Assessment of vaccination timeliness and associated factors among children in Toke Kutaye district, central Ethiopia: A Mixed study

Diarrheal disease and associated factors among children aged 6 to 59 months in Oda Bultum District, Eastern Ethiopia: a community-based cross-sectional study

BACKGROUND

Diarrhea is a serious health problem in children under the age of five that is both preventable and treatable. In low-income countries like Ethiopia, children under the age five years frequently experience diarrhea. However, the burden and associated factors of these diarrheal diseases are understudied in Eastern Ethiopia, Thus, this study aimed to determine the factors associated with the prevalence of diarrheal diseases in Eastern Ethiopia from September 1-30, 2022.

METHODS

A cross-sectional study was conducted on the total of 602 children aged 6 to 59 months in Oda Bultum district in eastern Ethiopia. A multistage sampling method was used. Three kebeles were selected from nine kebeles by the lottery method. Data was entered into Epi data 4.0.2 and exported to SPSS version 21 for analysis. Descriptive analysis was used for frequency, mean, and standard deviations. In addition, bivariable, and multivariable Poisson regression model was used to identify predictors of diarrhea along with a 95% confidence interval. Finally, statistical significance was declared at a p-value of 0.05.

RESULT

A total of 602 children were included in this study. The prevalence of diarrhea 7.4% (47/602), 95% CI; 5.5-9.7%) among the children. Factors such as being unvaccinated for any vaccine (AOR = 10.82, 95%CI; 4.58-25.48) and born from a mother who had medium level of empowerment (AOR = 0.34, 95%CI; 0.11-0.88) in the household had statistically significant association with diarrhea among the children compared to their counterparts.

CONCLUSION

The study found that nearly one out of thirteen children aged 6 to 59 months had any form of diarrheal diseases in Oda Bultum District, Eastern Ethiopia. In addition, the study revealed that children who were vaccinated for their age developed diarrhea less likely compared to those who did not receive any form of vaccine for their age. Moreover, children with mothers who had a medium level of empowerment were less likely to get diarrhea than children with mothers who had a low level of empowerment.

Patterns of basic pneumococcal conjugated vaccine coverage in Ethiopia from 2015 to 2018; further analysis of Ethiopian DHS (2016-2019)

Background

Geographic variation is crucial in spotting performance gaps in immunization programs, including the Pneumococcal Conjugated Vaccine (PCV). This will help speed up targeted vaccination and disease elimination programs in resource-limited countries. Thus, this study aimed to investigate the geographic variation and determinants of PCV vaccination coverage among children aged under five years old in Ethiopia.

Methods

This analysis was carried out based on the 2016 and 2019 nationally representative Ethiopia Demographic and Health Survey (EDHS). We included two surveys of 10,640 children aged 12-23 months. The spatial analysis also covered 645 and 305 clusters with geographical information for both 2016 and 2019, respectively. We explored the spatial distribution, global spatial autocorrelation, spatial interpolation, and Stats Can windows of children with PCV-3 vaccination. P-values were generated using 999 Monte Carlo simulations to identify statistically significant clusters. To understand the coverage of PCV-3 in all areas of the country, we employed the ordinary Kriging interpolation method to estimate the coverage in unsampled areas. We also used hierarchical multivariate logistic regression to identify the factors associated with the utilization of the PCV vaccine (full vaccination).

Results

Except for Addis Ababa, children in all regions have lower odds of receiving all three PCV vaccines compared to the Tigray region. Residence, sex of a child, mother's literacy status, household wealth index, and place of delivery were significant factors associated with receiving the third dose of PCV. Spatial analysis also showed the Somali and Afar regions had the lowest coverage, while the Addis Ababa and Tigray regions had higher coverage in both surveys.

Conclusion

Even though the coverage of the full PCV vaccine improved from 2016 to 2019, variation was observed among regions and between rural and urban areas. The wealth index and educational status of mothers were the most important determinants of PCV vaccine utilization. Hence, the mass campaign might boost coverage in nomadic and semi-nomadic regions and rural areas. Similarly, programs that narrow the gap due to low socioeconomic differences should be formulated and implemented to increase uptake and general coverage.

