Vaccine non-receipt and refusal in Ethiopia: The expanded program on immunization coverage survey, 2012

Reasons for Being "Zero-Dose and Under-Vaccinated" among Children Aged 12-23 Months in the Democratic Republic of the Congo

(1) Introduction: The Democratic Republic of the Congo (DRC) has one of the largest cohorts of un- and under-vaccinated children worldwide. This study aimed to identify and compare the main reasons for there being zero-dose (ZD) or under-vaccinated children in the DRC. (2) Methods: This is a secondary analysis derived from a province-level vaccination coverage survey conducted between November 2021 and February 2022; this survey included questions about the reasons for not receiving one or more vaccines. A zero-dose child (ZD) was a person aged 12-23 months not having received any pentavalent vaccine (diphtheria-tetanus-pertussis-Hemophilus influenzae type b (Hib)-Hepatitis B) as per card or caregiver recall and an under-vaccinated child was one who had not received the third dose of the pentavalent vaccine. The proportions of the reasons for non-vaccination were first presented using the WHO-endorsed behavioral and social drivers for vaccination (BeSD) conceptual framework and then compared across the groups of ZD and under-vaccinated children using the Rao-Scott chi-square test; analyses were conducted at province and national level, and accounting for the sample approach. (3) Results: Of the 51,054 children aged 12-23 m in the survey sample, 19,676 ZD and under-vaccinated children were included in the study. For the ZD children, reasons related to people's thinking and feelings were cited as 64.03% and those related to social reasons as 31.13%; both proportions were higher than for under-vaccinated children (44.7% and 26.2%, respectively, p < 0.001). Regarding intentions to vaccinate their children, 82.15% of the parents/guardians of the ZD children said they wanted their children to receive "none" of the recommended vaccines, which was significantly higher than for the under-vaccinated children. In contrast, "practical issues" were cited for 35.60% of the ZD children, compared to 55.60% for the under-vaccinated children (p < 0.001). The distribution of reasons varied between provinces, e.g., 12 of the 26 provinces had a proportion of reasons for the ZD children relating to practical issues that was higher than the national level. (4) Conclusions: reasons provided for non-vaccination among the ZD children in the DRC were largely related to lack of parental/guardian motivation to have their children vaccinated, while reasons among under-vaccinated children were mostly related to practical issues. These results can help inform decision-makers to direct vaccination interventions.

Delayed vaccination the children up to 2 years of age

OBJECTIVE

To analyze factors associated with vaccination delay in children up to 2 years of age.

METHODS

Cross-sectional study with primary data from a probabilistic sample of 388 children born in 2015. The data were described using absolute and relative frequencies. For the analysis of factors associated with vaccination delay, Cox proportional risk regression was performed, considering the time from birth to the first vaccination delay as a dependent variable and as sociodemographic, economic, behavioral aspects related to health services as independent variables.

RESULTS

The delayed vaccination rate was 88.66%. Variables associated with delayed vaccination were: mother's health problems during delivery or in the first 7 days (HR: 0.68; 95% CI: 0.48-0.96); hospitalization of the child in the first 2 years of life (HR: 1.52; 95% CI: 1.10-2.11); mother's poor bond with health professionals at the health unit (HR: 1.75; 95% CI: 1.01-3.03); purposeful decision to delay or not to vaccinate the child (HR: 1.56; 95% CI: 1.14-2.13).

CONCLUSIONS

The factors associated with health care, such as the mother's health problems, the child's hospitalization in the first 2 years of life, and the bond between the mother and the health professionals affect the timeliness of vaccine doses.

Reasons given for non-vaccination and under-vaccination of children and adolescents in sub-Saharan Africa: A systematic review

To achieve the full benefits of vaccination, it is key to understand the underlying causes of low vaccination by researching the barriers to vaccination at a local level. This systematic literature review aims to identify the reasons given by community members for the non-vaccination and under-vaccination of children and adolescents in sub-Saharan Africa. PubMed, Web of Science, PsycINFO, African Index Medicus, and African Journals Online databases were searched to identify articles published between 2010 and 2020. A total of 37 articles were included. As 17 studies did not report the reasons for non-vaccination and under-vaccination separately, we considered these two outcomes as “incomplete vaccination”. The most common reasons for incomplete vaccination were related to caregiver’s time constraints, lack of knowledge regarding vaccination, the unavailability of vaccines/personnel in healthcare facilities, missed opportunities for vaccination, caregiver’s fear of minor side effects, poor access to vaccination services, and caregiver’s vaccination beliefs.

