Factors influencing full immunization coverage among 12-23 months of age children in Ethiopia: Evidence from the national demographic and health survey in 2011

BMC Public Health, Volume 15, No. 1, Year 2015

Interprétation

Background: Immunization remains one of the most important public health interventions to reduce child morbidity and mortality. The 2011 national demographic and health survey (DHS) indicated low full immunization coverage among children aged 12-23 months in Ethiopia. Factors contributing to the low coverage of immunization have been poorly understood. The aim of this study was to identify factors associated with full immunization coverage among children aged 12-23 months in Ethiopia. Methods: This study used the 2011 Ethiopian demographic and health survey data. The survey was cross sectional by design and used a multistage cluster sampling procedure. A total of 1,927 mothers with children of 12-23 months of age were extracted from the children’s dataset. Mothers’ self-reported data and observations of vaccination cards were used to determine vaccine coverage. An adjusted odds ratio (AOR) with 95 % confidence intervals (CI) was used to outline the independent predictors. Results: The prevalence of fully immunized children was 24.3 %. Specific vaccination coverage for three doses of DPT, three doses of polio, measles and BCG were 36.5 %, 44.3 %, 55.7 % and 66.3 %, respectively. The multivariable analysis showed that sources of information from vaccination card [AOR 95 % CI; 7.7 (5.95-10.06)], received postnatal check-up within two months after birth [AOR 95 % CI; 1.8 (1.28-2.56)], women’s awareness of community conversation program [AOR 95 % CI; 1.9 (1.44-2.49)] and women in the rich wealth index [AOR 95 % CI; 1.4 (1.06-1.94)] were the predictors of full immunization coverage. Women from Afar [AOR 95 % CI; 0.07 (0.01-0.68)], Amhara [AOR 95 % CI; 0.33 (0.13-0.81)], Oromiya [AOR 95 % CI; 0.15 (0.06-0.37)], Somali [AOR 95 % CI; 0.15 (0.04-0.55)] and Southern Nation and Nationalities People administrative regions [AOR 95 % CI; 0.35 (0.14-0.87)] were less likely to fully vaccinate their children. Conclusion: The overall full immunization coverage in Ethiopia was considerably low as compared to the national target set (66 %). Health service use and access to information on maternal and child health were found to predict full immunization coverage. Appropriate strategies should be devised to enhance health information and accessibility for full immunization coverage by addressing the variations among regions. The 2011 Ethiopian Demographic and Health Survey (EDHS) was conducted in nine regional states of Ethiopia namely; Tigray, Afar, Amhara, Oromiya, Somali, Benishangul Gumuz, Southern Nations Nationalities and Peoples (SNNP), Gambella and Harari and two city Administrations (Addis Ababa and Dire Dawa). Ethiopia is one of the sub-Saharan countries found in the horn of Africa with a population of 73.5 million based on the 2007 national population and housing census [26]. This study used the 2011 EDHS data. The survey employed a two-stage cluster sampling design. All women age 15–49 who were usual residents or who slept in the selected households the night before the survey were eligible. A total of 17,385 eligible women were identified and finally 16,515 women in the age group 15–49 were interviewed. The detailed methodology is found elsewhere [8]. Of all interviewed women, 11,654 gave birth in the past five years and 10,808 were interviewed for vaccination status. Children between 12–23 months of age are the youngest cohort who have reached the age by which they should be fully vaccinated. This age group was our target population for our analysis. So a total of 1,927 women with 12–23 months of children were extracted from the variable current age of child’s in the dataset. Information on a wide-range of potential independent variables (i.e. socio-demographic, economic, fertility history and health service use) were extracted accordingly. After reviewing the detailed data coding, further recoding of variables was done to better suit with other studies for comparison and intervention recommendations. The EDHS data include a women’s questionnaire that measures socio-demographic characteristics of the mothers, information on reproductive health and service use behaviors, as well as child-specific information for all births in the past five years from women of reproductive age group between 15–49 years. The 2011 EDHS collected information on vaccination coverage in two ways: (1) from vaccination cards shown to the interviewers and (2) from mothers’ verbal reports. If the cards were available, the interviewer copied the vaccination dates directly onto the questionnaire. When there was no vaccination card available for the child or if a vaccine had not been recorded on the card as being given, the respondent was asked to recall the vaccines given to her child. In this analysis, the dependent variable was full immunization coverage. According to the WHO guideline [27], “complete or full immunization” coverage is defined as a child has received a BCG vaccination against tuberculosis; three doses of DPT vaccine to prevent diphtheria, pertusis, and tetanus (DPT); at least three doses of polio vaccine; and one dose of measles vaccine. This dependent variable had five response categories: no, vaccination date on card, reported by mothers, vaccination marked on card and DK (don’t know). We recoded each variable into 0 and 1. 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”. Then, we added all yes – zero scores and labeled them “Immunization status”. The immunization status was recoded as “0” if the child had received all the doses of vaccinations and categorized as “complete or full immunization” or “1” if the child had missed one or more doses of vaccinations and categorized as “incomplete immunization”. The individual level exposure variables considered in this study were age of mothers, mother’s occupation, child death, parity, religion, women’s education, husband’s education, wealth index, birth order, awareness of community conversation (CC) program, sources of vaccination information, received postnatal check-up within 2 months after birth, antenatal care follow up of at least 4 times, place of delivery, number of living children in the household, sex of child and marital status. Whereas place of residence, agro-climatic zone and administrative regions were considered as the community level exposure variables. In this manuscript, ANC attendance refers to when women get services during pregnancy according to the WHO recommendations of at least four ANC visits for low-risk pregnant women and parity is defined as the number of children ever born. The wealth index constructed from household assets and characteristics available in the survey was used [8]. Occupational status was defined as non-paid and paid who were engaged in the areas of professional/technical/managerial, clerical, sales and services, skilled manual, unskilled manual and agricultural occupation classifications of the country. Descriptive statistics including prevalence and frequency distributions were used to determine the level of full immunization coverage by socio-demographic characteristics. Bivariate analysis was used to show the association between socio-demographic characteristics and full immunization coverage. Variables that were determined statistically significant at p-value <0.25 during bivariate analysis were considered for adjustment in the multivariable logistic regression model [28, 29]. This cut off point prevented removing variables that would potentially have an effect during multivariable analysis. A stepwise approach was used to assess the iteration of variables and to control potential confounders [30]. In the multivariable model, odds ratio with 95 % CI was used. A multi-collinearity test was done and as a result marital status and birth order were omitted from the multivariable analysis because of collinearity with variance inflation factors (VIF) of greater than 10 [31]. Sample weights were applied in order to compensate for the unequal probability of selection between the strata that has been geographically defined as well as for non-responses. A detailed explanation of the weighting procedure can be found in the DHS 2011 [8]. The “svy” command in STATA version 11 (Stata Corporation, College Station, TX, USA) was used to weight the survey data. The 2011 EDHS data is available to the general public by request in different formats from the Measure DHS website [http://www.measuredhs.com]. We submitted a request to the Measure DHS by briefly stating the objectives of this analysis and thereafter received permission to download the children’s’ dataset in SPSS format.

