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INTRODUCTION: Vaccination can reduce child mortality significantly and is a cost effective way to improve child health.Worldwide, more than 22 million children do not receive the basic recommended vaccinations.Vaccination coverage in Ethiopia remains low. Research on child health has focused on socio-economic factors such as maternal education and access to health care, but little attention has been given to demographic factors and women’s autonomy within the household. The purpose of this study was to examine the influences of demographic factors and women’s autonomy on the completion of childhood vaccination in rural Ethiopia.
A cross-sectional survey was conducted in the Gilgel Gibe Health and Demographic Surveillance System (HDSS) which is located 260 kilometers to the southwest of Addis Ababa (the capital) in southwestern Ethiopia. The Gilgel Gibe HDSS, which is run by Jimma University, is used to collect vital events data. The HDSS covers more than 10,000 households and a population of over 55,000 people. Women residing in the demographic surveillance area who had a live birth in the two years before the survey served as a sampling frame for the present study. The data used for this study were collected as part of a larger study on the effects of unintended pregnancy and related socio-demographic factors on maternal and child health in the HDSS. A sample size of 1,456 women was estimated for the study. Participants were drawn from eleven kebeles (smallest administrative unit in Ethiopia) in the HDSS area using simple random sampling. There were 1,370 women interviewed in the main study who gave birth to 1,382 children in the two years before the survey. A sub-sample of 889 children of age 12-24 months were eligible for the present analysis. Data collection took place from March to May 2012. Data were collected by ten trained female data collectors who had a diploma-level training and data collection experience. They were closely supervised by supervisors who had similar or higher level of education and experience in supervision of data collection. The data collectors and supervisors participated in 5 days of training focusing on questionnaire administration and ethical considerations. After the training, a pre-test of the questionnaire was conducted. Information from the pre-test was used to finalize the questionnaire. Data were collected using a structured questionnaire originally developed in English and translated to Oromo. Vaccination data were recorded from cards if the mother was able to present a card or reported verbally. All study participants were interviewed at their home in private area. Ethical approval was obtained from the College of Health Sciences, Addis Ababa University. Support letters were obtained from regional and district health offices. Local (kebele) administrations were informed about the study. Participants were briefed on the study and provided informed consent. The main outcome variable was full vaccination coverage of children age 12-24 months. We used the WHO definition of full vaccination which states that children are considered to be fully vaccinated when they have received a vaccination against tuberculosis (BCG), three doses each of DPT-HepB-Hib vaccine and polio vaccines, and a measles vaccination by the age of 12 months. The main explanatory variables were women’s pregnancy intention for the index child, number of under-five children in the household and women’s participation in household decision making. Pregnancy intention was measured using the standard DHS approach, which asks women to recall their feelings at the time they became pregnant; “At the time you became pregnant, did you want to become pregnant then, did you want to wait until later, or did you not want to have any (more) children at all?” Women’s participation in decision making was measured by asking the following questions; “who makes decisions in your household about: (1) obtaining health care for yourself; (2) large household purchases; (3) household purchases for daily needs; and (4) visits to family or relatives?” The responses were: (1) respondent alone, (2) respondent and husband/partner, (3) husband/partner alone, (4) someone else. Women were considered to participate in a decision if they usually make that decision alone or jointly with their husbands. A composite index was constructed by grouping women into two categories: women who participate in all four household decisions, indicating a higher level of autonomy, and women who do not have any say in one or more decisions. The internal consistency of the scale, as assessed using Cronbach’s alpha, was 0.82. Socio-economic status was measured using a household assets index derived using principal components analysis. Maternal health seeking behaviour included antenatal care, place of delivery and postnatal check up. We also included several control variables including education, wealth index, parity, and distance from health facility. Data analysis Data were analyzed using STATA software version 11. Bivariate associations between child vaccination and the explanatory and control variables were assessed using Chi-square analyses. At the multivariate level, two logistic regression models were run to identify factors associated with complete versus incomplete vaccination and receipt of at least one vaccination versus no vaccination. Variables were entered into the models based on their association in the bivariate analysis (at p < 0.20). Adjusted odds ratio and 95% confidence intervals are reported.
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