Measuring Zero-Dose Children: Reflections on Age Cohort Flexibilities for Targeted Immunization Surveys at the Local Level

Zero-dose (ZD) children is a critical objective in global health, and it is at the heart of the Immunization Agenda 2030 (IA2030) strategy. Coverage for the first dose of diphtheria-tetanus-pertussis (DTP1)-containing vaccine is the global operational indicator used to estimate ZD children. When surveys are used, DTP1 coverage estimates usually rely on information reported from caregivers of children aged 12-23 months. It is important to have a global definition of ZD children, but learning and operational needs at a country level may require different ZD measurement approaches. This article summarizes a recent workshop discussion on ZD measurement for targeted surveys at local levels related to flexibilities in age cohorts of inclusion from the ZD learning Hub (ZDLH) initiative-a learning initiative involving 5 consortia of 14 different organizations across 4 countries-Bangladesh, Mali, Nigeria, and Uganda-and a global learning partner. Those considerations may include the need to generate insights on immunization timeliness and on catch-up activities, made particularly relevant in the post-pandemic context; the need to compare results across different age cohort years to better identify systematically missed communities and validate programmatic priorities, and also generate insights on changes under dynamic contexts such as the introduction of a new ZD intervention or for recovering from the impact of health system shocks. Some practical considerations such as the potential need for a larger sample size when including comparisons across multiple cohort years but a potential reduction in the need for household visits to find eligible children, an increase in recall bias when older age groups are included and a reduction in recall bias for the first year of life, and a potential reduction in sample size needs and time needed to detect impact when the first year of life is included. Finally, the inclusion of the first year of life cohort in the survey may be particularly relevant and improve the utility of evidence for decision-making and enable its use in rapid learning cycles, as insights will be generated for the population being currently targeted by the program. For some of those reasons, the ZDLH initiative decided to align on a recommendation to include the age cohort from 18 weeks to 23 months, with enough power to enable disaggregation of key results across the two different cohort years. We argue that flexibilities with the age cohort for inclusion in targeted surveys at the local level may be an important principle to be considered. More research is needed to better understand in which contexts improvements in timeliness of DTP1 in the first year of life will translate to improvements in ZD results in the age cohort of 12-23 months as defined by the global DTP1 indicator.

Spatial pattern and associated factors of timely vaccination in Ethiopia using EDHS-2016 data: A multilevel and spatial analysis

BACKGROUND

Age-appropriate vaccination or vaccine timeliness is the administering of vaccines on the specified schedule of immunization. One of the qualities of the immunization program is an age-appropriate vaccine, it has become an ignored indicator of program performance. Even though age-appropriate vaccination is critical for child health, there are no national-level studies to generate conclusive and tangible evidence about the determination of timely vaccination in Ethiopia.

OBJECTIVE

To assess the spatial pattern and associated factors of timely vaccination in Ethiopia using EDHS-2016 data: A multilevel and spatial analysis.

METHOD

Community based cross-sectional study design was employed from 18 January to 27 June 2016. To select the participants, two-stage cluster sampling was employedin the Ethiopian Demographic Health Survey 2016 data. Permission was obtained via online request by explaining the aim of this particular study from DHS international. A statistical package for social science-21 software was used for data cleaning, recoding, and analysis. Arc GIS 10.3 software was used to show the spatial variation of age-appropriate vaccination practices. A generalized linear mixed-effect model was used. For all models, intra-class correlation, a proportional change in variance, the log-likelihood test, and the Akaike information criterion were calculated. The best model was selected by the lowest value Akaike information criterion. Variables with a p-value less than 0.05 and a 95% confidence level were considered for the statistically significant association.

RESULT

The spatial distribution of age-appropriate vaccination practice in Ethiopia was non-randomly distributed with the global Moran's I value of 0.22 (p-value <0.001). The prevalence of age-appropriate vaccination practice in Ethiopia was 33.8%. Women who receive ≥ 2 TT vaccines (AOR = 1.48; 1.22, 1.79), women who lived in rural residences (AOR = 0.77; 0.62, 0.96), gave birth at a health facility (AOR = 1.2; 1.12, 1.37), ANC follow up (AOR = 174; 1.45, 2.1), richest (AOR = 1.65; 1.15, 2.37), richer (AOR = 1.72; 1.3, 2.22), middle-level income (AOR = 1.65; 1.16, 2.36), poorer (AOR = 1.47; 1.11, 1.96) were the factors of age-appropriate vaccination practice.

CONCLUSION

The spatial distribution of age-appropriate vaccination practice in Ethiopia was non-randomly distributed across the regions. Age-appropriate vaccination practice was low in Ethiopia. Wealth index, usual caretaker of the child, ANC utilization, history of TT vaccination, place of delivery, and residence were associated with age-appropriate vaccination practice.

