Impact of antenatal care visits on childhood immunization: a propensity score-matched analysis using nationally representative survey

Timeliness of the second dose of measles-containing vaccine uptake and its determinants among children aged 24-36 months in Gondar City, Northwest Ethiopia, 2023: Community-based cross-sectional study design

Background

Measles remains a global public health concern, despite the availability of effective vaccines. Recent outbreaks highlight the need for strong vaccination programs. Since launching both doses, Ethiopia has been working with global health organizations to increase vaccination coverage. However, focusing solely on coverage overlooks the importance of timely vaccination. In Ethiopia, despite occasional increases in coverage, measles outbreaks persist due to insufficient attention to timeliness. This study aims to assess the timeliness and its determinants of second-dose measles-containing vaccine uptake in Gondar City to inform efforts to strengthen immunization programs and prevent measles infections.

Methods

A community-based cross-sectional study was conducted among 618 children aged 24-36 months. Participants were selected using a two-stage systematic random sampling method from April 25 to May 25. Structured questionnaires were administered through interviews, and data were collected using the Kobo toolbox and then analyzed using Stata version 17. A binary logistic regression model was utilized to determine factors associated with the outcome, with significance declared at a p-value <0.05. Adjusted odds ratios with 95 % confidence intervals were used to assess the direction and strength of associations.

Results

Among the total of 618 children, 523 (84.63 %) (95 % CI: 81.77 %-87.48 %) were vaccinated for MCV2 timely (in the national recommended age). Paternal college and above in their education (AOR: 5.84, 95 % CI: 1.55-8.18), four or more ANC follow-ups (AOR: 5.84, 95 % CI: 1.55-8.18), at least two doses of vitamin An uptake (AOR: 6.39, 95 % CI: 2.92-12.59), mothers having high awareness (AOR: 2.04, 95 % CI: 1.05-3.99), and mothers having positive perception (AOR: 4.81, 95 % CI: 2.13-10.86) to measles vaccination were significant determinants for timely uptake of the second dose measles-containing vaccine.

Conclusion and recommendations

The timely uptake of the second dose of the measles vaccine in the study area was suboptimal, and efforts should be continued to eradicate measles infection. Paternal educational status, ANC follow-ups, repeated vitamin An uptake, maternal awareness, and perception of measles vaccination were statistically significant determinants for the timely uptake of a second dose of measles-containing vaccine. Strengthening maternal and child health services, increasing awareness, and changing mothers' perceptions about measles vaccination may increase the timely uptake of MCV2 among children receiving a second MCV dose.

Estimated effect of media use on mothers' vaccination of their children in Sub-Saharan Africa: a quasi-experimental propensity score matching analysis using DHS data

BACKROUND

Media channels are a primary source of health information for mothers/caregivers to enhance their children's vaccination uptake, particularly in Sub-Saharan Africa, where there is a dearth of health workers. WHO set mass media exposure as a potential strategy to increase vaccination uptake. However, estimating the effect of media exposure on child vaccination using observational studies suffers from problems of selection bias. Thus, this study used the propensity score matching (PSM) analysis to estimate the effect of media exposure on childhood vaccinations.

METHODS

We used nationally representative demography and health survey data collected from 2019 to 2024 among 23,194 children aged 12-23 months in SSA countries. A total of 23,194 weighted sample were included in the analysis. We employed PSM analysis with the logit model using the psmatch2 command package in STATA to estimate the causal effect of media exposure on women's uptake of child immunization. The Average Treatment Effect (ATE), average treatment effect on the treated (ATT), and the average treatment on the untreated (ATU) represent the overall effect of media exposure on the entire population, among women who had media exposure, and the hypothetical effect if unexposed women had experienced media exposure, respectively. Radius matching with a caliper width of 0.01 was employed to match the groups. The quality of matching was examined statistically and graphically. Sensitivity analysis was done to test the robustness of the PSM estimate using the Mantel-Haenszel test statistics.

RESULTS

The overall prevalence of full child vaccination was 61.27% (95% CI (60.64%, 61.89%)) in the treatment group. In the PSM analysis, the ATT values in the treatment and control groups were 0.68 and 0.59, respectively, indicating that the childhood immunization uptake increased by 8.76% because of media exposure. The ATU values in the treatment and control groups were 0.51 and 0.62, respectively. This showed that for the women or caregivers who did not have media exposure, the probability of vaccinating their children would have increased by 10.8% if they had media exposure. The final ATE estimate was 0.0828 among the samples. Quality of matching was good, and the estimates were insensitive to hidden bias.

CONCLUSION AND RECOMMENDATIONS

This study finding highlighted that policymakers and planners in SSA countries should give great emphasis to further enhancing media exposure coverage for target groups since it has a substantial impact on improving childhood vaccination uptake. Further research is recommended to examine the cause-effect relationship of media exposure on childhood vaccination by including more proximal variables that were not observed in the present study.

Individual and community level maternal factors for zero-dose children in Ethiopia using mini-EDHS 2019: a mixed effects model

INTRODUCTION

Zero-dose children refer to a child who has not yet received any childhood vaccines. Globally, zero-dose children are the major public health problem. In sub-Saharan African countries, one among five children do not have access to vaccines. But the efforts to identify the factors contributing to the zero-dose children are not well addressed in Ethiopia.

OBJECTIVES

To assess individual and community-level maternal factors of zero-dose children in Ethiopia using mini-Ethiopian Demographic Health Survey 2019.

