Vaccination Coverage and Predictors of Vaccination among Children Aged 12–23 Months in the Pastoralist Communities of Ethiopia: A Mixed Methods Design
Abstract
:1. Introduction
2. Materials and Methods
2.1. Study Area and Design and Population
2.2. Sample Size Determination and Sampling Procedure
2.3. Study Variables and Operational Definitions
2.4. Data Collection and Management
2.5. Data Processing and Analysis
3. Results
3.1. Sociodemographic Characteristics of Respondents
3.2. Child Characteristics
3.3. Factors Related to Vaccine Refusal and Vaccination Service Satisfaction
3.4. Maternal Health Service
3.5. Vaccination Coverage
3.5.1. Proportion of Vaccination Based on Card Observation
3.5.2. Proportion of Vaccination without Card Observation
3.5.3. Proportion of Full Immunization
3.6. Barriers to Child Vaccination
“The health centre is far away from the majority of kebele residents. Those community members close to this health centre received frequent services from the institution, while those farther away from it did not often access the service. This scenario also applies to other health facilities in the region. Therefore, the long distance to the nearest health facility is the main barrier to EPI services.”
“The biggest problem for desert or Berhama areas such as the Afar region is the lack of health facilities, such as a nearby health center, which makes vaccination services inaccessible and creates problems in the supply of vaccines.”
“When COVID-19 first began to spread in our nation, we had delays in implementing routine EPI delivery services. Later, when the COVID-19 epidemic began to decline, we promptly resumed our normal EPI activities integrated with COVID-19 prevention.”
“The major barriers to not vaccinating children in our communities include a lack of commitment among health care workers, a shortage of EPI logistics and distribution, a lack of transportation access and high staff turnover.”
“There is a lack of incentive for health workers, HEWs, and women’s developmental army. The provision of incentives is the best way to motivate people and increase the performance of activities. In our cases, we tried this approach, and we achieved better results. However, it was not enough and was not supported by health higher officials. In addition, our woreda is a geographically vast, populated, and repeatedly conflict-affected area. The woreda had only one health centre, which made it very distant from three health posts. This made it very difficult to conduct the expected follow-up and support on EPI services across different catchment areas. Therefore, additional health centres should be constructed, and conflict issues should also receive attention and should be resolved permanently.”
“In this woreda vaccine service, delivery strategies are implemented only with the initiative of NGOs, and this alone couldn’t solve our community’s problem at large. Therefore, itis essential to integrate woreda political leaders, community influential leaders and other concerned stakeholder leaders to be involved in vaccine service delivery strategies.”
“Amref Health Africa is an NGO partner that is engaged in promoting the expansion of EPI vaccination coverage. Additionally, Amref and other stakeholders should support us build health posts in five difficult-to-reach kebeles in Woreda. Consequently, this will help us increase immunization coverage.”
“Amref, supported us on implementation of capacity building of voluntary communities Woreda level review meetings and the EPI Vaccination program. The Woreda Health Office supported us in vaccine logistics supply and transportation, but it is not enough if any partner supported us with a transportation vehicle with fuel; it would help us to enhance our vaccination coverage.”
“The community representatives should participate during the planning and implementation of immunization activities. For example, in deciding the outreach sites, target identification, and arrangement of the services. Therefore, their participation will help us to achieve better vaccination coverage.”
3.7. Factors Associated with Full Immunization among Children
4. Discussion
Policy Implication
5. Conclusions and Recommendation
- Promoting Maternal Education—The study found a significant positive association between maternal education and full immunization coverage. Enhancing educational opportunities for mothers and caretakers could lead to a better understanding and prioritization of vaccination.
- Increasing Mobile Phone Ownership—The study identified a significant link between mobile phone ownership and increased immunization rates. Programs could focus on leveraging mobile technology to disseminate information, send reminders, and provide support related to vaccination.
- Encouraging ANC visits—The study highlights the importance of ANC visits, showing a strong association with full immunization. Strengthening ANC services and ensuring that more women attend these visits could enhance vaccination coverage.
- Promoting Health Facility Delivery—The study found that childbirth at a health facility is strongly associated with higher immunization rates. Efforts to increase institutional deliveries could have a positive impact on immunization outcomes.