Machine learning algorithms' application to predict childhood vaccination among children aged 12-23 months in Ethiopia: Evidence 2016 Ethiopian Demographic and Health Survey dataset

INTRODUCTION

Childhood vaccination is a cost-effective public health intervention to reduce child mortality and morbidity. But, vaccination coverage remains low, and previous similar studies have not focused on machine learning algorithms to predict childhood vaccination. Therefore, knowledge extraction, association rule formulation, and discovering insights from hidden patterns in vaccination data are limited. Therefore, this study aimed to predict childhood vaccination among children aged 12-23 months using the best machine learning algorithm.

METHODS

A cross-sectional study design with a two-stage sampling technique was used. A total of 1617 samples of living children aged 12-23 months were used from the 2016 Ethiopian Demographic and Health Survey dataset. The data was pre-processed, and 70% and 30% of the observations were used for training, and evaluating the model, respectively. Eight machine learning algorithms were included for consideration of model building and comparison. All the included algorithms were evaluated using confusion matrix elements. The synthetic minority oversampling technique was used for imbalanced data management. Informational gain value was used to select important attributes to predict childhood vaccination. The If/ then logical association was used to generate rules based on relationships among attributes, and Weka version 3.8.6 software was used to perform all the prediction analyses.

RESULTS

PART was the first best machine learning algorithm to predict childhood vaccination with 95.53% accuracy. J48, multilayer perceptron, and random forest models were the consecutively best machine learning algorithms to predict childhood vaccination with 89.24%, 87.20%, and 82.37% accuracy, respectively. ANC visits, institutional delivery, health facility visits, higher education, and being rich were the top five attributes to predict childhood vaccination. A total of seven rules were generated that could jointly determine the magnitude of childhood vaccination. Of these, if wealth status = 3 (Rich), adequate ANC visits = 1 (yes), and residency = 2 (Urban), then the probability of childhood vaccination would be 86.73%.

CONCLUSIONS

The PART, J48, multilayer perceptron, and random forest algorithms were important algorithms for predicting childhood vaccination. The findings would provide insight into childhood vaccination and serve as a framework for further studies. Strengthening mothers' ANC visits, institutional delivery, improving maternal education, and creating income opportunities for mothers could be important interventions to enhance childhood vaccination.

Determinants of defaulter to full vaccination among children aged 12-23 months in Siraro district, West Arsi zone, Oromia, Ethiopia: a case-control study

BACKGROUND

Vaccination is one of the most cost-effective global public health interventions to reduce childhood morbidity and mortality. Defaulters to full vaccination can put children at greater risk of acquiring vaccine-preventable disease outbreaks. The reason for not receiving full vaccination is not well explored, and hence, there is limited evidence about defaulters of vaccination in Ethiopia.

OBJECTIVES

To identify determinants of defaulter to full vaccination among children aged 12-23 months in Siraro District, West Arsi Zone, Oromia Region, Ethiopia.

METHODS

A community-based unmatched case-control study was conducted among children aged 12-23 months from March 20 to April 30, 2022, with a total sample size of 444 (148 cases and 296 controls). Cases were children aged 12-23 months who had missed at least one routine vaccination dose, while controls were children who had received all of the recommended routine vaccinations. Consecutive sampling and simple random sampling techniques were used to select representative cases and controls respectively. Data were collected using a structured questionnaire, entered into Epi-data version 4.6, and exported to Statistical Package for Social Sciences version 26 for analysis. Logistic regression was used to identify determinants of the defaulter to full vaccination and the variables with p-value < 0.25 were recruited for multivariable analysis, and an adjusted odds ratio with a 95% confidence interval and a p-value of ≤ 0.05 was used to declare the statistical significance of the association.

RESULT

Of the assessed determinants of the defaulter to full vaccination; inadequate knowledge of mothers/caretakers (AOR = 4.32, 95% CI:2.78-6.70), educational status of a father unable to read and write (AOR = 3.66, 95% CI:1.29-10.39), time to reach health facility ≥ 30 minutes (AOR = 2.45, 95% CI:1.51-3.97), not told about the type of vaccine received (AOR = 2.37, 95% CI;1.27-4.45), no parents discussion on vaccination (AOR = 2.16, 95% CI:1.24-3.79), home delivery (AOR = 2.43, 95% CI:1.39-4.25) and not participated in pregnant mother conference (AOR = 2.47, 95% CI = 1.35-4.49) were the identified determinants of the defaulter to full vaccination.

