, 95% CI: 3.25-8.29) were significantly associated factors with second dose of measles vaccination utilization. Conclusion: Second dose measles vaccination utilization in the district was lower than the national target. Maternal education, distances from vaccination site, information about MCV2, and knowledge about immunization were significantly associated variables with second dose measles vaccination utilization. Therefore, in order to increase the utilization of the second dose of the measles vaccine, improved health education and service expansion to difficult-to-reach areas are required. This community-based cross-sectional study design was conducted at Jabitehnan District in Amhara region from 1st September 2020 to 1st October 2020. It is located 180 km from Bahir Dar, the capital city of Amhara region and 385 km from Addis Ababa, the capital city of Ethiopia. It is bordered on the west by Burie district, on the southwest by Sekela district, on the east by Dembecha district, and on the north by Quarit district. It has a total population of 226 000 and area of 1200.5 km2. It had 39 rural and 3 urban Kebeles, 41 health posts and 11 health centers. Health posts and health centers give vaccination services for children based on their residence: children who reside within 5 km radius of the health center receive their vaccination at the health center and those who reside beyond 5 km from the health center receive their vaccination in health posts and outreach settings (a total of 126 sites). Mothers/caregivers who had children aged 24–35 months and who had lived at least 6 months in Jabitehnan district were the source population, while mothers/caregivers who had children aged 23–35 months in the selected Kebeles of Jabitehnan district were the study population of the study. Those mothers/caregivers who were seriously ill during data collection period were excluded from the study. Sample size was determined by using single population proportion formula n = (Za/2)2(P)(1−P)/(d)2 with the assumption of 50% proportion, 5% margin of error, 95% confidence level of certainty, 10% non-respondent rate, 2% design effect, and a total 845 mothers/caregivers were included. Multi-stage systematic random sampling technique was used to select study participants. The district was stratified into 38 rural and 3 urban Kebeles, and 9 rural and 1 urban Kebeles (25% of Keble’s in both strata) were selected randomly. Samples were distributed proportionally by their number of households (HHs) having children aged 24–35 months of randomly selected Kebeles. Finally, eligible children aged 24–35 months were selected using systematic random sampling technique with “k” value of 2, and lottery method was used to select the first household for data collection of this study. A household having more than 1 child aged 24–35 months in this study was studied by selecting the young child and for twin selecting the one by lottery method. Second dose measles vaccination utilization was the outcome variable of this study. Socio-demographic characteristics (age, sex, residence, educational status, marital status, occupational status and income, number of infants, and religion), obstetrics-related factors (visits of antenatal care, postnatal care, illness of mothers, type of pregnancy, place of birth and maternal conference participation and birth attendant), access-related factors (time to reach vaccination site, mode of transportation, place of vaccination, and availability of electronic media and availability of telephone), and awareness-related factors (information about measles vaccine, knowledge, and attitude) were independent variables. If a child had received the second dose measles vaccine between the ages of 15 and 24 months in addition to a first dose of measles vaccination received before, he/she was considered as having received the second dose measles vaccination, coded as “1.” Eight knowledge assessment items were used and those who scored greater than 50% of the total knowledge measuring score were considered as having good knowledge.18 For Likert-scale attitude assessment items, strongly agree and agree were considered as positive and neutral, disagree and strongly disagree were considered as negative attitude. If respondents positively react, at least 75% or more of attitude questions were considered as favorable attitude.19,20 Data were collected through an interviewer-administered pretested structured questionnaire developed from different literatures,21-26 and information about children’s vaccination status was collected from children’s vaccination card and mothers/caregivers. Socio-demographic information, maternal health services, knowledge, access-related factors, and a child’s second dose of measles vaccination status were included in the questionnaire. Eight diploma and two BSC qualified nurses were recruited for data collection and supervision, respectively. The questionnaire was prepared in English and translated to Amharic which is the local and working language in the study area and back to English by language experts to maintain consistency. Prior to data collection, 1-day training was given for data collectors and supervisors on the study objectives, data collection instruments, techniques, and producers. A pretest was done on 43 mothers/caregivers (5%) at Dembecha district, nearby district, and necessary amendments were done based on the pretest findings. The consistency and completeness of data were checked by the principal investigator and supervisors on daily basis. The reliability of the tool was checked by investigators, and Cronbach’s α for measuring knowledge was .97, and attitudes .78, respectively, indicating good reliability. The data was entered into Epi-data version 4.6 Software and exported to SPSS version 23 for cleaning, coding, and analysis. Descriptive measures were computed to summarize the participants’ socio-demographic characteristics and second dose measles utilization. Bi-variable and multivariable logistic regression analysis was used to assess any association between each independent variable and second dose measles utilization. Independent variables with a P-value of less than .2 during the bi-variable logistic regression were entered into the multiple logistic regression analysis. Adjusted odds ratio (AOR) with a 95% confidence interval and P-value <.05 was used to show the association between explanatory and dependent variables. Variables with P-value of <.05 were considered as significant. Model fitness was checked using the Hosmer–Lemeshow goodness-of-a-fit test (P = .58), and multi-collinearity was also checked using the Variance Inflation Factor (VIF), VIF <10 and tolerance greater than .1 were used to declare the absence of multi-collinearity.