Résumé de l’IA

Study Justification:

The study aimed to identify factors associated with low full immunization coverage among children aged 12-23 months in Ethiopia. This is important because immunization is a crucial public health intervention to reduce child morbidity and mortality. Understanding the factors contributing to low immunization coverage can help inform strategies to improve vaccination rates and ultimately save lives.

Highlights:

– The prevalence of fully immunized children in Ethiopia was only 24.3%.
– Specific vaccination coverage for DPT, polio, measles, and BCG were also low.
– Factors such as sources of information from vaccination cards, postnatal check-ups, awareness of community conversation programs, and wealth index were found to predict full immunization coverage.
– Certain regions in Ethiopia, including Afar, Amhara, Oromiya, Somali, and Southern Nation and Nationalities People administrative regions, were less likely to fully vaccinate their children.

Recommendations:

– Enhance health information and accessibility to improve full immunization coverage.
– Devise appropriate strategies to address variations in vaccination rates among different regions in Ethiopia.

Key Role Players:

– Ministry of Health: Responsible for implementing and coordinating immunization programs.
– Health workers: Involved in delivering vaccines and providing information to parents.
– Community leaders: Can help raise awareness and promote the importance of immunization.
– Non-governmental organizations (NGOs): Can support immunization campaigns and outreach efforts.