CONCLUSION

Mother's' knowledge, father's education, place of delivery, time to reach a health facility, health workers who told the type of vaccine received, participation in pregnant mother conference, and parents' discussion on vaccination were the determinants of the defaulter to full vaccination status. Thus, the district health office should work on defaulters of vaccination by strengthening immunization service delivery and improving maternal knowledge on vaccination through pregnant mother conference participation.

Achieving the IA2030 Coverage and Equity Goals through a Renewed Focus on Urban Immunization

The 2021 WHO and UNICEF Estimates of National Immunization Coverage (WUENIC) reported approximately 25 million under-vaccinated children in 2021, out of which 18 million were zero-dose children who did not receive even the first dose of a diphtheria-tetanus-pertussis-(DPT) containing vaccine. The number of zero-dose children increased by six million between 2019, the pre-pandemic year, and 2021. A total of 20 countries with the highest number of zero-dose children and home to over 75% of these children in 2021 were prioritized for this review. Several of these countries have substantial urbanization with accompanying challenges. This review paper summarizes routine immunization backsliding following the COVID-19 pandemic and predictors of coverage and identifies pro-equity strategies in urban and peri-urban settings through a systematic search of the published literature. Two databases, PubMed and Web of Science, were exhaustively searched using search terms and synonyms, resulting in 608 identified peer-reviewed papers. Based on the inclusion criteria, 15 papers were included in the final review. The inclusion criteria included papers published between March 2020 and January 2023 and references to urban settings and COVID-19 in the papers. Several studies clearly documented a backsliding of coverage in urban and peri-urban settings, with some predictors or challenges to optimum coverage as well as some pro-equity strategies deployed or recommended in these studies. This emphasizes the need to focus on context-specific routine immunization catch-up and recovery strategies to suit the peculiarities of urban areas to get countries back on track toward achieving the targets of the IA2030. While more evidence is needed around the impact of the pandemic in urban areas, utilizing tools and platforms created to support advancing the equity agenda is pivotal. We posit that a renewed focus on urban immunization is critical if we are to achieve the IA2030 targets.

Vaccination timeliness and associated factors among children aged 12-23 months in Debre Libanos district of North Shewa Zone, Oromia Regional State, Ethiopia

BACKGROUND

Globally, vaccination is one of the most cost-effective interventions in promoting child survival, preventing 2-3 million child deaths annually from vaccine-preventable diseases (VPDs). In Ethiopia, timely vaccination is stated as key to the prevention of unnecessary childhood mortality from measles, pneumonia, diarrheal diseases, and other VPDs. However, Ethiopia ranked fifth among the ten countries with the most unprotected children. Furthermore, previous vaccine timeliness studies produced widely disparate results. As a result, it was suggested that more research be conducted to investigate the potential factors behind the high proportion of untimely vaccination. Therefore, this study was intended to explore the association between different factors and the proportion of vaccination timeliness administered under the Expanded Program on Immunization in Debre Libanos district, Ethiopia.

METHODS

A community-based cross-sectional study design was employed from 1 May to 30 May 2021 among children aged 12 to 23 months with their mother/caregiver, who had started vaccination and had vaccination cards in the Debre Libanos. Simple random sampling techniques and pretested semi-structured questionnaires were used for data collection. At last, a multivariable logistic regression was used to identify factors associated with the vaccination timeliness.

RESULT

In this study, 413 children aged 12 to 23 months were interviewed with their mother/caregiver. Overall, 33.7% [95% CI (29.1-38.3)] of children received their vaccines timely. Having a female child [AOR: 2.9, 95% CI: 1.58-5.35], mother/caregiver attending primary [AOR: 6.33, 95% CI: 2.66-15.06] and secondary/above education [AOR: 5.61, 95% CI: 2.41-13.04], sufficient vaccination knowledge [AOR: 3.46, 95% CI: 1.87-6.38], mother/caregiver with least hesitant [AOR: 3.35, 95% CI: 1.51-7.41] and middle hesitant [AOR: 1.89, 95% CI: 1.05-3.58], utilization of ANC [AOR: 2.89, 95% CI: 1.32-6.33], and giving birth at health facility [AOR: 4.32, 95% CI: 1.95-9.59] were the factors independently associated with vaccination timeliness.

CONCLUSION

In comparison to Ethiopia's existing vaccination coverage, the proportion of children immunized at the recommended time interval is low in the study district. Policymakers should prioritize vaccine timeliness and integrate it into childhood vaccination strategies.