Determinants of full immunization coverage among children 12-23 months of age from deviant mothers/caregivers in Ethiopia: A multilevel analysis using 2016 demographic and health survey

Regional disparities of full pentavalent vaccine uptake and the determinants in Ethiopia: Mapping and spatial analysis using the EDHS data

BACKGROUND

The full pentavalent (DPT-HepB-Hib) vaccination is the main strategy to prevent five communicable diseases in early childhood, especially in countries with huge communicable disease burdens like Ethiopia. Exploring spatial distributions and determinants of full pentavalent vaccination status in minor ecological areas in Ethiopia is crucial for creating targeted immunization campaigns and monitoring the advancement of accomplishing sustainable development goals. This study aimed to investigate the spatial disparities and determinants of full pentavalent vaccination among 12-23-month-old children in Ethiopia.

METHOD

The data on pentavalent vaccine uptake was found in the Ethiopian Health and Demographic Survey (EDHS, 2019). A two-stage cluster sampling method was applied to collect the EDHS data. The enumeration area was the primary sample unit while the household served as the secondary sampling unit. The geographical variations of full pentavalent vaccine uptake were explored using Quantum Geographic Information System (QGIS) software. The significant predictors of full pentavalent vaccination were identified using a simple logistic regression model through R version 4.1 software.

RESULT

The national full pentavalent vaccine uptake was 59.2%. The spatial distribution of full pentavalent vaccine uptake was not uniform in Ethiopia. Spatial cluster analysis revealed that most of low coverage regions for full pentavalent vaccine uptake were Afar, Somali, and Harari. The regions with the highest and lowest rates of vaccine uptake were Tigray and Harari region, respectively. Maternal age of 35-49 years (AOR = 3.42; 95% CI: 1.99, 5.87), and 25-34 years (AOR = 1.55; 95% CI: 1.17, 2.19), primary education attended (AOR = 1.51; 95%CI: 1.07, 2.11), richness wealth index (AOR = 1.96; 95% CI: 1.40, 2.75), birth order of 1-3 (AOR = 1.88; 95% CI: 1.19, 2.96), and delivery in the health facility (AOR = 3.41: 95% CI: 2.52, 4.61) were the determinants of full pentavalent vaccine uptake in Ethiopia.

CONCLUSION

Ethiopia's full pentavalent vaccine uptake was far lower than the global target. Older maternal age, maternal education, wealth index, birth order, and giving birth in a health facility were the determinants of full pentavalent vaccine uptake. Special attention should be given to Afar, Somali, and Harari regions, to strengthen the vaccine uptake. Moreover, improved socioeconomic status and getting maternal health services during delivery are necessary to enhance vaccine uptake.

Socio-demographic factors affecting the first and second dose of measles vaccination status among under-five children: Perspectives from South Asian countries

Background

The measles vaccine is crucial in preventing fatalities and reducing widespread childhood infections worldwide, yet achieving the desired immunization rates remains a challenge in developing countries. Our study aims to identify the impact of socio-demographic factors on measles vaccination among children in South Asian countries.

Methods

Participants (89513) were taken from the most recent Demographic and Health Survey (DHS) datasets of South Asian countries between 2015 and 2021. Descriptive statistics and multivariable analyses were employed to find out the factors associated with measles vaccination among South Asian countries.

Results

Our study found that the first dose of vaccinated children was 51.7 % in Afghanistan which is the lowest among South Asian countries. The key determinants related to two doses of measles vaccination include parental characteristics, media access, and antenatal care (ANC). Mothers who had done baby postnatal checkups (AOR = 1.22, CI = 1.17-1.26) and made more than four ANC (AOR = 1.77, CI: 1.65-1.89) were more likely to fully immunize their child than mothers with no postnatal and antenatal checkups.

Conclusion

The complete dose of measles vaccination rate in South Asia is still low compared to the first dose of measles vaccination among children. The government and stakeholders should organize frequent awareness programs through media and health personnel to inform people about routine vaccinations to eliminate measles.