COVID-19 vaccine hesitancy among health professionals in a tertiary care center at the University of Gondar Specialized Hospital, Ethiopia: A cross-sectional study

Background

COVID-19 is a highly communicable disease that can be transmitted from animal-to-human and human-to-human contacts. It is still now a major global threat for which vaccination remains the ultimate solution to protect it, especially healthcare professionals are the first frontiers to fight against the COVID-19 virus which makes them at higher risk of this disease. Therefore, to reduce the spread of COVID-19, we need to improve the acceptance of COVID-19 vaccines is crucial. The aim of this study was to assess the vaccine hesitancy of the COVID-19 vaccine among health professionals who worked at the University of Gondar Specialized Hospital.

Methods

A cross-sectional survey was conducted between 1 May and 10 June 2021. And the data were analyzed using Statistical Package for Social Sciences version 26. A chi-square test was conducted and to assess the associations between socio-demographic characteristics, perceived risk of COVID-19, attitude, and acceptance of COVID-19 vaccine, a p-value of less than 0.05 was considered to declare statistical significance.

Results

We surveyed 319 health professionals with a response rate of 67.87%. Of these, 74.9% (239) were male, and 81.2% (259) of health professionals were perceived exposed to COVID-19 without testing. 87.7% of respondents would like to vaccinate their parents. 66.2% (208) of them have accepted the COVID-19 vaccine. 54.85% (175) of health professionals had a good attitude and 45.8% (146) of health professionals were received the first-round COVID-19 vaccine.

Conclusion

This study showed that more than 60% of health professionals had good acceptance of COVID-19 vaccination during the pandemic period. Regarding vaccine safety profile may reduce the vaccination in the future. To increase vaccine uptake in response to the COVID-19 pandemic, COVID-19 vaccination programs should be redesigned to remove barriers to vaccine acceptance. Knowledge and attitude toward the COVID-19 vaccine should be promoted.

Child vaccination in sub-Saharan Africa: Increasing coverage addresses inequalities

BACKGROUND

Vaccines have substantially contributed to reducing morbidity and mortality among children, but inequality in coverage continues to persist. In this study, we aimed to examine inequalities in child vaccination coverage in sub-Saharan Africa.

METHODS

We analysed Demographic and Health Survey data in 25 sub-Saharan African countries. We defined full vaccination coverage as a child who received one dose of bacille Calmette-Guérin vaccine (BCG), three doses of diphtheria, pertussis, and tetanus vaccine (DTP 3), three oral polio vaccine doses (OPV 3), and one dose of measles vaccine. We used the concentration index (CCI) to measure wealth-related inequality in full vaccination, incomplete vaccination, and zero-dose children within and between countries. We fitted a multilevel regression model to identify predictors of inequality in receipts of full vaccination.

RESULTS

Overall, 56.5% (95% CI: 55.7% to 57.3%) of children received full vaccination, 35.1% (34.4% to 35.7%) had incomplete vaccination, while 8.4% (95% CI: 8.0% to 8.8%) of children remained unvaccinated. Full vaccination coverage across the 25 sub-Saharan African countries ranged from 24% in Guinea to 93% in Rwanda. We found pro-rich inequality in full vaccination coverage in 23 countries, except for Gambia and Namibia, where we found pro-poor vaccination coverage. Countries with lower vaccination coverage had higher inequalities suggesting pro-rich coverage, while inequality in unvaccinated children was disproportionately concentrated among disadvantaged subgroups. Four or more antenatal care contracts, childbirth at health facility, improved maternal education, higher household wealth, and frequently listening to the radio increased vaccine uptake.

CONCLUSIONS

Continued efforts to improve access to vaccination services are required in sub-Saharan Africa. Improving vaccination coverage and reducing inequalities requires enhancing access to quality services that are accessible, affordable, and acceptable to all. Vaccination programs should target critical social determinants of health and address barriers to better maternal health-seeking behaviour.