Cost Items for Planning Recommendations:

– Vaccine procurement and distribution: Budget for purchasing vaccines and ensuring their availability in all regions.
– Training and capacity building: Allocate funds for training health workers on immunization practices and communication skills.
– Information and communication materials: Budget for the development and dissemination of educational materials on immunization.
– Outreach activities: Allocate funds for community-based campaigns and mobile vaccination clinics.
– Monitoring and evaluation: Set aside resources for monitoring immunization coverage and evaluating the impact of interventions.

Force de la preuve

The strength of evidence for this abstract is 8 out of 10.
The evidence in the abstract is strong, as it is based on the 2011 Ethiopian Demographic and Health Survey data. The study used a large sample size and employed a multistage cluster sampling procedure. The prevalence of fully immunized children and specific vaccination coverage rates are provided. The study also conducted multivariable analysis to identify predictors of full immunization coverage. However, to improve the evidence, it would be helpful to include information on the statistical significance of the predictors and provide more details on the methodology, such as the specific statistical tests used and any potential limitations of the study.

Abstrait

The 2011 Ethiopian Demographic and Health Survey (EDHS) was conducted in nine regional states of Ethiopia namely; Tigray, Afar, Amhara, Oromiya, Somali, Benishangul Gumuz, Southern Nations Nationalities and Peoples (SNNP), Gambella and Harari and two city Administrations (Addis Ababa and Dire Dawa). Ethiopia is one of the sub-Saharan countries found in the horn of Africa with a population of 73.5 million based on the 2007 national population and housing census [26]. This study used the 2011 EDHS data. The survey employed a two-stage cluster sampling design. All women age 15–49 who were usual residents or who slept in the selected households the night before the survey were eligible. A total of 17,385 eligible women were identified and finally 16,515 women in the age group 15–49 were interviewed. The detailed methodology is found elsewhere [8]. Of all interviewed women, 11,654 gave birth in the past five years and 10,808 were interviewed for vaccination status. Children between 12–23 months of age are the youngest cohort who have reached the age by which they should be fully vaccinated. This age group was our target population for our analysis. So a total of 1,927 women with 12–23 months of children were extracted from the variable current age of child’s in the dataset. Information on a wide-range of potential independent variables (i.e. socio-demographic, economic, fertility history and health service use) were extracted accordingly. After reviewing the detailed data coding, further recoding of variables was done to better suit with other studies for comparison and intervention recommendations. The EDHS data include a women’s questionnaire that measures socio-demographic characteristics of the mothers, information on reproductive health and service use behaviors, as well as child-specific information for all births in the past five years from women of reproductive age group between 15–49 years. The 2011 EDHS collected information on vaccination coverage in two ways: (1) from vaccination cards shown to the interviewers and (2) from mothers’ verbal reports. If the cards were available, the interviewer copied the vaccination dates directly onto the questionnaire. When there was no vaccination card available for the child or if a vaccine had not been recorded on the card as being given, the respondent was asked to recall the vaccines given to her child. In this analysis, the dependent variable was full immunization coverage. According to the WHO guideline [27], “complete or full immunization” coverage is defined as a child has received a BCG vaccination against tuberculosis; three doses of DPT vaccine to prevent diphtheria, pertusis, and tetanus (DPT); at least three doses of polio vaccine; and one dose of measles vaccine. This dependent variable had five response categories: no, vaccination date on card, reported by mothers, vaccination marked on card and DK (don’t know). We recoded each variable into 0 and 1. 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”. Then, we added all yes – zero scores and labeled them “Immunization status”. The immunization status was recoded as “0” if the child had received all the doses of vaccinations and categorized as “complete or full immunization” or “1” if the child had missed one or more doses of vaccinations and categorized as “incomplete immunization”. The individual level exposure variables considered in this study were age of mothers, mother’s occupation, child death, parity, religion, women’s education, husband’s education, wealth index, birth order, awareness of community conversation (CC) program, sources of vaccination information, received postnatal check-up within 2 months after birth, antenatal care follow up of at least 4 times, place of delivery, number of living children in the household, sex of child and marital status. Whereas place of residence, agro-climatic zone and administrative regions were considered as the community level exposure variables. In this manuscript, ANC attendance refers to when women get services during pregnancy according to the WHO recommendations of at least four ANC visits for low-risk pregnant women and parity is defined as the number of children ever born. The wealth index constructed from household assets and characteristics available in the survey was used [8]. Occupational status was defined as non-paid and paid who were engaged in the areas of professional/technical/managerial, clerical, sales and services, skilled manual, unskilled manual and agricultural occupation classifications of the country. Descriptive statistics including prevalence and frequency distributions were used to determine the level of full immunization coverage by socio-demographic characteristics. Bivariate analysis was used to show the association between socio-demographic characteristics and full immunization coverage. Variables that were determined statistically significant at p-value <0.25 during bivariate analysis were considered for adjustment in the multivariable logistic regression model [28, 29]. This cut off point prevented removing variables that would potentially have an effect during multivariable analysis. A stepwise approach was used to assess the iteration of variables and to control potential confounders [30]. In the multivariable model, odds ratio with 95 % CI was used. A multi-collinearity test was done and as a result marital status and birth order were omitted from the multivariable analysis because of collinearity with variance inflation factors (VIF) of greater than 10 [31]. Sample weights were applied in order to compensate for the unequal probability of selection between the strata that has been geographically defined as well as for non-responses. A detailed explanation of the weighting procedure can be found in the DHS 2011 [8]. The “svy” command in STATA version 11 (Stata Corporation, College Station, TX, USA) was used to weight the survey data. The 2011 EDHS data is available to the general public by request in different formats from the Measure DHS website [http://www.measuredhs.com]. We submitted a request to the Measure DHS by briefly stating the objectives of this analysis and thereafter received permission to download the children’s’ dataset in SPSS format.