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
References
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Variables | Frequency | Percentage (%) |
---|---|---|
Woreda | ||
Elidar | 154 | 36.8 |
Dubti | 190 | 45.3 |
Gereni | 75 | 17.9 |
Residence | ||
Rural | 328 | 78.3 |
Urban | 91 | 21.7 |
Age (mean age was 31.8 ± 4) | ||
<22 | 80 | 19.1 |
22–25 | 142 | 33.9 |
26–29 | 80 | 19.1 |
≥30 | 117 | 27.9 |
Marital status | ||
Married | 408 | 97.4 |
Single/divorced/widowed | 11 | 2.6 |
Maternal educational status | ||
Unable to read and write | 345 | 82.3 |
Read and write only | 43 | 10.3 |
Primary school | 17 | 4.1 |
Secondary and above | 14 | 3.4 |
Father’s educational status | ||
Unable to read and write | 296 | 70.6 |
Read and write only | 58 | 13.8 |
Primary school | 18 | 4.3 |
Secondary school | 30 | 7.2 |
College and above | 17 | 4.1 |
Mother’s occupation | ||
Housewife | 331 | 79.0 |
Merchant | 40 | 9.5 |
Farming/pastoralist | 29 | 6.9 |
Governmental employed | 17 | 4.1 |
Other specified | 2 | 0.5 |
Religion status of respondent | ||
Muslim | 398 | 95 |
Orthodox | 21 | 5.0 |
Mass media possession | ||
Electrical/solar lump (light) | 162 | 38.7 |
Radio | 139 | 33.2 |
Television | 139 | 33.2 |
Mobile phone | 307 | 73.3 |
Household economic status | ||
Able to meet basic needs | 343 | 81.9 |
Unable to meet basic needs without charity | 52 | 12.4 |
Refuse to answer | 14 | 3.3 |
Able to meet basic needs and some nonessential goods | 9 | 2.1 |
Able to purchase most nonessential goods | 1 | 0.2 |
Total family size (the mean family size of the study was 5.9) | ||
<4 | 155 | 37.0 |
≥4 | 264 | 63.0 |
Distance to nearest health post | ||
≤30 min | 252 | 60.1 |
>30 min | 167 | 39.9 |
Distance to nearest health center | ||
≤30 min | 137 | 32.7 |
>30 min | 282 | 67.3 |
Distance to the nearest vaccination center | ||
≤30 min | 230 | 54.9 |
>30 min | 189 | 45.1 |
Variables | Frequency | Percentage (%) |
---|---|---|
Gravidity (mean 3.4 ± 1.5) | ||
≤4 | 302 | 72.1 |
>4 | 117 | 37.9 |
Parity (mean 3.2 ± 1.2) | ||
≤4 | 332 | 79.2 |
>4 | 87 | 20.8 |
Sex of index child | ||
Male | 235 | 56.1 |
Female | 184 | 53.9 |
Age of indexed child in months (mean 15.2 months ± 5.2) | ||
12–13 | 127 | 30.3 |
13–16 | 100 | 23.9 |
17–20 | 89 | 21.2 |
21–23 | 103 | 24.6 |
Order of indexed child | ||
First | 48 | 11.5 |
Second | 81 | 19.3 |
Third | 115 | 27.4 |
Fourth and later | 175 | 41.8 |
Index childbirth condition | ||
Single | 403 | 96.2 |
Twins | 16 | 3.8 |
Index child living with | ||
Both parents | 399 | 95.2 |
Mother only | 20 | 4.8 |
Variables | Frequency | Percentage (%) |
---|---|---|
Heard of vaccination | ||
Yes | 313 | 74.7 |
No | 106 | 25.3 |
Advantages of vaccinating children (n = 313) | ||
To protect them from disease | 284 | 90.7 |
To have healthy child | 224 | 71.6 |
Have no benefits | 2 | 0.64 |
Do not know | 2 | 0.64 |
Disadvantages of vaccine | ||
Side or adverse effects | 210 | 67.1 |
May make children sick | 178 | 56.9 |
Takes time | 20 | 6.4 |
Other (sterilize children, politics) | 12 | 3.8 |
Do not know/not sure | 50 | 16 |
How likely the vaccine is prevented | ||
Very likely | 191 | 61.0 |
Somewhat likely | 45 | 14.4 |
Not likely at all | 35 | 11.2 |
Do not know/not sure | 60 | 19.2 |
Seriousness of vaccine preventable diseases | ||
Very serious | 146 | 46.6 |
Somewhat serious | 91 | 29.1 |
Not serious at all | 33 | 10.5 |
Do not know/not sure | 55 | 17.6 |
When to start | ||
At birth | 78 | 24.9 |
First few weeks | 34 | 10.9 |
First few months | 121 | 38.7 |
Later | 58 | 18.5 |
Do not know | 49 | 15.7 |
Where to get child vaccine | ||
Outreach site | 139 | 44.4 |
Health post | 110 | 35.1 |