AI Digest

Study Justification:

The study aimed to assess the utilization of the second dose of measles vaccination and the factors that affect it among children aged 24-35 months in Jabitehnan district, Northwest Ethiopia. This study is important because achieving herd immunity against measles requires at least 95% coverage for each of the two doses of measles vaccine. Understanding the utilization status and factors influencing the second dose of measles vaccination can help identify barriers and develop strategies to improve vaccination coverage.

Highlights:

– The overall utilization of the second dose of measles vaccination in Jabitehnan district was 48.1%.
– Factors significantly associated with second dose measles vaccination utilization included maternal education, information about the vaccine, distance from vaccination site, knowledge about immunization, and favorable attitude about immunization.
– Maternal education, distances from vaccination site, information about the vaccine, and knowledge about immunization were identified as key factors influencing the utilization of the second dose of measles vaccination.

Recommendations for Lay Reader:

– Improved health education: Enhancing awareness and knowledge about the importance of the second dose of measles vaccination among mothers and caregivers can help increase utilization.
– Service expansion to difficult-to-reach areas: Providing vaccination services in remote areas and improving access to vaccination sites can help reach more children with the second dose of measles vaccine.

Recommendations for Policy Maker:

– Strengthening health education programs: Allocate resources to develop and implement effective health education campaigns that emphasize the importance of the second dose of measles vaccination.
– Infrastructure development: Invest in improving transportation infrastructure to ensure better access to vaccination sites, especially in remote areas.
– Training and capacity building: Provide training and capacity building programs for healthcare workers to enhance their knowledge and skills in delivering vaccination services.

Key Role Players:

– Ministry of Health: Responsible for policy development, coordination, and resource allocation for vaccination programs.
– District Health Office: Implements vaccination programs at the district level and coordinates with health facilities and community health workers.
– Health Facilities: Provide vaccination services and ensure the availability of vaccines and trained healthcare workers.
– Community Health Workers: Play a crucial role in raising awareness, mobilizing communities, and facilitating vaccination campaigns.

Cost Items for Planning Recommendations:

– Health education materials: Budget for the development and distribution of educational materials such as brochures, posters, and audiovisual resources.
– Transportation: Allocate funds for improving transportation infrastructure and providing transportation services for vaccination campaigns in remote areas.
– Training and capacity building: Set aside a budget for training programs for healthcare workers to enhance their knowledge and skills in delivering vaccination services.
– Vaccine supply: Ensure an adequate budget for procuring and maintaining a sufficient supply of measles vaccines.
– Monitoring and evaluation: Allocate resources for monitoring and evaluating the implementation and impact of vaccination programs.
Please note that the cost items provided are general categories and not actual cost estimates. The actual budget will depend on the specific context and requirements of the vaccination program in Jabitehnan district.