Matériaux

N/A

Innovations

Based on the provided information, here are some potential innovations that can be used to improve access to maternal health:

1. Mobile Health (mHealth) Applications: Develop and implement mobile applications that provide information and reminders about maternal health, including immunization schedules and postnatal check-ups. These apps can also provide access to telemedicine services for remote consultations with healthcare providers.

2. Community Conversation Programs: Expand and promote community conversation programs that raise awareness about maternal health and immunization. These programs can involve community leaders, healthcare workers, and mothers themselves to discuss the importance of immunization and address any concerns or misconceptions.

3. Improved Health Information Systems: Enhance health information systems to ensure accurate and up-to-date recording of immunization data. This can include the use of electronic health records and interoperable systems that allow for seamless sharing of information between healthcare facilities.

4. Targeted Interventions for Underserved Regions: Implement targeted interventions in regions with low immunization coverage, such as Afar, Amhara, Oromiya, Somali, and Southern Nation and Nationalities People administrative regions. These interventions can include mobile clinics, outreach programs, and community health workers to improve access to immunization services.

5. Financial Incentives: Explore the use of financial incentives, such as conditional cash transfers or vouchers, to encourage mothers to fully immunize their children. These incentives can help overcome barriers related to transportation costs and lost wages.

6. Strengthening Antenatal and Postnatal Care: Improve antenatal and postnatal care services to ensure that mothers receive comprehensive care throughout their pregnancy and after childbirth. This can include increasing the number of antenatal care visits, providing counseling on immunization, and offering postnatal check-ups within two months after birth.

7. Public-Private Partnerships: Foster partnerships between the public and private sectors to improve access to maternal health services. This can involve collaboration with private healthcare providers, pharmaceutical companies, and technology companies to leverage their resources and expertise.

8. Health Education and Awareness Campaigns: Launch targeted health education and awareness campaigns to educate mothers and communities about the importance of immunization and maternal health. These campaigns can use various channels, such as radio, television, social media, and community events, to reach a wide audience.

9. Training and Capacity Building: Invest in training and capacity building for healthcare providers to ensure they have the knowledge and skills to provide quality maternal health services. This can include training on immunization practices, counseling techniques, and cultural sensitivity.

10. Research and Data Analysis: Conduct further research and data analysis to identify specific factors contributing to low immunization coverage in different regions of Ethiopia. This can help tailor interventions and strategies to address the unique challenges faced by each region.