Health center | 183 | 58.5 |
Public hospital | 51 | 16.3 |
Received information on vaccination when the child was less than one year (n = 313) | ||
Yes | 239 | 76.4 |
No | 74 | 23.6 |
Source of information | ||
Health professionals (doctors, nurses) | 193 | 80.8 |
Health extension workers | 127 | 53.1 |
Radio | 20 | 8.4 |
Television | 48 | 20.1 |
Other printed materials (poster, banner) | 6 | 2.5 |
Husband/partner | 113 | 47.3 |
Family/friend/neighbor | 68 | 28.5 |
Religious/community leaders | 2 | 0.8 |
Type of information heard | ||
Importance of vaccination | 232 | 97.1 |
About vaccination campaigns | 134 | 56.1 |
Where to get routine vaccination | 43 | 18.0 |
Timing for vaccination | 27 | 11.3 |
Return to next doses of vaccination | 25 | 10.5 |
Possible adverse events vaccination | 66 | 27.6 |
Harms of vaccination | 20 | 8.4 |
Do not know/not sure | 4 | 1.7 |
Informed about side effects | ||
Yes | 239 | 76.4 |
No | 74 | 23.6 |
Informed what to do if adverse effects occurred | ||
Yes | 236 | 98.7 |
No | 3 | 1.3 |
Characteristics | Frequency | Percentage |
---|---|---|
Ever refused child vaccine | ||
Yes | 52 | 21.8 |
No | 261 | 78.2 |
Reasons for refusal | ||
Too many injections at visit | 28 | 53.8 |
Child was ill | 26 | 50.0 |
Fear of injection pain | 21 | 40.4 |
Fear of side effects | 11 | 21.2 |
Fear of risk of disease transmission | 6 | 11.5 |
Doubts on the benefit of the vaccine | 6 | 11.5 |
Has already been vaccinated | 4 | 7.7 |
Fear, doubts, suspicions about vaccine (n = 313) | ||
Yes | 27 | 8.6 |
No | 278 | 88.8 |
Not sure | 8 | 2.6 |
Reasons for fear, doubts, suspicions about vaccine (n = 27) | ||
Vaccinations cause side effects | 15 | 55.6 |
Vaccinations can make children sick | 8 | 29.6 |
Vaccinations sterilize children | 2 | 7.4 |
Others (politics, religious) | 2 | 7.4 |
Vaccine recommendation to other community members | ||
Yes | 271 | 86.6 |
No | 42 | 13.4 |
Reasons not to recommend to others | ||
Do not believe vaccines are useful | 30 | 71.4 |
Causes side effects/makes them sick | 29 | 69 |
Injection can transmit diseases | 9 | 21.4 |
Against social/religious norm | 1 | 2.4 |
Satisfaction of vaccination service | ||
Yes | 211 | 67.4 |
No | 102 | 32.6 |
ANC Follow-Up | Frequency | Percentage |
---|---|---|
Yes | 240 | 57.3 |
No | 179 | 42.7 |
Place of ANC booking | ||
Health post | 66 | 27.5 |
Health center | 152 | 63.3 |
Public hospital | 67 | 27.9 |
ANC frequency | ||
≤3 | 237 | 98.8 |
>3 | 3 | 1.2 |
Information about child vaccination during ANC | ||
Yes | 207 | 86.3 |
No | 25 | 10.4 |
Not sure/do not know | 8 | 3.3 |
Place of birth | ||
Home | 227 | 54.2 |
Health facility | 192 | 45.8 |
Birth assistance | ||
Health professionals including HEWs | 192 | 45.8 |
Traditional birth attendant | 214 | 51.1 |
Family/friend/neighbor | 11 | 2.6 |
No one | 2 | 0.5 |
Check-up after birth | ||
Yes | 103 | 24.6 |
No | 316 | 75.4 |
Who made the check-up | ||
Health professionals | 93 | 90.3 |
Health extension workers | 9 | 8.7 |
Traditional birth attendant | 1 | 0.9 |
Information on vaccination during check-up | ||
Yes | 97 | 94.2 |
No | 4 | 3.9 |
Not sure/do not know | 2 | 1.9 |
Vaccines | Proportion (Total n = 92) | 95% CI |
---|---|---|
BCG | 97.8% (n = 90) | 91.6–99.5% |
Polio-1 | 98.9% (n = 91) | 92.5–99.9% |
Penta-1 | 96.7% (n = 89) | 90.2–98.9% |
PCV-1 | 97.8% (n = 90) | 91.6–99.5% |
IPV at 14 weeks | 88.1% (n = 81) | 79.5–93.3% |
Polio-2 | 90.2% (n = 83) | 82.1–94.9% |
Penta-2 | 90.2% (n = 83) | 82.1–94.9% |
PCV-2 | 89.1% (n = 82) | 80.8–94.1% |
Polio-3 | 84.8% (n = 78) | 80.8–94.1% |
Penta-3 | 83.7% (n = 77) | 79.5–93.3% |
PCV-3 | 82.6% (n = 76) | 80.8–94.1% |