Knowledge, attitudes and behaviors of Inonu University faculty members regarding childhood vaccine refusal

INTRODUCTION

Although there is a lot of scientific evidence that the benefits of vaccines outweigh their risks, hesitancy about the safety of vaccines can occur in every segment of the community. In this study, we aimed to determine the knowledge, attitudes, and associated factors of vaccine hesitancy among Inonu University faculty members regarding childhood vaccinations.

METHOD

This is a cross-sectional study, and 258 faculty members were included in the study. The questionnaire used in the study explored the sociodemographic characteristics of the faculty members and their knowledge, attitudes and behaviors regarding childhood vaccination. A chi-square test and a fisher exact test were used for statistical analysis.

RESULTS

Of the faculty members, 31.8% were hesitant about childhood vaccines, 51.9% stated that there were studies reporting the side effects of vaccines, 48.1% did not agree with giving booster doses of vaccines, 35.7% stated that vaccines could cause autism due to the chemicals contained in the vaccines. The most important information sources of university faculty regarding childhood vaccines members are scientific publications and health professionals.

CONCLUSIONS

Faculty members level of hesitancy about vaccines was high and since health professionals and scientific articles are the most important information sources of faculty members, misinformation here may affect their knowledge, attitudes and behaviors about vaccination.

Bayesian Analysis of Predictors of Incomplete Vaccination against Polio among Children Aged 12-23 Months in Ethiopia

Background: The re-introduction of polio among children aged 12–23 months is likely to occur in Ethiopia due to the low vaccination rates against poliovirus. The study sought to examine the predictors of incomplete vaccination against polio among children aged 12–23 months in Ethiopia. Methods: The data used were obtained from the 2016 Ethiopia Demographic and Health Survey. Binary and Bayesian logistic regressions were used for the data analysis, with parameters estimated using classical maximum likelihood and the Bayesian estimation method. Results: The results revealed that 43.7% of the children were not fully vaccinated against polio in Ethiopia. Maternal age, educational level, household wealth index, exposure to mass media, place of residence, presence of nearby healthy facility, counseling on vaccination, and place of delivery were significant determinants of incomplete polio vaccination among children aged between 12 and 23 months in Ethiopia. Conclusion: Considerable numbers of children are not fully vaccinated against polio in Ethiopia. Individual and contextual factors significantly contributed to incomplete polio vaccination among children in the country. Therefore, the government and other stakeholders should pay particular attention to maternal education to increase mothers’ educational level in all regions and give training and counseling in all urban and rural parts of the country on child vaccination to overcome the problem of children’s incomplete polio vaccination and/or vaccination dropout.

Determinants of Long Immunization Clinic Wait Times in a Sub-Saharan African Country

The wait time clients spend during immunization clinic visits in low- and middle-income countries is a not well-understood reported barrier to vaccine completion. We used a prospective, observational design to document the total time from client arrival-to-discharge and all sequential provider-client activities in 1 urban, semi-urban, and rural immunization clinic in Nigeria. We also conducted caregiver and provider focus group discussions to identify perceived determinants of long clinic wait times. Our findings show that the time from arrival-to-discharge varied significantly by the clinic and ranged between 57 and 235 minutes, as did arrival-to-all providers-client activities. Focus group data attributed workflow delays to clinic staff waiting for a critical mass of clients to arrive for their immunization appointment before starting the essential health education talk or opening specific vaccine vials. Additionally, respondents indicated that complex documentation processes caused system delays. Research on clinic workflow transformation and simplification of immunization documentation is needed.

Willingness of Ethiopian Population to Receive COVID-19 Vaccine

BACKGROUND

Despite efforts to decrease the burden, vaccine reluctance is increasing worldwide and hindering efforts to control the spread of COVID-19. Therefore, understanding the willingness of a community to receive a COVID-19 vaccine will help to develop and implement effective means of promoting COVID-19 vaccine uptake.

OBJECTIVES

This study was aimed to assess the willingness of the Ethiopian population to receive the COVID-19 vaccine and its determinant factors.

