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Background: Vaccination is one of the cost effective strategies reducing childhood morbidity and mortality. Further improvement of immunization coverage would halt about 1.5 million additional deaths globally. Understanding the level of immunization among children is vital to design appropriate interventions. Therefore, this study aimed to assess full immunization coverage and its determinants among children aged 12-23 months in Ethiopia. Methods: The study was based on secondary data analysis from the 2016 Ethiopia Demographic and Health Survey (EDHS). Information about 1,909 babies aged 12-23 months was extracted from children dataset. Both bivariate and multivariable logistic regression models were utilized to assess the status and factors associated with full immunization. Adjusted odds ratio (AOR) with a 95% confidence interval (CI) was computed. Variables with less than 0.05 p-values in the multivariable logistic regression model were considered as statistically and significantly associated with the outcome variable. Results: The overall full immunization coverage was 38.3% (95% CI: 36.7, 41.2). Rural residence (AOR = 0.60, 95% CI: 0.43, 0.84), employed (AOR = 1.62, 95% CI: 1.31, 2.0), female household head (AOR = 0.58, 95% CI: 0.44, 0.76), wealth index [middle (AOR = 1.44, 95% CI: 1.07, 1.94) and richness (AOR = 1.65, 95% CI: 1.25,2.19)], primary school maternal education (AOR = 1.38,95% CI: 1.07, 1.78), secondary school maternal education (AOR = 2.19, 95% CI: 1.43, 3.36), diploma graduated mothers (AOR = 1.99, 95% CI: 1.09, 3.61), ANC follow ups (AOR = 2.79, 95% CI:2.17 3.59), and delivery at health facilities (AOR = 1.76, 95% CI: 1.36, 2.24) were significantly associated factors with full immunization. Conclusion: Full immunization coverage in Ethiopia was significantly lower than the global target. Female household head and rural dwellings were negatively associated with full immunization. In contrast higher maternal education, employment, middle and rich economic status, ANC follow up, and delivery at health facility were positively associated with full immunization among 12-23 months old children. This suggests that improved health education and service expansion to remote areas are necessary to step immunization access.
The data used in this paper is from the 2016 Ethiopian Demographic and Health Survey report. Ethiopia is the second largest populous country in Africa with 102.4 million people and an annual population growth rate of 2.5%. The country is divided into nine regional and two-city administrations and has a three-tier health care system with the primary care facilities situated in nearby communities. The two stage stratified sampling technique/ method was used for the survey. Initially, the enumeration area were stratified into urban and rural. The first stage involved selecting clusters, within the enumeration areas. The second stage was a systematic listing of households in the selected clusters. Out of each cluster 28 households were randomly selected to constitute the total sample size of households. Out of 7,193 women who gave birth in the past 5 years preceding of the survey, 5,980 were interviewed about the vaccination status of their children, and data gathered from 1,909 of the mothers who had children aged 12–23 months of were analyzed [23]. Full immunization was the response variable, whereas socio-demographic characteristics (age, residence, religion, marital status), reproductive health history (place of delivery, birth order, antenatal care and postnatal care follow up) were the independent variables. The information in the 2016 EDHS report on vaccination coverage was collected from immunization cards shown to the interviewers and from mothers’ verbal responses. When cards were available, the interviewer copied the vaccination dates directly onto questionnaires. When vaccination cards were not available for the child or if the vaccine was not recorded on the card as being given, the respondents were asked to recall if vaccine were given to her child. According to the WHO guideline [1], “complete or full immunization” coverage is defined as a child that has received one dose of BCG, three doses of pentavalent, pneumococcal conjugate (PCV), oral polio vaccines (OPV); two doses of Rota virus and one dose of measles vaccine. We recoded each variable (vaccinations) as “0” and “1” for children who didn’t take the recommended doses and those who took, respectively, on the basis of the reports of mothers and information in the child vaccination card. Then we added all “0” and “1”s and labeled the total as “Immunization status”. The immunization status was recoded as “1” if the child had received all the recommended doses of all vaccinations and categorized as “full immunization” or “0” if the child had missed one or more doses of vaccinations and categorized as “Incomplete immunization”. Descriptive statistics were used to describe the level of full immunization coverage by socio-demographic characteristics. Bivariate and multivariable logistic regression analyses were conducted to identify the determinants of full immunization. Logistic regression was chosen because our dependent variable was dichotomous (i.e., 0 and 1). Variables in bivariable logistic regression analysis with p-values less than 0.2 were entered into the multivariable analysis. Adjusted odds ratio (AOR) and 95% confidence Interval (CI) were used to assess the strength of associations between the outcome and the independent variables. The threshold for statistical significance was set at p < 0.05. The whole analysis was performed using STATA version 15.0.
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