Timely completion of vaccination and its determinants among children in northwest, Ethiopia: a multilevel analysis

Abstract

Background: Timely vaccination is key to prevent unnecessary childhood mortality from vaccine-preventable diseases. Despite the substantial efforts to improve vaccination completeness, the effort towards timeliness of vaccination is limited with non-attendance and delays to vaccination appointments remaining a big challenge in developing countries. There is also a limited evidence on timeliness of vaccination. Therefore, this study aimed to determine the magnitude and associated factors for timely completion of vaccination among children in Gondar city administration, northwest , Ethiopia. Method: This study employed a community-based cross sectional study design. A sample size of 821 children aged 12 to 23 months were considered. Two stages random sampling technique was used to select study subjects. To account the effect of clustering, bivariable and multivariable multilevel logistic regression analysis were applied. The measures of association estimates were expressed as adjusted odds ratio (AOR) with their 95% confidence intervals (CIs). Results: Of the 774 children included for analysis, 498 (64.3%) were fully vaccinated while 247 (31.9%) were fully vaccinated on-time. Caregivers who had secondary education and above (AOR = 2.391; 95% CI: 1.317-4.343), from richest households (AOR = 2.381; 95% CI: 1.502-3.773), children whose mother attended four or more ante natal care visits (AOR = 2.844; 95% CI: 1.310-6.174) and whose mother had two or more post natal care visits (AOR = 2.054; 95%CI:1.377-3.063) were positively associated with on-time full vaccination. In contrary, caregivers aged above 35 years (AOR = 0.469; 95 % CI: 0.253-0.869], being vaccinated at health post (AOR = 0.144; 95%CI: 0.048-0.428) and travelling more than 30 min to the vaccination site (AOR = 0.158; 95%CI: 0.033-0.739) were negatively associated with on-time full vaccination. The random effects indicated that 26% of the variability in on-time full vaccination was attributable to differences between communities. Conclusion: In this study, untimely vaccination was found to be high. Different individual and contextual factors were found to be associated with on-time full vaccination. Therefore, tailored strategies have to be designed and implemented to address people and the communities where they live. Moreover, timeliness of vaccination should be considered as important indicator of the immunization program performance in Ethiopia.

Factors Influencing Childhood Immunization Uptake in Africa: A Systematic Review.

“…Furthermore, this could also be as a result of changes that accompany maternal education, such as changes in attitudes, traditions and beliefs, increased autonomy and control over household resources which enhance healthcare seeking [53]. Similar ndings have been reported in many studies [53,15,54,18,[66][67][68]70].…”

“…The study showed mothers who frequently attend ANC during their pregnancy were about four times more likely to have their children fully vaccinated compared with mothers who did not attend ANC regularly [16]. This nding is supported by the ndings of a study conducted in Uganda and four more studies from Ethiopia [19,66,67,68,70]. Mothers who frequented health facilities during pregnancy may have received counselling on childhood immunisation where the importance of timely childhood immunisation uptake may be prioritised regularly [16].…”

“…Three different cross-sectional studies conducted in Ethiopia among children aged 12-23 months found wealth index to be a factor in uencing childhood immunisation uptake. Children born to mothers from a rich index group were found to be twice as likely to be fully vaccinated compared with children from mothers from a poor wealth index group [20,66,70]. Rich parents may have more access to media and probably have more exposure to information on the bene t of childhood immunisation uptake.…”

“…In respect to parental socio-demographic factors, three studies reported maternal age (AOR=1.08-9.54; 95% CI: 1.08, 18.09; p<0.05) [30,31,33], nine studies reported maternal educational status (AOR=3.55-7.50; 95% CI: 1.02, 10.60) [15,18,53,54,18,66,67,68,70], three studies reported paternal education (AOR=3.1; 95% CI: 1.3, 7.4) [16,44,59], three studies reported maternal occupation and mothers' marital status respectively (AOR=1.62-3.01; 95% CI: 1.0, 5.8) [16,66,37,58]. Another two studies reported area of residence (AOR=2.70; 95% CI: 1.52, 4.81) [18,53], wealth index was reported in three studies (AOR=1.4-2.38; 95% CI: 1.06, 3.73) [20, 66.…”

National trends of childhood vaccination coverage in Bangladesh: Understanding gaps from 2011, 2014 and 2017-18 Demographic and Health Surveys data

“…Most of these de ciencies in childhood vaccination coverage are recorded in low-and-middle-income countries (LMICs). Evidence from Ethiopia suggests that in 2018, more than 1.2 million children were not vaccinated with the rst dose of measles vaccines [11]. The WHO asserts that, in remote rural areas of LMICs, only 1 out of 20 children have access to vaccination [12].…”