METHODS

E-survey was conducted from February 2021 to March 2021. After developing the questionnaire, the template was created on Google Forms and disseminated in public on different social media channels (e.g., Telegram, WhatsApp, Facebook, email, etc.) by using a shareable link. Descriptive statistics were performed. Finally, multivariable logistic regression analysis was done to assess their relationship with socio-demographic factors.

RESULTS

In total, 31.4% (n = 372) of respondents were willing to get a vaccine. One-third of respondents, 32.2% (n = 381), reported that COVID-19 vaccines are safe. Almost all 94.9% (n = 1124) responded that health workers should be vaccinated first. Only 21.7% (n = 257) willing to buy the vaccine if it is not provided free. Being female [OR (95% CI):1.85 (1.05-3.25)], aged less than 25 years old [OR (95% CI): 5.09 (3.41-7.59)], aged between 26-30 years [OR (95% CI): 3.57 (2.55-5.00)], being unmarried[OR (95% CI):1.12 (0.81-1.55)], urban in residence [OR (95% CI): 1.06 (0.69-1.62)], private sector worker in occupation [OR (95% CI):0.45 (0.26 -0.77)], university/college student [OR (95% CI): 0.88 (0.59-1.32)], not having a health-related job [OR (95% CI): 4.08 (2.57-6.48)], orthodox [OR (95% CI): 1.16 (0.61-2.19)], Muslim [OR (95% CI): 0.285 (0.13 -0.61)], educational status of university/above [OR (95% CI): 4.87 (3.15-7.53)] have a statistically significant association and were more likely willing to take COVID-19 than their counterparts.

CONCLUSION

This study found that only 31.4% were willing to take the COVID-19 vaccine. Being female, older age, marital status, residence, occupations, not having a health-related job, religion, educational status were statistically significantly associated with willingness to receive the COVID-19 vaccine.

Determinants of Incomplete Vaccination Among Children Aged 12 to 23 Months in Gindhir District, Southeastern Ethiopia: Unmatched Case-Control Study

Background

Incomplete vaccination can put children at greater risk of acquiring vaccine-preventable diseases. In Ethiopia, vaccination coverage against vaccine-preventable diseases is still a significant and persistent public health challenge. Thus, the aim of this study was to identify the determinants of incomplete childhood vaccination among children aged 12-23 months in Gindhir District, Southeast Ethiopia.

Methods

A community-based unmatched case-control design was employed among children aged 12-23 months from 1 to 28 February 2020. A total of 254 cases and 508 controls were included using the stratified random sampling technique. Cases included children aged 12-23 months who missed at least one dose of the routine vaccination, and controls were the children with complete vaccination with all required doses. Binary logistic regression analyses were used to identify the independent factors for children's incomplete vaccination status.

Results

Of all assessed determinants, maternal knowledge about vaccination (AOR=0.50, 95% CI: 0.31, 0.80), educational status (AOR=2.61, 95% CI: 1.19, 5.67), average monthly income (AOR=0.33, 95% CI: 0.15, 0.77), model family (AOR = 2.50, 95% CI: 1.51, 4.14), taking TT vaccine (AOR= 0.45 95% CI: 0.29, 0.78), number of under five children (AOR= 4.90 95% CI: 1.72, 13.93) and birth order (AOR= 6.33, 95% CI: 1.89, 14.87) were found to have statistically significant association with childhood incomplete vaccination.

Conclusion

In this study, the mother's education, model family, birth order, average monthly income, and knowledge were some of the independent determinants of incomplete childhood vaccination. Improving maternal knowledge, income, and educational status should be the expectable measure to reduce incomplete vaccination.

Vaccine hesitancy in the global south: Towards a critical perspective on global health

The complex phenomenon of vaccine hesitancy has been causing increasing global concern. This systematic review aims at analysing the state of art of scientific literature concerning vaccine hesitancy in Latin America and Africa, observing if: (i) they use the same research trends as the global North; and (ii) the parameters recommended by the World Health Organization (WHO) and taken from the experience of the global North are adequate to the Global South's context. This review analyses empirical, qualitative, quantitative, or mixed-study publications, from 2015 to 2020, available at five different databases. The studies produced in the Global South bring up important context-specific issues, such as issues of access (that are not included in the WHO's definition of vaccine hesitancy), cultural and religious issues, reactions to governments, reactions to recent episodes of vaccine tests on populations, and reactions to past of colonial violence. Initiatives to understand the phenomenon based on methodological and conceptual frameworks from the global North alone can cause wrongful conclusions.

