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

Abstract

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.

Immunization coverage in Ethiopia among 12–23 month old children: systematic review and meta-analysis

“…The minimum sample size was 173 [41] and maximum sample size was 2004 [16]. Nin (32.1%) of studies were from Amhara region [31, 33-35, 37, 42, 44, 47, 49], six (21.4%) from South Nation Nationality and People's region [8,27,38,41,48,52], four (14.3%) from Oromia region [32,36,39,43], were three (10.7%) survey nationwide [15,16,55], two (7.1%) from pastoral and semipastoral area of the country [50,51], lastly one (3.6%) from Somali state [40] and one (3.6%) from Tigrai regional states [25]. All studies were published in peer review journals.…”

“…Studies with largest weight were EDHS 2016 [16], EDHS 2011 [53] and Mebrahtom and Birhane [46] 9.99,9.62,7.65 respectively. While those with smallest weight were from Facha wolde [48], Porth et al [52] and Gualu and Dillie [33] respectively 1.05, 1.16 and 1.44 (Table 2) (below). Using random effect model analysis the pooled prevalence of immunization coverage among 12-23 moths in Ethiopia showed (I 2 = 0.000, p-value< 0.005) (Fig.…”

Impact of Multiple Risk Factors on Vaccination Inequities: Analysis in Indian Infants Over 2 Decades

“…In some settings, maternal recall showed either a good correlation with vaccination card entries or underestimated the doses received; however, it is unclear whether this is true for India. 36,37 There were 3 options to present vaccination data in this analysis: the proportions of infants with full coverage, no coverage, or partial coverage. Full vaccination was chosen because it represents success (or otherwise) of the immunization program toward the goal of protecting individual infants and the community.…”

Immunization coverage in Ethiopia among 12-23 month children: systematic review and meta-analysis.

“…All retained twenty eight studies in this systematic review and meta-analysis conducted in Ethiopia all of them were cross sectional; twenty five of them were conducted from eight regional states and three national survey, a total sample size of 20,048 of (aged 12-23 months) old children included. The minimum sample size was 173 [26] and maximum sample size was 2004 [27] Nin (32.1%) of studies were from Amhara region [28][29][30][31][32][33][34][35][36], six (21.4%) from South Nation Nationality and People's region [18,26,[37][38][39][40], four (14.3%) from Oromia region [41][42][43][44], were three (10.7%) survey nationwide [27,45,46], two (7.1%) from pastoral and semi-pastoral area of the country [25,47], lastly one (3.6%) from Somali state [48] and one (3.6%) from Tigrai regional states [49] All studies were published in peer review journals that fulfills WHO/UNICEF case definition for maternal recall, immunization card and scare were used.…”

“…, EDHS 2011[51] and Mebrahtom and Birhane [52] 9.99,9.62,7.65 respectively. Those with smallest weight were Facha wolde [40], Porth et al[37] and Gualu and Dillie[31] with respective weight of 1.05, 1.16 and 1.44.…”