The status of immunization program and challenges in Ethiopia: A mixed method study

Introduction

Immunization helps reduce morbidity and mortality attributable to severe vaccine-preventable childhood illnesses. However, vaccination coverage and the quality of immunization data remain challenging in Ethiopia. This has led to poor planning, suboptimal vaccination coverage, and the resurgence of vaccine-preventable disease outbreaks in under-immunized pocket areas. The problem is further compounded by the occurrence of the COVID-19 pandemic and the disruption of the health information system due to recurrent conflict. This study assessed the current status of the immunization service and its challenges in Ethiopia.

Methods

A mixed-methods study was conducted in three regions of Ethiopia from 21 to 31 May, 2023. A survey of administrative reports was done in a total of 69 health facilities in 14 woredas (districts). Nine KIIs were conducted at a district level among immunization coordinators selected from three regions to explore the challenges of the immunization program. Linear regression and descriptive statistics were used to analyze the quantitative data. Thematic analysis was applied to analyze the qualitative data. The findings from the qualitative data were triangulated to supplement the quantitative results.

Result

Two-thirds (66.4%) of the children were fully vaccinated, having received all vaccines, including the first dose of the MCV1, by 12 months of age, as reported through administrative reports collected from health facility records. Catchment area population size and region were significantly associated with the number of fully immunized children (p < 0.001 and p = 0.005, respectively). The vaccination dropout rates of the first to third dose of pentavalent vaccine and the first dose of pentavalent vaccine to the first dose of MCV1 were 8.6% and 7.4%, respectively. A considerable proportion of health facilities lack accurate data to calculate vaccination coverage, while most of them lack accurate data for dropout rates. Longer waiting time, interruptions in vaccine supply or shortage, inaccessibility of health facilities, internal conflict and displacement, power interruption and refrigerator breakdown, poor counseling practice, and caretakers' lack of awareness, fear of side effects, and forgetfulness were the reasons for the dropout rate and low coverage. The result also showed that internal conflict and displacement have significantly affected immunization coverage, with the worst effects seen on the most marginalized populations.

Conclusion

The study revealed low vaccination coverage, a high dropout rate, and poor quality of immunization data. Access and vaccination coverage among marginalized community groups (e.g., orphans and street children) were also low. Hence, interventions to address organizational, behavioral, technical, and contextual (conflict and the resulting internal displacement) bottlenecks affecting the immunization program should be addressed.

Knowledge and attitudes of community pharmacists on vaccination, barriers and willingness to implement community pharmacy-based vaccination services in Ethiopia

This study aimed to evaluate the knowledge and attitudes of community pharmacists (CPs) on vaccination and assess the barriers and willingness to implement community pharmacy-based vaccination services (CPBVS) in Ethiopia. An online cross-sectional study was conducted on 423 CPs in Ethiopia, and questionnaires were distributed to CPs through the Ethiopian Pharmaceutical Association telegram group and e-mail invitations. Data were analyzed using the Statistical Package for Social Sciences (SPSS) version 27. Most CPs (92%) had good knowledge of vaccination, and 43.5% strongly agreed that the population's immunization rates would rise if CPs were authorized to provide vaccinations. The overall mean attitude score (±SD) toward vaccination was 35.95 (±4.11) out of a total score of 45, with 187 (44.2%) scoring below the mean. The most common barriers were lack of authorization (94.1%), costs and time associated with professional development and training (71.4%), time requirements for professional development (70%), and insufficient staff or resources for implementation (70%). Two hundred thirty CPs (54.4%) expressed a willingness to implement CPBVS. Educational qualifications were significantly associated with knowledge of CPs regarding vaccination. Those with inadequate knowledge had about 2.5 times (AOR = 2.51, 95% CI: 1.19, 5.31, p = .016) a poorer attitude toward vaccination services compared with those with adequate knowledge. Those study participants who had a good attitude toward vaccination services were nearly seven (AOR = 6.80, 95% CI: 4.36-10.59, p = .0001) times more willing to provide CPBVS when compared with their counterparts. Implementing CPBVS in Ethiopia requires overcoming barriers and providing professional development opportunities.