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Background Despite the effort to increase access to routine immunization, majority of children in low-resource countries including Ethiopia are still either unvaccinated or under-vaccinated. In Ethiopia for the past four decades, the completion rate of routine childhood immunization remains low particularly in a rural area. In this study setting, evidence regarding the socioeconomic, maternal continuum care, and caregiver characteristics effect on child immunization is limited. Hence, this study aimed to identify the determinants of incomplete vaccination among children aged 12–23 months in Dabat district, Northwest Ethiopia. Methods A community-based unmatched case-control study design was employed among 132 cases and 262 controls. Multi-stage sampling method was used to recruit eligible study participants. Logistic regression analysis was used to identify the determinants to children’s incomplete vaccination. Results Caregivers’ attitude towards vaccine (AOR: 6.1, 95% CI 3.4 to 11.1), knowledge on the schedule of vaccination (AOR: 4, 95% CI 2.2 to 7.1), Place of delivery (AOR: 2.7, 95% CI 1.3 to 5.5), and marital status (AOR: 2.36, 95% CI 1.22 to 4.56) were statistically significant association with incomplete childhood vaccination. Conclusion Home delivery, caregivers’ poor knowledge on the schedule of vaccination, caregivers’ negative perception towards vaccine and unmarried marital status were predictors to incomplete vaccination. Therefore, to enhance full vaccination coverage, immunization health education program needs to address vaccine related safety enquiries in a meaningful
A Community based unmatched case control study design was conducted with ratio of case to control 1:2 in Dabat district, from April to May 2021. Dabat district found in Northwest Ethiopia. It has 4 urban, and 32 rural kebeles (the smallest unit of administration); 145,458 total population, and 17,112 children age 12–23 months. The district has six health centers, one primary hospital and 35 health posts and more than 650 health care providers. All children aged 12–23 months with their caretakers and who had taken at least one dose of routine vaccination were considered as a source population. Study populations were children aged 12–23 months with mothers/caregivers residing in randomly selected kebele’s of the district in northwest Ethiopia. Cases were children aged 12–23 months and defaulted recommended vaccination before their 1st birthday. In contrast, those children aged 12–23 months and completed the recommended vaccination before their 1st birthday were considered as controls. Caregivers who were critically ill, and unable to communicate were excluded from the study. To estimate the sample size; 95% confidence level, 80% power, 2 design effect, case to control ratio of 1:2 and 10% of non-response rate assumptions were used. Moreover, to estimate the sample size all significantly associated factors in previous studies were considered [12, 15–20]. Finally, using independent variable not attending postnatal care (PNC), 394 (132 cases and 262 controls) sample size was estimated. Multi-stage sampling technique was employed to select cases and controls. Initially, the kebeles in the district were stratified into urban and rural. Six rural and two urban kebeles were randomly selected by a lottery method from each stratum. To identify all eligible cases and controls health facility the EPI registration books were used. Then, proportional allocation of simple size employed to each selected kebeles based on number of eligible children. Finally, to get study participants from selected kebele simple random sampling method were employed. A child who received ten basic vaccines (one dose of BCG, three doses each of the DPT-HepB-Hib (pentavalent), three doses of polio vaccines, three doses of PCV, two doses of Rota vaccine, and one dose of measles vaccine before her/his 1st birthday) was considered as completely vaccinated [21]. A child between 12–23 months old who missed at least one dose of the ten vaccines before their 1st birthday [17]. To assess the knowledge of caregivers were used four items’ questions. Caregivers who score greater than 50% were categorized as good knowledge [22]. Six perception related questions were asked using Likert scale items. Each item has five response options. Caregivers who score 70% and above were categorized as positive attitude [22]. Six misconception related questions were asked using Likert scale tool. Each item has five response options. Caregivers who score 70% and above were categorized as having misconception [22]. To collect data, pretested, structured interviewer administered questionnaires were used. A questionnaire was developed through reviewing different literatures [10–13, 15–19, 21–23]. The questionnaire initially developed in English and translated to local Amharic language, and then translated back to English language to check consistency. The questionnaire has three sections; socio-demographic characteristics, obstetric history, and health service-related variables. Six Bsc nurses and two public health officers were involved on data collection and supervision activities. Caregivers who were not present at home during the first day of data collection were revisited in the subsequent days until the final day of data collection. To ensure quality of data, training was given for data collectors and supervisor on data collection technique. The Pretest was done on 5% (20) of sample size at Wegera district and some minor modifications were made after pretest. The data collection process was supervised by supervisor and principal investigator daily. At the end of each data collection day, the principal investigator and supervisors checked the completeness of questionnaires daily. Data were checked for completeness and consistency before entered into EpiData version 4.6 software and then exported to SPSS version 20 for further analysis. Data were cleaned for missing value, outlier, and inconsistency before analysis. Descriptive statistics such as means, median, proportion, percentage, and interquartile range were computed and presented in text, table and graph. To assess the association of covariates and dependent variables bi-variable logistic regression analysis was performed. A p-value of less than 0.05 and Adjusted Odds Ratios (AOR) with a 95% confidence interval (CI) were used to report significantly associated variables. Moreover, Hosmer and Lemeshow goodness fitted to check model fitness and variance inflation factor (VIF) to assess multi-collinearity were also performed. To estimate household wealth status principal component analysis was done. Finally, the wealth status was ranked into three quantiles. Ethical clearance was obtained from ethics committee of the University of Gondar, College of Medicine and Health Science, Institute of Public Health. Permission letter to conduct the study was also be taken from Dabat Woreda Health office. Before data collection, adequate information was given on study procedure, data storage, benefit, privacy concern and voluntary participation. Verbal informed consent was obtained from study participants before data collection. In the Informed consent the purpose of study, risk and benefit of the study, procedures, interview taking time, and the right of participants rights were explained. To ensure study participants confidentiality and privacy, the data was stored in separate computer and the access was restricted using password. Furthermore, the personal name and other identification of the participants were not recorded on the data collection format.
