Determinants of immunization status among 12-24 months old children in Ethiopia: Using 2019 Ethiopian mini demographic and health survey data

Polio vaccination and marginal effects among children aged 12-23 months in Lesotho using 2024 LDHS data: A multilevel analysis approach

BACKGROUND

Infectious diseases that have affected countless newborns, children, and adults can be avoided with polio vaccination. The WHO and Lesotho's health strategy placed a strong emphasis on vaccination as a means of preventing and controlling infectious diseases. The current study's goal was to indicate marginal effects and identify the determinants of polio vaccination status in children between the ages of 12 and 23 months.

METHODS

The polio vaccination status in Lesotho was evaluated using LDHS data collected from 490 children aged 12-23 months. The prevalence of polio vaccination was presented through frequencies and percentages. The heterogeneity in child polio vaccination status across clusters was determined using the ICC value and the chi-square test. The data was analyzed using a multilevel ordinal model, and model selection was based on IC values.

RESULTS

The descriptive findings of the study revealed that approximately 29.6% of children were not fully vaccinated against polio. The use of multilevel analysis was deemed appropriate based on a significant chi-square result (p-value = 0.033). Clusters accounted for approximately 15.9% (ICC = 15.88) of the overall variation in polio vaccination status among children. The final adjusted random intercept PO model indicated a significant relationship (p-value < 0.05) between children's polio vaccination status and factors such as district type, health facility visits in the past 12 months, number of ANC visits, place of delivery, and family size. The marginal effects of these key variables were also significant for each category of polio vaccination status.

CONCLUSIONS

In Lesotho and around the world, polio vaccination is a crucial health measure to enhance children's development. Approximately 29.6% of the children in the study were not fully vaccinated. These rates differed by district and the number of ANC visits the moms had. Treatments and safeguards for children's health should be more focused on enhancing medical facilities and services and encouraging ANC visits to receive care.

Changes and determinants of pneumococcal vaccine uptake in Ethiopia

Pneumococcal pneumonia is one of the most common causes of severe pneumonia and pneumonia-related mortality globally. It ranked among the leading causes of morbidity and mortality in children under five years in Ethiopia. Vaccination reduces the burden of pneumonia and pneumococcal infections in both children and adults. This study assesses changes in pneumococcal vaccine coverage over time and identifies factors associated with the vaccine uptake. The study was based on secondary data from the Ethiopian Demographic and Health Surveys (EDHS) in 2016 and 2019, involving 1,929 children in 2016 and 1,008 in 2019, aged 12-23 months. A cross-sectional study design was conducted. The percentage change in pneumococcal conjugate vaccine (PCV) coverage was used to quantify the degree of change over time, while multilevel ordinal logistic regression identifies significant factors. All statistical tests were performed using a 5% significance threshold. The study found a significant 21.8% (95% CI: 9.8-35.2) change in the proportion of children receiving complete doses of PCV, from 49.1% in 2016 to 59.8% in 2019. Children in rural areas were 69% less likely to receive more doses of PCV vaccinations than those living in urban areas (AOR = 0.307, 95% CI: 0.127 - 0.742). Second or higher-order births were associated with greater uptake doses of PCV (AOR = 2.519, 95% CI: 1.143-5.548). Child born in health facilities were 2.35 times more likely to receive full vaccination than those born at home (AOR = 2.350, 95% CI: 1.132-4.882). Additionally, children whose mothers had more antenatal care (ANC) visits were more likely to complete their pneumococcal vaccination. Despite the increase in uptake, Ethiopia remains far from reaching its immunization goals. The study showed that place of residence, birth order, place of delivery, antenatal care and regional variation were significantly associated with pneumococcal vaccine uptake.

Exploring factors influencing childhood immunization status in East Africa using multilevel ordinal logistic regression analysis

Introduction

Childhood vaccinations are crucial in safeguarding children from infectious diseases and are recognized as one of the most cost-effective public health interventions. However, children in East African countries face more than a fifteen-fold increased risk of death from vaccine-preventable diseases compared to those in high-income nations. This study aimed to identify the factors influencing childhood immunization status in East Africa.

Methods

A sample of 22,734 children aged 12 to 23 months was included to assess immunization status, utilizing recent data from the Demographic and Health Survey conducted between 2015 and 2022 across ten East African countries. A Level-3 multilevel generalized odds model with a logit link function was employed for the analysis.

Results

Among the 22,734 children in the sample, only 67.4% were fully immunized, 27.7% were partially immunized, and the remaining were not immunized at all. The null hypothesis of proportionality was rejected based on the Brant test. Consequently, various partial and non-proportional odds models were fitted, with the generalized odds model demonstrating the best fit compared to other ordinal regression models. The findings indicated that 43.14% of the variation in children's immunization status was attributable to differences between countries, while 18.18% was due to variations between regions. Specific factors associated with immunization status revealed that mothers who attended antenatal care were 1.23 times more likely to fully immunize their children compared to those who did not, and those who received postnatal care were 1.13 times more likely to do so. Additionally, mothers who had antenatal and postnatal services were 1.07 and 1.08 times more likely, respectively, to fully or partially immunize their children compared to those who did not.

Conclusion

The fitted generalized odds model indicated that several factors significantly associated with childhood immunization status included maternal age, number of antenatal and postnatal care visits, tetanus injections received by mothers, vitamin A intake, presence of health documentation, place of delivery, birth order, mother's occupation, sex of the household head, distance to health facilities, maternal education, community maternal education, community wealth index, and community media exposure. Therefore, it is recommended that interventions focus on enhancing household wealth, educating mothers, and improving health systems.

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.