Strength of Evidence

The strength of evidence for this abstract is 7 out of 10.
The evidence in the abstract is moderately strong. The study design is community-based cross-sectional, which allows for data collection from a large sample size. The study includes a clear description of the population, sampling technique, and data collection methods. The statistical analysis is appropriate, using both bi-variable and multivariable logistic regression. The results provide specific percentages and confidence intervals. The study identifies significant associated factors with second dose measles vaccination utilization. However, the abstract does not mention the limitations of the study or potential biases. To improve the evidence, the abstract should include a discussion of limitations and potential biases, as well as recommendations for future research to address these limitations.

Abstract

This community-based cross-sectional study design was conducted at Jabitehnan District in Amhara region from 1st September 2020 to 1st October 2020. It is located 180 km from Bahir Dar, the capital city of Amhara region and 385 km from Addis Ababa, the capital city of Ethiopia. It is bordered on the west by Burie district, on the southwest by Sekela district, on the east by Dembecha district, and on the north by Quarit district. It has a total population of 226 000 and area of 1200.5 km2. It had 39 rural and 3 urban Kebeles, 41 health posts and 11 health centers. Health posts and health centers give vaccination services for children based on their residence: children who reside within 5 km radius of the health center receive their vaccination at the health center and those who reside beyond 5 km from the health center receive their vaccination in health posts and outreach settings (a total of 126 sites). Mothers/caregivers who had children aged 24–35 months and who had lived at least 6 months in Jabitehnan district were the source population, while mothers/caregivers who had children aged 23–35 months in the selected Kebeles of Jabitehnan district were the study population of the study. Those mothers/caregivers who were seriously ill during data collection period were excluded from the study. Sample size was determined by using single population proportion formula n = (Za/2)2(P)(1−P)/(d)2 with the assumption of 50% proportion, 5% margin of error, 95% confidence level of certainty, 10% non-respondent rate, 2% design effect, and a total 845 mothers/caregivers were included. Multi-stage systematic random sampling technique was used to select study participants. The district was stratified into 38 rural and 3 urban Kebeles, and 9 rural and 1 urban Kebeles (25% of Keble’s in both strata) were selected randomly. Samples were distributed proportionally by their number of households (HHs) having children aged 24–35 months of randomly selected Kebeles. Finally, eligible children aged 24–35 months were selected using systematic random sampling technique with “k” value of 2, and lottery method was used to select the first household for data collection of this study. A household having more than 1 child aged 24–35 months in this study was studied by selecting the young child and for twin selecting the one by lottery method. Second dose measles vaccination utilization was the outcome variable of this study. Socio-demographic characteristics (age, sex, residence, educational status, marital status, occupational status and income, number of infants, and religion), obstetrics-related factors (visits of antenatal care, postnatal care, illness of mothers, type of pregnancy, place of birth and maternal conference participation and birth attendant), access-related factors (time to reach vaccination site, mode of transportation, place of vaccination, and availability of electronic media and availability of telephone), and awareness-related factors (information about measles vaccine, knowledge, and attitude) were independent variables. If a child had received the second dose measles vaccine between the ages of 15 and 24 months in addition to a first dose of measles vaccination received before, he/she was considered as having received the second dose measles vaccination, coded as “1.” Eight knowledge assessment items were used and those who scored greater than 50% of the total knowledge measuring score were considered as having good knowledge.18 For Likert-scale attitude assessment items, strongly agree and agree were considered as positive and neutral, disagree and strongly disagree were considered as negative attitude. If respondents positively react, at least 75% or more of attitude questions were considered as favorable attitude.19,20 Data were collected through an interviewer-administered pretested structured questionnaire developed from different literatures,21-26 and information about children’s vaccination status was collected from children’s vaccination card and mothers/caregivers. Socio-demographic information, maternal health services, knowledge, access-related factors, and a child’s second dose of measles vaccination status were included in the questionnaire. Eight diploma and two BSC qualified nurses were recruited for data collection and supervision, respectively. The questionnaire was prepared in English and translated to Amharic which is the local and working language in the study area and back to English by language experts to maintain consistency. Prior to data collection, 1-day training was given for data collectors and supervisors on the study objectives, data collection instruments, techniques, and producers. A pretest was done on 43 mothers/caregivers (5%) at Dembecha district, nearby district, and necessary amendments were done based on the pretest findings. The consistency and completeness of data were checked by the principal investigator and supervisors on daily basis. The reliability of the tool was checked by investigators, and Cronbach’s α for measuring knowledge was .97, and attitudes .78, respectively, indicating good reliability. The data was entered into Epi-data version 4.6 Software and exported to SPSS version 23 for cleaning, coding, and analysis. Descriptive measures were computed to summarize the participants’ socio-demographic characteristics and second dose measles utilization. Bi-variable and multivariable logistic regression analysis was used to assess any association between each independent variable and second dose measles utilization. Independent variables with a P-value of less than .2 during the bi-variable logistic regression were entered into the multiple logistic regression analysis. Adjusted odds ratio (AOR) with a 95% confidence interval and P-value <.05 was used to show the association between explanatory and dependent variables. Variables with P-value of <.05 were considered as significant. Model fitness was checked using the Hosmer–Lemeshow goodness-of-a-fit test (P = .58), and multi-collinearity was also checked using the Variance Inflation Factor (VIF), VIF <10 and tolerance greater than .1 were used to declare the absence of multi-collinearity.