Drivers of hesitancy towards recommended childhood vaccines in African settings: a scoping review of literature from Kenya, Malawi and Ethiopia

INTRODUCTION

There is a dearth of literature on vaccine hesitancy in Africa. In this study, we aimed to explore the drivers of hesitancy toward recommended childhood vaccines in Kenya, Malawi, and Ethiopia.

METHODS

A scoping review methodology was used as this evidence synthesis approach is suitable for mapping existing literature and identifying knowledge gaps. For this study, we systematically searched four electronic databases for published and unpublished literature from the three African countries. The methodological framework that was used is in line with Arksey and O'Malley's recommendations as modified by Levac.

RESULTS

A total of 23 publications met the inclusion criteria and were included in the study. Majority of the studies were published after 2012. In these three African countries, hesitancy toward recommended childhood vaccines is driven by a mix of caregiver-related factors, health systems-related factors as well as the influence of community context.

CONCLUSION

This study demonstrated that vaccine hesitancy in Kenya, Malawi, and Ethiopia is a complex phenomenon that is driven by multiple interrelated and interconnected factors.

Incomplete Vaccination and Its Predictors among Children in Ethiopia: A Systematic Review and Meta-Analysis

Background. Vaccination is an effective public health intervention that has contributed to a substantial reduction in the burden of vaccine-preventable diseases. Abridged evidence on incomplete vaccination is not well established in Ethiopia. Therefore, this meta-analysis aimed to estimate the pooled prevalence of incomplete vaccination and its predictors among children aged 12 to 23 months. Methods. Primary studies conducted in Ethiopia were searched. The methodological quality of the included studies was assessed using the Joanna Briggs Institute (JBI) checklist. The analysis was conducted using STATA 14 and RevMan. The presence of statistical heterogeneity was checked using the Cochran Q test, and its level was quantified using I2 statistics. Pooled prevalence and odds ratio (OR) were computed at a 95% confidence interval (CI). Results. The pooled prevalence of incomplete vaccination was 30% (95% CI: 25-35). Maternal illiteracy (OR = 1.96; 95% CI: 1.40, 2.74) and home delivery (OR = 2.78; 95% CI: 2.28, 3.38) were associated factors that increased incomplete vaccination. However, maternal autonomy (OR = 0.54; 95% CI: 0.33, 0.89), maternal knowledge (OR = 0.31; 95% CI: 0.20, 0.47), husband employment (OR = 0.49; 95% CI: 0.35, 0.67), urban residence (OR = 0.61; 95% CI: 0.43, 0.86), ANC visits (OR = 0.30; 95% CI: 0.23, 0.39), postnatal care (OR = 0.39; 95% CI: 0.30, 0.52), and tetanus toxoid vaccine (3+) (OR = 0.42; 95% CI: 0.26, 0.69) were factors that reduced incomplete vaccination. Conclusion. In Ethiopia, 3 out of 10 children have incomplete vaccination. Policies should focus on strengthening and improving women’s education, maternal health knowledge, empowering women, and the utilization of prenatal care can overcome some of the barriers.

Parental concerns and uptake of childhood vaccines in rural Tanzania - a mixed methods study

BACKGROUND

Vaccine hesitancy has been recognized as an important barrier to timely vaccinations around the world, including in sub-Saharan Africa. In Tanzania, 1 in 4 children is not fully vaccinated. The objective of this mixed methods study was to describe and contextualize parental concerns towards vaccines in Tanzania.

METHODS

Between 2016 and 2017, we conducted a cross-sectional survey (n = 134) and four focus group discussions (FGDs, n = 38) with mothers of children under 2 years of age residing in Mtwara region in Southern Tanzania. The survey and FGDs assessed vaccination knowledge and concerns and barriers to timely vaccinations. Vaccination information was obtained from government-issued vaccination cards.

