Association of War With Vaccination Dropout Among Children Younger Than 2 Years in the North Wollo Zone, Ethiopia

Abstract

ImportanceA civil war that lasted for about 6 months in the North Wollo zone of Ethiopia destroyed numerous health care facilities. However, no studies have been conducted to determine the association of the war with vaccination dropout in the area.ObjectiveTo assess the association of war with vaccination dropout among children younger than 2 years in the North Wollo zone.Design, Setting, and ParticipantsThis population-based cross-sectional study was conducted in the North Wollo zone from April 1 to June 30, 2022. Participants included children younger than 2 years and their mothers. A multistage sampling technique was used to select the participants.Main Outcomes and MeasuresA vaccination dropout rate (yes or no) was assessed by interviewing mothers.ResultsThe study included 449 children younger than 2 years and their mothers, 291 (64.8%) of whom were 20 to 34 years of age. Almost all of the mothers (426 [94.9%]) were married. More than half of the mothers (271 [60.4%]) had a primary level education. Seventy-one children (15.8%) in the area received all basic vaccinations. One hundred ninety-eight children (44.1%) who started vaccination prior to the war dropped out of the immunization program. Additionally, 64 children (14.3%) born during the war did not receive any vaccination. Losing a family member (adjusted odds ratio [AOR], 3.11 [95% CI, 1.63-5.93]; P = .001), not being informed about catch-up vaccination (AOR, 2.18 [95% CI, 1.39-3.43]; P < .001), being a rural resident (AOR, 2.22 [95% CI, 1.37-3.58]; P < .001), home birth (AOR, 1.75 [95% CI, 1.11-2.77]; P = .002), and length of war (AOR for 5 months, 0.51 [95% CI, 0.28-0.93; P = .04]) were associated with the outcome variable.Conclusions and RelevanceThe findings of this cross-sectional study suggest that nearly 60% of children in the North Wollo zone remained undervaccinated or unvaccinated. Stakeholders should make coordinated efforts to overcome the humanitarian crisis in the area and optimize the accessibility of health services.

Not only vaccine hesitancy, but also vaccination campaign hesitancy drives measles epidemics in conflict-torn eastern DR Congo

“…Armed conflict often disrupts societies and hampers access to health care [ 6 ]. Children who are affected by conflict suffer disproportionately from vaccine-preventable disease (VPD) outbreaks [ 7 ]. More than two-thirds of children who have not received their essential vaccines, live in countries that are either partially or entirely affected by conflict [ 6 ].…”

“…More than two-thirds of children who have not received their essential vaccines, live in countries that are either partially or entirely affected by conflict [ 6 ]. Even if health structures are not directly targeted in the Masisi region, the conflict increases food insecurity and forces people to flee into the bushes or gather in small towns where health infrastructure was already precarious before [ 7 ]. Crowding in a population with low vaccination coverage and a high malnutrition rate, inevitably leads to VPD outbreaks (like measles) [ 6 , 7 ].…”

“…It is of utmost importance to uphold and strengthen international treaties that protect essential medical services (like vaccination) during conflict, also in remote areas, not just in theory but in practice [ 6 ]. In North-Kivu, we believe that it is crucial to negotiate a humanitarian corridor with the belligerent parties to allow catch-up vaccination and health promotion [ 7 ]. The use of new technologies could facilitate such an effort [ 6 ]: one could for example map populations with satellites or explore the possibility of drones to deliver vaccines when roads are less accessible.…”

The status of immunization program and challenges in Ethiopia: A mixed method study

“…According to a study conducted in Ethiopia, only 39.9% of children aged 12–23 months had received all recommended vaccinations. 15 This demonstrates the necessity of assessing the regular immunization program’s efficacy to identify areas that call for improvement. Furthermore, data quality issues that emanate from poor recording and reporting affect the accuracy of vaccination coverage.…”

JAMA Network Open—The Year in Review, 2022

“…13 We strongly believe that this fits with the mission of the journal and our commitment to serve a global audience of readers. The response to the call has been rewarding, with important studies on the effect of war on vaccination of children, 14 disability among veterans related to Gulf War Illness, 15 interventions to treat combat-related posttraumatic stress disorder, 16 and support for medical professionals in Ukraine. 17 Our other calls for papers on enhancing aging and ending agesim, 18 prevention and the effect of systemic racism in health, 19 and severe maternal Finally, our greatest expression of appreciation is to our authors, who have entrusted JAMA Network Open with the fruits of their toil and the many patients, families, and members of the community who participated in the studies and made all of this possible.…”