The association between travel time to health facilities and childhood vaccine coverage in rural Ethiopia. A community based cross sectional study

Abstract

BackgroundFew studies have examined associations between access to health care and childhood vaccine coverage in remote communities that lack motorised transport. This study assessed whether travel time to health facilities was associated with childhood vaccine coverage in a remote area of Ethiopia.MethodsThis was a cross-sectional study using data from 775 children aged 12–59 months who participated in a household survey between January –July 2010 in Dabat district, north-western Ethiopia. 208 households were randomly selected from each kebele. All children in a household were eligible for inclusion if they were aged between 12–59 months at the time of data collection. Travel time to vaccine providers was collected using a geographical information system (GIS). The primary outcome was the percentage of children in the study population who were vaccinated with the third infant Pentavalent vaccine ([Diphtheria, Tetanus,-Pertussis Hepatitis B, Haemophilus influenza type b] Penta3) in the five years before the survey. We also assessed effects on BCG, Penta1, Penta2 and Measles vaccines. Analysis was conducted using Poisson regression models with robust standard error estimation and the Wald test.ResultsMissing vaccination data ranged from 4.6% (36/775) for BCG to 16.4% (127/775) for Penta3 vaccine. In children with complete vaccination records, BCG vaccine had the highest coverage (97.3% [719/739]), Penta3 coverage was (92.9% [602/648]) and Measles vaccine had the lowest coverage (81.7% [564/690]). Children living ≥60mins from a health post were significantly less likely (adjRR = 0.85 [0.79-0.92] p value < =0.001) to receive Penta3 vaccine compared to children living <30mins from a health post. This effect was not modified by household wealth (p value = 0.240). Travel time also had a highly significant association with BCG (adjRR = 0.95 [0.93-0.98] p value =0.002) and Measles (adjRR = 0.88 [0.79-0.97] p value =0.027) vaccine coverage.ConclusionsTravel time to vaccine providers in health posts appeared to be a barrier to the delivery of infant vaccines in this remote Ethiopian community. New vaccine delivery strategies are needed for the hardest to reach children in the African region.

Barriers to access for severe acute malnutrition treatment services in Pakistan and Ethiopia: a comparative qualitative analysis

“…In Ethiopia the acceptability of distance to services differed based on the time-intensiveness of other domestic responsibilities such as fetching water and caring for cattle or other family members. Other evidence from rural Ethiopia further highlights the critical implications of distance barriers, showing that children living more than 1·5 h from a health centre (but not from health posts) have a two to three times greater risk of death than those living closer (27) and that travel time is significantly associated with coverage of important childhood vaccines (28) . Both of these Ethiopian studies suggest that households in remote rural areas are more vulnerable to the distance barrier compared with those in more densely populated areas.…”

Reasons for defaulting from childhood immunization program: a qualitative study from Hadiya zone, Southern Ethiopia

“…A few studies also identified household income, child illness [19, 20], poor male partner involvement [15], and large family size [16] to be associated with defaulting. Incomplete immunization is also commonly linked to weaknesses in the health systems, such as the lack of vaccines during vaccination sessions [17] and poor geographic access and long distance from the sites [7, 8, 12, 15, 21], including in urban settings [13]. Poor service arrangements with long waiting time [13, 15], inconvenient schedules [16], unwelcoming health care environment [16, 19], and not holding sessions as planned [22] were also mentioned.…”

Factors influencing the uptake of influenza vaccine vary among different groups in the hard‐to‐reach population

“…Traditionally, outreach vaccination programs have been used in low‐ and middle‐income countries. Some communities in these countries frequently have difficulty accessing vaccines due to geographical barriers to healthcare facilities 25–27 . Since early 2000, the World Health Organization advocated using the ‘Reaching Every District’ (RED) strategy to reach out to under‐served, un‐reached communities 28 .…”

“…Some communities in these countries frequently have difficulty accessing vaccines due to geographical barriers to healthcare facilities. [25][26][27] Since early 2000, the World Health Organization advocated using the 'Reaching Every District' (RED) strategy to reach out to under-served, un-reached communities. 28 This has been successfully rolled out in certain countries.…”