Prevalence and determinants of incomplete or not at all vaccination among children aged 12-36 months in Dabat and Gondar districts, northwest of Ethiopia: Findings from the primary health care project

Objective Ethiopia is one of the Africa’s signatory countries for implementation of the primary healthcare strategy including immunisation. In Ethiopia, however, 16% of child death is due to vaccine-preventable disease. Thus, this study aimed to assess the prevalence and determinants of incomplete or not at all vaccination among children aged 12-36 months in Dabat and Gondar districts, Northwest Ethiopia. Study design The study is community-based cross-sectional study. Study setting Dabat and Gondar Zuria districts, Northwest Ethiopia. Participants Mothers/caregivers with children aged 12-36 months were enrolled in the study. Participants were randomly selected through systematic sampling and a total of 603 participants were included in the analysis. Methods A binary logistic regression analysis was done. In the multivariable logistic regression analysis, a p value of <0.05 and adjusted OR (AOR) with 95% CI were used to identify statistically associated factors with incomplete or not at all vaccination. Outcomes Incomplete or not at all vaccination. Results The prevalence of incomplete or not at all vaccinated children was 23.10% (95% CI 16.50 to 29.70). The multivariable analysis revealed that the odds of incomplete or not at all vaccination were higher among mothers who had no antenatal care (ANC) visit (AOR: 1.81, 95% CI 1.21 to 4.03) and no postnatal care (PNC) visit (AOR=1.52, 95% CI 1.05 to 2.25). Conclusions In the study area, nearly one-fourth of children are incompletely or not at all vaccinated. Our finding suggests that ANC and PNC visits are key determinants of incomplete or not at all vaccination. Thus, in low-resource settings like Ethiopia, the health system approaches to improved ANC and PNC services should be intensified with more effective advice on child immunisation to reduce vaccine preventable disease. A community-based cross-sectional study was conducted from May 1 to 29 June 2019 in Dabat and Gondar Zuria districts, Northwest Ethiopia (figure 1). Dabat and Gondar Zuria districts, 2 of the total 23 districts in North Gondar zone of the Amhara region, consist of 30 and 38 kebeles (the smallest administrative units), respectively, located in different ecological zones (high, middle and low land). The districts have 145 509 (Dabat) and 231 324 (Gondar Zuria) inhabitants who are largely depended on agriculture. Of the total inhabitants, 3973 in Dabat and 6180 in Gondar Zuria district are children aged 12–36 months, respectively. Map of the study areas. Mothers/caregivers with children aged 12–36 months who lived in study area for at least 6 months were included in the study. Thus, a total of 603 children aged 12–36 months fulfilling the eligibility criteria were included. However, those who were unable to respond or very sick were excluded. Initially, the study was aimed to assess accessibility and availability of primary healthcare services at the community level, in Dabat and Gondar Zuria districts, Northwest Ethiopia. Of the total kebeles, 8 in Dabat and 10 kebeles in Gondar Zuria district were selected randomly. Systematic sampling was used to select the study participants. For households with more than one child who fulfilled the inclusion criteria, a child was selected randomly. As part of the original survey, this particular study used the data extracted from the original survey database. Accordingly, only mothers with children aged 12–36 months were considered to investigate the magnitude of incomplete or not at all vaccination and associated factors. To this effect, sample size was calculated using Epi-info V.3.7 by considering the assumptions: 24.3% prevalence of incomplete immunisation among children aged 12–23 months in Gondar Town,16 95% level of confidence and 5% margin of error. A design effect of 1.5% and 10% non-response rate were also anticipated to obtain the final sample size of 622. Data from the mothers or caregivers of the children were collected through home-to-home visits using a structured interviewer-administered questionnaire adapted from the Ethiopian Demography and Health Survey (EDHS). The questionnaire was designed to capture sociodemographic characteristics, health service utilisation and physical access to maternal health services and visits by health extension workers. The questionnaire was prepared in English, translated to Amharic (the local language) and was administered, and the responses were translated back to English for analysis. A 2-day training on sampling procedure and data collection techniques was given to data collectors and supervisors. The acceptability and the logical structure of the questionnaire were checked on the field, during pretesting. Fifteen data collectors and three field supervisors were recruited for the study. The data collectors checked for the presence of child’s immunisation card. Data on child vaccination (timing and type of vaccines received) were collected from vaccination cards and, if unavailable, by only interviewing parent’s, as suggested by WHO.10 Data were checked for completeness and quality, on daily basis, by the field supervisors. The outcome variable, incomplete vaccination or not at all vaccination, was defined as: a child aged 12–36 months who had missed at least one dose of the eight vaccines was considered to be incomplete vaccination and a child aged 12–36 months who did not receive any vaccine before this study was considered to be not at all vaccination. The prevalence of incomplete or not at all vaccination was computed as the ratio of children with incomplete or received no vaccination to the total number of children included in the study. However, fully vaccinated was defined as: a child aged 12–36 months who received the following vaccines: one dose of BCG, one dose of measles, two doses of rota, at least three doses of pentavalent, three doses of OPV and three doses of PCV. Partially vaccinated was defined as a child aged 12–36 months who received at least one dose of the above six vaccines. Antenatal care (ANC) was defined as women who received at least one maternal healthcare service during the pregnancy. Likewise, postnatal care (PNC) also defined as women who received at least one maternal health services within 48 hours after delivery by an appropriate health provider in the health facilities. Finally, formal education was also defined as study participants at least completed grade one or attending formal learning in the school. Epi-data V.3.1 was used for data entry, and data were exported to SPSS V.21 for analysis. Descriptive statistics were computed. Binary logistic regression model was used to identify the relationship between dependent (incomplete vaccination or not vaccinating) and independent variables. Those independent variables with p value <0.2 in the bivariable analysis in regard to the association with the dependent variable were included in the final multivariable analysis. In the binary logistic regression model, backward-stepwise multivariable analysis was used to elicit associated factors of incomplete vaccination or not vaccinating. In the final model, a significant association was declared at a p value <0.05, and finally, the results were presented in texts and tables with adjusted OR (AOR) and the corresponding 95% CI. Patients were not involved in this study. We are unable to disseminate the results of the research directly to study participants.