Individual- and Community-Level Determinants for Complete Vaccination among Children Aged 12-23 Months in Ethiopia: A Multilevel Analysis

Abstract

Background. Childhood vaccination continues to increase dramatically. In spite of the success of immunization programs to date, millions of children continued to die each year, and sub-Saharan Africa (SSA) accounted for the world’s highest neonatal deaths. Childhood vaccination was designed as one of the most effective ways to reduce child mortalities from fatal vaccine-preventable diseases. Therefore, this study is aimed at investigating the individual- and community-level determinants of childhood complete vaccination in Ethiopia. Methods. A secondary data analysis was done based on the 2016 Ethiopian Demographic and Health Survey (EDHS). A total weighted sample of 1,984 children aged 12-23 months was included for analysis. Considering the hierarchical nature of EDHS data, a two-level multilevel analysis for assessing individual- and community-level determinants of childhood complete vaccination was done. The intraclass correlation coefficient (ICC), Median Odds Ratio (MOR), Proportional Change in Variance (PCV), and deviance (-2LL) were used for model comparison and for checking model fitness. Variables with p value < 0.2 in the bivariable multilevel analysis were considered for the multivariable multilevel analysis. In the multivariable multilevel logistic regression analysis, the Adjusted Odds Ratio (AOR) with 95% Confidence Interval (CI) was reported to declare significant determinants of complete childhood vaccination. Results. Overall complete vaccination status among children aged 12-23 months was 39% (95% CI: 36.8, 41.2). In the multilevel analysis, secondary or above educated mothers (AOR=2.48; 95% CI: 1.41, 4.36), richest wealth status (AOR=2.24; 95% CI: 1.16, 4.32), ≥four ANC visits (AOR=2.77; 95% CI: 1.90-4.02), employed mothers (AOR=1.66; 95% CI: 1.26, 2.18), urban residence (AOR=1.84; 95% CI: 1.00, 3.51), and children in city administration (AOR=2.66; 9% CI: 1.53, 4.62) were positively associated with vaccination status. On the other hand, children with a female household head (AOR=0.68; 95% CI: 0.48, 0.96) were negatively associated. Conclusion. Overall, childhood full vaccination status was low compared with the WHO targets. Maternal education, wealth status, ANC visit, maternal occupation, residence, region, and sex of household head were significant predictors of childhood complete vaccination. As a result, it is better to design a compensation mechanism to the costs associated with childhood vaccination for the poor households and strengthen awareness creation for rural residents to improve the access, utilization, and continuum of vaccination service.

Ecological Analysis Of Complete Basic Immunization Coverage For Infants In Indonesia (2017-2019)

“…The scatter plot results show that the plots spread on the left and top side, this means that the higher the percentage of the less of midwives in primary health care, the lower complete basic immunization coverage in the province of Indonesia (Figure 2). This is in line with previous research which stated that the higher a person's income level, the higher the chance for complete basic immunization (Debie et al, 2020;Fenta et al, 2021). Immunization coverage gaps due to income-based inequality were widened by maternal education and place of residence (Sharma et al, 2021).…”

“…The percentage of poor people in September 2018 was 9.66%, has decreased to 9.41% in March 2019 (Ministry of Health in Indonesia, 2020). The higher the income level of a person, the higher the chance to complete basic immunization (Debie et al, 2020).…”

Spatial distribution of complete basic childhood vaccination and associated factors among children aged 12–23 months in Ethiopia. A spatial and multilevel analysis

“…According to the Ethiopian demographic and health survey (EDHS) report, there is an improvement in complete basic childhood vaccination representing one dose of BCG, three doses of pentavalent (DPT-HepB-Hib), three doses of polio, and one dose of measles vaccine among children aged 12-23 months in the country, increased from 24% in 2011, 39% in 2016, to 44% in 2019 [14][15][16]. However, complete basic childhood vaccination status is yet very low compared with the national (at least 90% nationally with 80% in each district) and WHO (> = 90%) targets [17].…”

Determinants of defaulter to full vaccination among children aged 12-23 months in Siraro District, West Arsi zone, Oromia, Ethiopia: A Case-Control study

“…The highest coverage of full vaccination in Addis Ababa (83%) and lowest in Afar region due to different challenges and opportunities as explained in other studies (20%) (5,13). Studies have also reported that maternal education, place of delivery, antenatal care (ANC) visits, postnatal care follow up, place of residence and exposure to mass media as predictors of poor child immunization status (13,14,17,19). However, most of the studies were cross-sectional and failed to include certain variables or factors that could be pertinent in the Ethiopian context, such as socioeconomic status, attitude and service satisfaction towards immunization services provision at grassroots of individual family members and few community-based studies are available.…”