RESULTS

In the cross-sectional survey, 72% of mothers reported missed or delayed receipt of vaccines for their child. Although vaccine coverage was high, timeliness of vaccinations was lower and varied by vaccine. Rural mothers reported more vaccine-related concerns compared to urban mothers; literacy and access to information were identified as key drivers of the difference. Mothers participating in FGDs indicated high perceived risk of vaccine-preventable illnesses, but expressed concerns related to poor geographic accessibility, unreliability of services, and missed opportunities for vaccinations resulting from provider efforts to minimize vaccine wastage.

CONCLUSIONS

Findings from our cross-sectional survey indicate the presence of vaccination delays and maternal concerns related to childhood vaccines in Tanzania. In FGDs, mothers raised issues related to convenience more often than issues related to vaccine confidence or complacency. Further research is necessary to understand how these issues may contribute to the emergence and persistence of vaccine hesitancy and to identify effective mitigation strategies.

Decomposition of socioeconomic inequalities in child vaccination in Ethiopia: results from the 2011 and 2016 demographic and health surveys

OBJECTIVES

Monitoring and addressing unnecessary and avoidable differences in child vaccination is a critical global concern. This study aimed to assess socioeconomic inequalities in basic vaccination coverage among children aged 12-23 months in Ethiopia.

DESIGN, SETTING AND PARTICIPANTS

Secondary analyses of cross-sectional data from the two most recent (2011 and 2016) Ethiopia Demographic and Health Surveys were performed. This analysis included 1930 mother-child pairs in 2011 and 2004 mother-child pairs in 2016.

OUTCOME MEASURES

Completion of basic vaccinations was defined based on whether a child received a single dose of Bacille Calmette-Guerin (BCG), three doses of diphtheria, tetanus toxoids and pertussis (DTP), three doses of oral polio vaccine and one dose of measles vaccine.

METHODS

The concentration Curve and Concentration Indices (CCIs) were used to estimate wealth related to inequalities. The concentration indices were also decomposed to examine the contributing factors to socioeconomic inequalities in childhood vaccination.

RESULTS

From 2011 to 2016, the proportion of children who received basic vaccination increased from 24.6% (95% CI 21.4% to 28.0%) to 38.6% (95% CI 34.6% to 42.9%). While coverage of BCG, DTP and polio immunisation increased during the study period, the uptake of measles vaccine decreased. The positive concentration index shows that basic vaccination coverage was pro-rich (CCI=0.212 in 2011 and CCI=0.172 in 2016). The decomposition analysis shows that use of maternal health services such as family planning and antenatal care, socioeconomic status, exposure to media, urban-rural residence and maternal education explain inequalities in basic vaccination coverage in Ethiopia.

CONCLUSIONS

Childhood vaccination coverage was low in Ethiopia. Vaccination was less likely in poorer than in richer households. Addressing wealth inequalities, enhancing education and improving maternal health service coverage will reduce socioeconomic inequalities in basic vaccination uptake in Ethiopia.

Barriers to childhood immunization in sub-Saharan Africa: A systematic review

Background

Immunization to prevent infectious diseases is a core strategy to improve childhood health as well as survival. It remains a challenge for some African countries to attain the required childhood immunization coverage. We aim at identifying individual barriers confronting parents/caretakers, providers, and health systems that hinder childhood immunization coverage in Sub-Saharan Africa.

Method

This systematic review searched PubMed/MEDLINE, Web of Science and EMBASE. We restricted to published articles in English that focused on childhood immunization barriers in sub-Saharan Africa from January 1988 to December 2019. We excluded studies if: focused on barriers to immunization for children in other regions of the world, studied adult immunization barriers; studies not available on the university library, they were editorial, reports, reviews, supplement, and bulletins. Study designs included were cross-sectional, second-hand data analysis; and case control.