It is important to note that these recommendations are based on the information provided and may need to be further evaluated and adapted to the specific context and needs of Ethiopia.

AI Innovations Description

The study titled “Factors influencing full immunization coverage among 12-23 months of age children in Ethiopia: Evidence from the national demographic and health survey in 2011” provides valuable insights into the low full immunization coverage among children in Ethiopia. Based on the findings of the study, the following recommendations can be developed into an innovation to improve access to maternal health:

1. Strengthening Health Information Systems: Develop a digital platform or mobile application that allows healthcare providers to easily access and update vaccination records. This will ensure accurate and up-to-date information on immunization coverage, making it easier to track and follow up on missed vaccinations.

2. Community Conversation Program: Increase awareness and participation in community conversation programs that focus on maternal and child health. These programs can provide information on the importance of immunization and address any misconceptions or concerns that parents may have.

3. Postnatal Check-ups: Promote and provide postnatal check-ups within two months after birth. This can be done through mobile clinics or outreach programs to ensure that mothers and newborns receive the necessary vaccinations and healthcare services.

4. Targeted Interventions: Develop targeted interventions for regions with lower immunization coverage, such as Afar, Amhara, Oromiya, Somali, and Southern Nation and Nationalities People administrative regions. These interventions should address the specific barriers to immunization in these regions and provide tailored solutions.

5. Health Education and Awareness: Implement comprehensive health education campaigns to increase awareness about the importance of immunization and address any misconceptions or cultural beliefs that may hinder vaccination uptake. These campaigns should target both mothers and community members to ensure a supportive environment for immunization.

6. Strengthening Health Service Delivery: Improve access to healthcare services, including antenatal care and delivery services, to ensure that mothers receive the necessary information and support for immunization. This can be achieved through the expansion of healthcare facilities and the training of healthcare providers.

By implementing these recommendations, it is possible to improve access to maternal health and increase full immunization coverage among children in Ethiopia.

AI Innovations Methodology

Based on the provided information, here are some potential recommendations to improve access to maternal health:

1. Strengthen Health Information Systems: Implementing a robust health information system can help track and monitor immunization coverage rates, identify gaps, and target interventions to improve access to maternal health services.

2. Enhance Community Engagement: Promote community conversation programs to increase awareness and knowledge about the importance of immunization. Engaging community leaders, local influencers, and mothers themselves can help address misconceptions and increase demand for immunization services.

3. Improve Postnatal Care: Encourage mothers to seek postnatal check-ups within two months after birth. This can provide an opportunity to educate mothers about immunization and ensure that their children receive the necessary vaccines.

4. Increase Access to Vaccination Information: Ensure that mothers have access to accurate and reliable information about vaccination through various channels such as vaccination cards, health facilities, community health workers, and mass media.

To simulate the impact of these recommendations on improving access to maternal health, a methodology could include the following steps:

1. Define the baseline: Collect data on the current immunization coverage rates, demographic characteristics, and other relevant factors affecting access to maternal health services.

2. Develop a simulation model: Use statistical modeling techniques to create a simulation model that incorporates the identified factors and their relationships with immunization coverage. This model should be based on the available data and literature on maternal health.

3. Introduce the recommendations: Incorporate the recommended interventions into the simulation model. This could involve adjusting the relevant variables or introducing new variables to represent the impact of the interventions.

4. Simulate the impact: Run the simulation model with the introduced recommendations to estimate the potential impact on immunization coverage. This could involve running multiple scenarios to assess the effectiveness of different combinations of interventions.

5. Analyze the results: Analyze the simulation results to determine the potential improvements in immunization coverage and identify any additional insights or recommendations.

6. Validate the findings: Validate the simulation results by comparing them with real-world data or conducting further research to assess the feasibility and effectiveness of the recommended interventions.

By following this methodology, policymakers and stakeholders can gain insights into the potential impact of different interventions on improving access to maternal health and make informed decisions on implementing the most effective strategies.

Auteur

Dima Health

Statistics:

Citations: 107

Identifiers:

DOI: 10.1186/s12889-015-2078-6

Research Areas:

Community Interventions, Environmental, 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, Cohort Study, Cross Sectional Study, randomised-control-trial

Study Approach:

Quantitative

Participants Gender:

Female

Partagez ceci :