Materials

N/A

Innovations

The study titled “Second Dose Measles Vaccination Utilization and Associated Factors in Jabitehnan District, Northwest Ethiopia” aimed to assess the utilization of the second dose of the measles vaccine and identify factors that affect its utilization among children aged 24-35 months in Jabitehnan district.

The study found that the overall utilization of the second dose of the measles vaccine in the district was 48.1%. Several factors were identified as significantly associated with the utilization of the second dose of the measles vaccine:

1. Maternal Education: Mothers with primary school education were more likely to utilize the second dose of the measles vaccine.

2. Information about MCV2: Mothers who had information about the second dose of the measles vaccine (MCV2) were more likely to utilize it.

3. Distance from Vaccination Site: Mothers who lived closer to vaccination sites were more likely to utilize the second dose of the measles vaccine.

4. Knowledge about Immunization: Mothers who had good knowledge about immunization were more likely to utilize the second dose of the measles vaccine.

5. Attitude about Immunization: Mothers with a favorable attitude towards immunization were more likely to utilize the second dose of the measles vaccine.

Based on these findings, the study recommends the following actions to improve access to maternal health:

1. Improve Health Education: Enhance the dissemination of information about the importance of the second dose of the measles vaccine. This can be done through community outreach programs, health campaigns, and targeted messaging to mothers and caregivers.

2. Service Expansion to Difficult-to-Reach Areas: Ensure that vaccination services are accessible to all children, including those living in remote or underserved areas. This may involve establishing mobile vaccination clinics, increasing the number of health posts, or providing transportation support for families who have difficulty reaching vaccination sites.

3. Maternal Education: Promote maternal education, particularly at the primary school level. Investing in education can empower mothers with knowledge and decision-making skills regarding their children’s health.

4. Information about MCV2: Increase awareness and knowledge about the second dose of the measles vaccine (MCV2) among mothers and caregivers. This can be achieved through targeted health education campaigns, community workshops, and the involvement of healthcare providers in providing accurate information during antenatal and postnatal care visits.

5. Addressing Distance from Vaccination Site: Take measures to reduce the distance and transportation barriers that may prevent families from accessing vaccination sites. This could involve establishing additional vaccination sites in closer proximity to communities or providing transportation support for families who live far from health facilities.

By implementing these recommendations, it is expected that the utilization of the second dose of the measles vaccine will increase, leading to improved maternal and child health outcomes in the Jabitehnan District and similar settings.

AI Innovations Description

The recommendation from the study to improve access to maternal health is to focus on improving health education and expanding services to difficult-to-reach areas. Specifically, the study suggests the following actions:

1. Improve Health Education: Enhance the dissemination of information about the importance of the second dose of the measles vaccine. This can be done through community outreach programs, health campaigns, and targeted messaging to mothers and caregivers. Providing clear and accurate information about the benefits and safety of the vaccine can help address any misconceptions or concerns.

