Immunization coverage and its associated factors among children aged 12–23 months in Ethiopia: An umbrella review of systematic review and meta-analysis studies

Abstract

Background Immunization estimated to prevent 2 to 3 million children deaths every year from vaccine preventable disease. In Ethiopia, limited and inconclusive studies have been conducted on immunization coverage so far. Therefore, this umbrella review was intended to estimate the pooled national immunization coverage and its associated factors among children age 12–23 months in Ethiopia. Methods This umbrella review included five systematic reviews and meta-analyses through literature search from PubMed, Science direct, and web of science, CINHALE, and data bases specific to systematic reviews such as the Cochrane Database of Systematic Reviews and Prospero, the International Prospective Register of Systematic Reviews from May 1 to 30/ 2023. Only systematic reviews and meta-analyses published in English from inception to May 1, 2023, were included. The quality of each study was assessed using Assessment of Multiple Systematic Reviews. Data were extracted using Microsoft excel 2016 and analyzed using STATA 17.0 statistical software. Heterogeneity among studies was assessed using the Cochran Q statistics and I2 test. The pooled effect sizes were determined using pooled proportion for the full vaccination coverage and odds ratios for the associated factors with the corresponding 95% confidence interval were used to declare statically significance. Results Five studies with 77,161 children aged 12–23 months were included. The overall pooled full vaccination coverage was 57.72% (95% CI 50.17, 65.28). Institutional delivery (OR: 2.12, 95% CI: 1.78–2.52), travel to vaccination site for <2 hours (OR: 2.43, 95%CI: 1.97–3.00), received at least one antenatal (ANC) visit (OR: 3.2, 95%CI: 2.46–4.1), good maternal knowledge of immunization (OR: 3.63, 95%CI: 2.82–4.67), being informed on immunization schedule (OR: 2.54, 95%CI: 2.02–3.2), living in urban areas (OR: 2, 95% CI: 1.54–2.6), and a household visit by health-care providers (HCP) during the postnatal period (OR: 2.23, 95%CI: 1.22–4.09) were the independent predictors of immunization coverage. Conclusion This study showed the full immunization coverage in Ethiopia was lower compared to the WHO-recommended level. Besides, the current umbrella review identifies several factors that contribute to higher immunization coverage. These includes; institutional delivery, near to vaccination site, having ANC visit, being urban residence, household visited by HCP, having good knowledge and informed on immunization schedule. Thus, the government should intensify the growth of immunization services by emphasizing outreach initiatives to reach remote areas and professionals must combine child immunization service with other medical services offered by health institutions.

Mapping geographical inequalities of incomplete immunization in Ethiopia: a spatial with multilevel analysis

“…In response to this pressing issue, the Ethiopian government designed and implemented various strategies. These included mobilizing volunteers, health extension workers, and healthcare facilities to expand immunization services, with the aim of substantially reducing morbidity and mortality among children under five from vaccine-preventable diseases ( 8 , 10 ). Following to these efforts, there has been a slight improvement in immunization coverage ( 8 , 11 ), with a noteworthy reduction in under-five mortality rates ( 11 , 12 ).…”

“…Various interconnected and interrelated individual, community, and service delivery-related factors affect the childhood immunization level in the country. Existing literature has primarily shown that individual-level factors, including mothers' educational status, antenatal care follow-up, place of delivery, postnatal care, residence, media exposure, and wealth level, play a significant role in determining the level of childhood immunization ( 10 , 14 – 20 ). In contrast, the influence of community-level factors on incomplete immunization has not been adequately investigated in Ethiopia.…”