Results

Of the 2652 items identified, 48 met inclusion criteria. Parents/caretakers were the most common subjects. Nine articles were of moderate and 39 were of high methodological quality. Nine studies analyzed secondary data; 36 used cross-sectional designs and three employed case control method. Thirty studies reported national immunization coverage of key vaccines for children under one, eighteen did not. When reported, national immunization coverage of childhood vaccines is reported to be low. Parents/caretaker’ barriers included lack of knowledge of immunization, distance to access point, financial deprivation, lack of partners support, and distrust in vaccines and immunization programs. Other associated factors for low vaccine rates included the number of off-springs, lifestyle, migration, occupation and parent’s forgetfulness, inconvenient time and language barrier. Barriers at health system level cited by healthcare providers included limited human resources and inadequate infrastructures to maintain the cold chain and adequate supply of vaccines.

Conclusion

In this review we identified more thoroughly the parents/caretakers’ barriers than those of providers and health systems. Factors that influenced decisions to get children vaccinated were mainly their gender, beliefs, socio-culture factors in the communities in which they live. Thus it is vital that immunization programs consider these barriers and address the people and societies in their communities across sub-Saharan Africa.

Childhood vaccination coverage and equity impact in Ethiopia by socioeconomic, geographic, maternal, and child characteristics

BACKGROUND

Ethiopia is a priority country of Gavi, the Vaccine Alliance to improve vaccination coverage and equitable uptake. The Ethiopian National Expanded Programme on Immunisation (EPI) and the Global Vaccine Action Plan set coverage goals of 90% at national level and 80% at district level by 2020. This study analyses full vaccination coverage among children in Ethiopia and estimates the equity impact by socioeconomic, geographic, maternal and child characteristics based on the 2016 Ethiopia Demographic and Health Survey dataset.

METHODS

Full vaccination coverage (1-dose BCG, 3-dose DTP3-HepB-Hib, 3-dose polio, 1-dose measles (MCV1), 3-dose pneumococcal (PCV3), and 2-dose rotavirus vaccines) of 2,004 children aged 12-23 months was analysed. Mean coverage was disaggregated by socioeconomic (household wealth, religion, ethnicity), geographic (area of residence, region), maternal (maternal age at birth, maternal education, maternal marital status, sex of household head), and child (sex of child, birth order) characteristics. Concentration indices estimated wealth and education-related inequities, and multiple logistic regression assessed associations between full vaccination coverage and socioeconomic, geographic, maternal, and child characteristics.

RESULTS

Full vaccination coverage was 33.3% [29.4-37.2] in 2016. Single vaccination coverage ranged from 49.1% [45.1-53.1] for PCV3 to 69.2% [65.5-72.8] for BCG. Wealth and maternal education related inequities were pronounced with concentration indices of 0.30 and 0.23 respectively. Children in Addis Ababa and Dire Dawa were seven times more likely to have full vaccination compared to children living in the Afar region. Children in female-headed households were 49% less likely to have full vaccination.

CONCLUSION

Vaccination coverage in Ethiopia has a pro-advantaged regressive distribution with respect to both household wealth and maternal education. Children from poorer households, rural regions of Afar and Somali, no maternal education, and female-headed households had lower full vaccination coverage. Targeted programmes to reach under-immunised children in these subpopulations will improve vaccination coverage and equity outcomes in Ethiopia.

Childhood Immunization in Ethiopia: Accuracy of Maternal Recall Compared to Vaccination Cards

Health surveys conducted in low- and middle-income countries typically estimate childhood vaccination status based on written vaccination cards, maternal recall (when cards are not available), or a combination of both. This analysis aimed to assess the accuracy of maternal recall of a child's vaccination status in Ethiopia. Data came from a 2016 cross-sectional study conducted in the Southern Nations, Nationalities, and Peoples' (SNNP) Region of Ethiopia. Vaccine doses received by a given 12-23-month-old child were recorded from both a vaccination card and based on maternal recall and then compared. Concordance, sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and Cohen's Kappa were calculated. Estimates of full immunization coverage were similar when collected via vaccination card (75%) and maternal recall (74%). For fully vaccinated children, comparison of maternal recall versus vaccination card showed high concordance (96%), sensitivity (97%), specificity (93%), PPV (98%), NPV (92%), and Kappa (90%). Accuracy of maternal recall of a child's vaccination status is high in the SNNP region of Ethiopia. Although determination of vaccination status via vaccination card is preferred since it constitutes a written record, maternal recall can also be used with confidence when vaccination cards are not available.