Rota-1 | 97.8% (n = 90) | 91.6–99.5% |
Rota-2 | 91.3% (n = 84) | 83.4–95.6% |
Measles at 9 months | 91.3% (n = 84) | 83.4–95.6% |
Variables | Frequency | Percentage (%) |
---|---|---|
Why children do not vaccinate | ||
Health workers did not come to the village | 247 | 58.9 |
Domestic workload | 180 | 43.0 |
Vaccination service not accessible | 155 | 37.0 |
Vaccination site closed/vaccinator absent | 153 | 36.5 |
Long waiting time | 138 | 32.9 |
No vaccine at the vaccination sites | 106 | 25.3 |
My husband discouraged me | 71 | 16.9 |
Vaccination makes them sick | 33 | 7.9 |
Vaccinator not friendly/poor relationship | 32 | 7.6 |
Family/community discouraged me | 27 | 6.4 |
Cultural or religious norms or beliefs | 14 | 3.3 |
Vaccine approval status | ||
Yes | 308 | 73.5 |
No | 85 | 20.3 |
Not sure/do not know | 26 | 6.2 |
Approved positively by | ||
Husband/partner | 301 | 97.7 |
Parents/parents-in-laws | 134 | 43.5 |
Neighbors/peers | 105 | 34.1 |
Other family members | 27 | 8.8 |
Difficulty in remembering the vaccination schedule (n = 247) | ||
Not difficult at all | 51 | 20.7 |
Somewhat difficult | 52 | 21.1 |
Very difficult | 161 | 65.2 |
Cultural taboos against vaccinating (n = 419) | ||
Yes | 66 | 15.8 |
No | 328 | 78.3 |
Do not know/not sure | 25 | 6.0 |
Variables | Fully Immunized | Crude Odds Ratio | Adjusted Odds Ratio | |
---|---|---|---|---|
Yes | No | |||
Health center distance | ||||
<30 min | 55 | 82 | 3.11 (197–4.92) | 1.76 (0.40–1.41) |
≥30 min | 50 | 232 | 1 | 1 |
Owning a mobile phone | ||||
Yes | 95 | 212 | 4.57 (2.29–9.14) | 2.99 (1.33–6.76) ** |
No | 10 | 102 | 1 | 1 |
Maternal education | ||||
Formal education | 23 | 2 | 10.73 (4.63–24.87) | 3.90 (1.53–9.98) ** |
No formal education | 82 | 306 | 1 | 1 |
Child’s age | ||||
12–15 | 42 | 156 | 0.62 (0.37–1.04) | 0.66 (0.35–1.25) |
16–19 | 26 | 73 | 0.82 (0.45–1.48) | 0.61 (0.31–1.23) |
20–23 | 37 | 85 | 1 | |
ANC visit | ||||
Yes | 91 | 149 | 7.19 (3.93–13.18) | 2.39 (1.14–5.01) ** |
No | 14 | 165 | 1 | 1 |
Place of birth | ||||
Health facility | 87 | 105 | 9.62 (5.50–16.83) | 5.79 (2.77–12.12) ** |
Home | 18 | 209 | 1 | 1 |
Birth order | ||||
First | 15 | 33 | 1.64 (0.81–3.33) | 0.99 (0.42–2.36) |
Second | 23 | 58 | 1.43 (0.78–2.61) | 1.32 (0.62–2.79) |
Third | 29 | 86 | 1.22 (0.69–2.11) | 1.08 (0.57–2.07) |
Fourth and later | 38 | 137 | 1 | |
Information received during post-natal period | ||||
Yes | 38 | 65 | 2.17 (1.34–3.52) | 0.74 (0.39–1.38) |
No | 67 | 249 | 1 |
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Share and Cite
Muluneh, M.D.; Abebe, S.; Ayele, M.; Mesfin, N.; Abrar, M.; Stulz, V.; Berhan, M. Vaccination Coverage and Predictors of Vaccination among Children Aged 12–23 Months in the Pastoralist Communities of Ethiopia: A Mixed Methods Design. Int. J. Environ. Res. Public Health 2024, 21, 1112. https://doi.org/10.3390/ijerph21081112
Muluneh MD, Abebe S, Ayele M, Mesfin N, Abrar M, Stulz V, Berhan M. Vaccination Coverage and Predictors of Vaccination among Children Aged 12–23 Months in the Pastoralist Communities of Ethiopia: A Mixed Methods Design. International Journal of Environmental Research and Public Health. 2024; 21(8):1112. https://doi.org/10.3390/ijerph21081112
Chicago/Turabian StyleMuluneh, Muluken Dessalegn, Sintayehu Abebe, Mihret Ayele, Nuhamin Mesfin, Mohammed Abrar, Virginia Stulz, and Makida Berhan. 2024. "Vaccination Coverage and Predictors of Vaccination among Children Aged 12–23 Months in the Pastoralist Communities of Ethiopia: A Mixed Methods Design" International Journal of Environmental Research and Public Health 21, no. 8: 1112. https://doi.org/10.3390/ijerph21081112