Objectives: Vaccine preventable diseases significantly lead to high under 5 mortality in sub-Saharan Africa. Much attention is given to immunization coverage, but little is known about the population of never-vaccinated children (those that have not received any dose of the WHO recommended immunizations) in Ethiopia. This study aims to (i) Describe the prevalence of never-vaccinated children in Ethiopia and (ii) Examine the effects of individual and contextual factors on non-vaccination of Ethiopian children. Methods: We conducted a secondary analysis using pooled cross-sectional data from 2000-2016 Ethiopia Demographic Health Survey. Analyses were restricted to children aged 12-59 months. A two-level multilevel regression analysis model was built with individuals (level 1) nested within communities (level 2). Results: A total of 20,212 children aged 12-59 months nested within 520 clusters were included in the analysis. Approximately 19% (n=3,943) of the study sample had never been vaccinated. Prevalence of non-vaccination was higher among mothers who delivered at home (86%), with no formal education (62%). In the fully adjusted model, the odds of not being vaccinated reduced for children whose mothers attended high school (adjusted odds ratio [aOR] = 0.35; 95% confidence interval [CI] =0.14-0.84), had employment (aOR, 0.74; 95% CI, 0.59-0.92) and delivered in the hospital (aOR, 0.68; 95% CI, 0.52-0.91). As wealth index increases, the odds of a child not being vaccinated decreased (aOR, 0.63; 95%CI, 0.42-0.93). The odds of being unvaccinated were higher among children whose mother lived in rural area (aOR, 1.76; 95% CI, 1.07-2.89), Somali region (aOR, 13.16; 95% CI, and Affar region (aOR, 8.28; 95% CI, 5.04-13.61) compare to those who lived in urban area or Addis Ababa. Conclusions: Both individual and contextual factors contributed to non-vaccination of children in Ethiopia. Interventions to improve childhood vaccination could benefit from putting these factors responsible for non-vaccination of under 5 children into consideration.
Aim: To investigate parental decisions associated with the antenatal diagnosis of hypoplasia of the left ventricle spectrum (HLV), and intermediate-term outcome. Methods: A cohort study was performed on all families with a foetal diagnosis of HLV. Assessment was performed at the sole tertiary cardiac feto-maternal service for Queensland from 2008 to 2012. Demographic data, incidence of termination of pregnancy, and post-natal survival outcomes were recorded. Results: HLV was diagnosed (using standardised foetal echocardiographic criteria) in 81 pregnancies. Sixty-two (76.5%) had HLHS (aortic ± mitral atresia), with the remainder having HLV variants. Three (3.7%) foetuses had chromosomal abnormalities. Median gestation at initial tertiary assessment was 21 weeks (range 16-36 weeks). Thirty-eight (46.9%) families were not from metropolitan Brisbane. Forty-five (55.8%) families elected termination of pregnancy. Seventeen (21%) families elected palliative care following delivery. Nineteen (23.5%) infants diagnosed antenatally were referred for surgery, and 14 (73.7%) were referred to RCH, Melbourne. There was no significant variation in antenatal and postnatal diagnosis. Sixteen (84.2%) had Norwood operations, two (10.5%) had bi-ventricular repairs and one (5.3%) is awaiting delivery. Fourteen (77.7%) surgically treated infants are alive at a median follow-up of 21 months (range 1-57 months). One patient has undergone a Fontan operation. Overall this represents an 82.7% intermediate loss (elective termination, palliative care and operative mortality) for foetuses following antenatal diagnosis of HLV. Conclusion: In our unit, foetal diagnosis of HLV is associated with a high probability of death, noting that the majority of mortality was in non-surgical cases.
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