METHODS

A secondary analysis of a cross-sectional study was used among a total of 3208 participants. STATA-14 was used for descriptive and multilevel binary logistic regression (mixed effects model) analysis. Model selection was conducted using Akaike information criteria. To identify significant factors for zero-dose children, a p value of <0.05 with 95% CI was used.

RESULTS

The prevalence of zero-dose children among children aged 12-35 months was 523 (16.3%, 95% CI 15% to 17.6%). Women with no antenatal care follow-up (adjusted OR (AOR)=1.55, 95% CI 1.02 to 2.35), uneducated women (AOR=1.47, 95% CI 1.11 to 1.95), women who gave birth at home (AOR=1.39, 95% CI 1.04 to 1.86), women who had poor wealth index (AOR=2.15, 95% CI 1.62 to 2.85) and women from low proportions of community media exposure (AOR=1.39, 95% CI 1.13 to 1.71) were the risk factors for zero-dose children in Ethiopia.

CONCLUSION

Compared with previous studies, the prevalence of zero-dose children was low in Ethiopia. Variables like urban residence, no education, home delivery, poor wealth index, no antenatal care(ANC) visit and women from low proportions of community media exposure were the risk factors for zero-dose children in Ethiopia. Therefore, expanding maternal health services and media access for women is highly recommended to reduce zero-dose children mortality.

Exploring factors influencing childhood immunization status in East Africa using multilevel ordinal logistic regression analysis

Introduction

Childhood vaccinations are crucial in safeguarding children from infectious diseases and are recognized as one of the most cost-effective public health interventions. However, children in East African countries face more than a fifteen-fold increased risk of death from vaccine-preventable diseases compared to those in high-income nations. This study aimed to identify the factors influencing childhood immunization status in East Africa.

Methods

A sample of 22,734 children aged 12 to 23 months was included to assess immunization status, utilizing recent data from the Demographic and Health Survey conducted between 2015 and 2022 across ten East African countries. A Level-3 multilevel generalized odds model with a logit link function was employed for the analysis.

Results

Among the 22,734 children in the sample, only 67.4% were fully immunized, 27.7% were partially immunized, and the remaining were not immunized at all. The null hypothesis of proportionality was rejected based on the Brant test. Consequently, various partial and non-proportional odds models were fitted, with the generalized odds model demonstrating the best fit compared to other ordinal regression models. The findings indicated that 43.14% of the variation in children's immunization status was attributable to differences between countries, while 18.18% was due to variations between regions. Specific factors associated with immunization status revealed that mothers who attended antenatal care were 1.23 times more likely to fully immunize their children compared to those who did not, and those who received postnatal care were 1.13 times more likely to do so. Additionally, mothers who had antenatal and postnatal services were 1.07 and 1.08 times more likely, respectively, to fully or partially immunize their children compared to those who did not.

Conclusion

The fitted generalized odds model indicated that several factors significantly associated with childhood immunization status included maternal age, number of antenatal and postnatal care visits, tetanus injections received by mothers, vitamin A intake, presence of health documentation, place of delivery, birth order, mother's occupation, sex of the household head, distance to health facilities, maternal education, community maternal education, community wealth index, and community media exposure. Therefore, it is recommended that interventions focus on enhancing household wealth, educating mothers, and improving health systems.

Second dose of measles-containing vaccine coverage and associated factors among children aged 24-36 months in Gondar city, Central Gondar, Northwest Ethiopia, 2023

Background

Measles caused 207,000 deaths worldwide in 2019. Ethiopia ranks among the top 10 countries in the world with the highest number of measles cases. However, the coverage of the second dose of measles-containing vaccine (MCV2) remains low. To increase coverage, the government of Ethiopia launched a nationwide measles vaccination campaign. Despite this intervention, the coverage is still below target, and there is scarce information in the study area. Therefore, this study aimed to assess MCV2 coverage and associated factors among children aged 24-36 months in Gondar city, Central Gondar, Northwest Ethiopia, 2023.

Methods

A community-based cross-sectional study was conducted among 621 children aged 24-36 months using a systematic random sampling technique from 25 April to 25 May. A pre-tested, interviewer-administered, and structured questionnaire was used and collected using Kobo Toolbox and then transferred to Stata version 17 for further analysis. The binary logistic regression model was used to identify factors, and the presence of an association was declared using a p-value of <0.05. Similarly, an adjusted odds ratio with a 95% confidence interval was used to interpret the direction and strength of an association.

Results

A total of 621 children, with a response rate of 98.1%, participated in the study. The coverage of the second dose of MCV was 75.68% (95% CI: 72.1-78.9). The following factors were significantly associated with measles-containing vaccine second dose (MCV2) coverage: father as the household head (AOR: 3.06, 95% CI: 1.43-6.44), first birth order (AOR: 4.45, 95% CI: 1.21-16.3), four and above antenatal care (ANC) follow-ups (AOR: 5.18, 95% CI:1.62-16.5), postnatal care (PNC) service utilization (AOR: 2.57, 95% CI:1.27-5.15), at least two doses of vitamin A uptake (AOR: 6.39, 95% CI: 2.67-15.2), mothers having high awareness (AOR: 1.97, 95% CI:1.15-3.4), and good perception (AOR: 3.6, 95% CI: 2-6.47) about measles vaccination.

Conclusion and recommendations

The coverage of MCV2 in the study area is lower than the national and global target of above 95%. Head of household, birth order, ANC follow-up, PNC service utilization, vitamin A uptake, awareness, and perception of mothers about measles vaccination were significant factors for MCV2 coverage. Creating awareness, increasing the perception of mothers about measles vaccination, and strengthening the ANC and PNC services will increase the coverage.