2. Service Expansion to Difficult-to-Reach Areas: Ensure that vaccination services are accessible to all children, including those living in remote or underserved areas. This may involve establishing mobile vaccination clinics, increasing the number of health posts, or providing transportation support for families who have difficulty reaching vaccination sites.

3. Maternal Education: Promote maternal education, particularly at the primary school level. The study found that mothers with primary school education were more likely to utilize the second dose of the measles vaccine. Investing in education can empower mothers with knowledge and decision-making skills regarding their children’s health.

4. Information about MCV2: Increase awareness and knowledge about the second dose of the measles vaccine (MCV2) among mothers and caregivers. This can be achieved through targeted health education campaigns, community workshops, and the involvement of healthcare providers in providing accurate information during antenatal and postnatal care visits.

5. Addressing Distance from Vaccination Site: Take measures to reduce the distance and transportation barriers that may prevent families from accessing vaccination sites. This could involve establishing additional vaccination sites in closer proximity to communities or providing transportation support for families who live far from health facilities.

By implementing these recommendations, it is expected that the utilization of the second dose of the measles vaccine will increase, leading to improved maternal and child health outcomes in the Jabitehnan District and similar settings.

AI Innovations Methodology

The methodology used in the study to simulate the impact of the main recommendations on improving access to maternal health involved a community-based cross-sectional study design. The study was conducted in Jabitehnan District, Northwest Ethiopia, from September 1st, 2020 to October 1st, 2020.

The study population consisted of mothers/caregivers who had children aged 24–35 months and had lived in Jabitehnan District for at least 6 months. The sample size was determined using the single population proportion formula, with a total of 845 mothers/caregivers included in the study.

A multi-stage systematic random sampling technique was used to select study participants. The district was stratified into rural and urban Kebeles, and a random selection of Kebeles was made. Samples were distributed proportionally based on the number of households with children aged 24–35 months in the selected Kebeles. Eligible children were then selected using systematic random sampling technique.

Data was collected through an interviewer-administered pretested structured questionnaire, which included information on socio-demographic characteristics, maternal health services, knowledge, access-related factors, and the child’s second dose of measles vaccination status. Data collectors and supervisors were trained prior to data collection, and a pretest was conducted to ensure the reliability of the questionnaire.

Descriptive measures were computed to summarize the participants’ characteristics and second dose measles utilization. Bi-variable and multivariable logistic regression analysis was used to assess the association between each independent variable and second dose measles utilization. Variables with a P-value of less than .2 in the bi-variable analysis were entered into the multiple logistic regression analysis.

The statistical significance of the variables was determined using adjusted odds ratios (AOR) with a 95% confidence interval and a P-value of less than .05. Model fitness was checked using the Hosmer-Lemeshow goodness-of-fit test, and multi-collinearity was assessed using the Variance Inflation Factor.

The study found that maternal education, information about the second dose of the measles vaccine, distance from vaccination site, knowledge about immunization, and favorable attitude about immunization were significantly associated with second dose measles vaccination utilization.

Based on these findings, the study recommended improving health education by enhancing the dissemination of information about the importance of the second dose of the measles vaccine. It also suggested expanding services to difficult-to-reach areas to ensure accessibility to vaccination services for all children.

By implementing these recommendations, it is expected that the utilization of the second dose of the measles vaccine will increase, leading to improved maternal and child health outcomes in the Jabitehnan District and similar settings. The study was published in the journal Dose-Response, Volume 21, No. 1, in the year 2023.

Author

Dima Health

Identifiers:

DOI: 10.1177/15593258231164042

Research Areas:

Community Interventions, Health System and Policy, Infectious Diseases, Maternal Access, Maternal and Child Health, Quality of Care, Sexual and Reproductive Health, Social Determinants

Study Countries:

Ethiopia

Study Design:

Case-Control Study, Cross Sectional Study, Grounded Theory

Study Approach:

Quantitative