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Environmental Health and Preventive Medicine
Published in: Environmental Health and Preventive Medicine 1/2021

Open Access 01-12-2021 | Research article

Geographical variations and associated factors of defaulting from immunization among children aged 12 to 23 months in Ethiopia: using spatial and multilevel analysis of 2016 Ethiopian Demographic and Health Survey

Authors: Mukemil Awol, Zewdie Aderaw Alemu, Nurilign Abebe Moges, Kemal Jemal

Published in: Environmental Health and Preventive Medicine | Issue 1/2021

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Abstract

Background

In Ethiopia, despite the considerable improvement in immunization coverage, the burden of defaulting from immunization among children is still high with marked variation among regions. However, the geographical variation and contextual factors of defaulting from immunization were poorly understood. Hence, this study aimed to identify the spatial pattern and associated factors of defaulting from immunization.

Methods

An in-depth analysis of the 2016 Ethiopian Demographic and Health Survey (EDHS 2016) data was used. A total of 1638 children nested in 552 enumeration areas (EAs) were included in the analysis. Global Moran’s I statistic and Bernoulli purely spatial scan statistics were employed to identify geographical patterns and detect spatial clusters of defaulting immunization, respectively. Multilevel logistic regression models were fitted to identify factors associated with defaulting immunization. A p value < 0.05 was used to identify significantly associated factors with defaulting of child immunization.

Results

A spatial heterogeneity of defaulting from immunization was observed (Global Moran’s I = 0.386379, p value < 0.001), and four significant SaTScan clusters of areas with high defaulting from immunization were detected. The most likely primary SaTScan cluster was seen in the Somali region, and secondary clusters were detected in (Afar, South Nation Nationality of people (SNNP), Oromiya, Amhara, and Gambella) regions. In the final model of the multilevel analysis, individual and community level factors accounted for 56.4% of the variance in the odds of defaulting immunization. Children from mothers who had no formal education (AOR = 4.23; 95% CI: 117, 15.78), and children living in Afar, Oromiya, Somali, SNNP, Gambella, and Harari regions had higher odds of having defaulted immunization from community level.

Conclusions

A clustered pattern of areas with high default of immunization was observed in Ethiopia. Both the individual and community-level characteristics were statistically significant factors of defaulting immunization. Therefore, the Federal Ethiopian Ministry of Health should prioritize the areas with defaulting of immunization and consider the identified factors for immunization interventions.
Literature
1.
Vakili R, Ghazizadeh Hashemi A, Khademi G, Ajilian Abbasi M, Saeidi M. Immunization coverage in WHO regions: a review article. Int J Pediatr. 2015;3(2.1):111–8.
2.
World Health Organization. Immunization in biologicals practice: a practical guide for health staff: World Health Organization; 2015.
3.
4.
Peck M, Gacic-Dobo M, Diallo MS, Nedelec Y, Sodha SS, Wallace AS. Global routine vaccination coverage, 2018. Morb Mortal Wkly Rep. 2019;68(42):937.CrossRef
5.
Vanderslott S, Dadonaite B, Roser M. Vaccination. Our World in Data; 2013.
6.
7.
Bhatti UA, Huang M, Wang H, Zhang Y, Mehmood A, Di W. Recommendation system for immunization coverage and monitoring. Human Vaccin Immunotherapeutics. 2018;14(1):165–71.CrossRef
8.
World Health Organization. Children: reducing mortality. Wkly Epidemiol Rec. 2014;89(38):418–20.
9.
10.
Ethiopia Demographic and Health Survey, 2016: ICF International, Central Statistical Agency, uly 2017; 2016.
11.
Facha W. Fully vaccination coverage and associated factors among children aged 12 to 23 months in Arba Minch Zuriya Woreda, Southern Ethiopia. J Pharm Altern Med. 2015;7:19–25.
12.
Tadesse H, Deribew A, Woldie M. Explorative assessment of factors affecting child immunization in Wonago district, Gedeo zone, South Ethiopia. Arch Med Sci. 2009;5(2):233.
13.
Kelkay BD, Seid KW. Identifying determinants of vaccination status of under five children in South Omo Zone, SNNPR, Ethiopia. Am J Theor Appl Stat. 2018;7(6):229–34.
14.
Debie A, Taye B. Assessment of fully vaccination coverage and associated factors among children aged 12-23 months in Mecha district, North West Ethiopia: a cross-sectional study. Sci J Public Health. 2014;2(4):342–8.CrossRef
15.
Mekonnen AG, Bayleyegn AD, Ayele ET. Immunization coverage of 12–23 months old children and its associated factors in Minjar-Shenkora district, Ethiopia: a community-based study. BMC Pediatr. 2019;19(1):198.PubMedPubMedCentralCrossRef
16.
Gualu T, Dilie A. Vaccination coverage and associated factors among children aged 12–23 months in Debre Markos town, Amhara regional state, Ethiopia. Adv Public Health. 2017;2017.
17.
Jiang Y, Fan F, Zanoni IH, Li Y. Global diffusion pattern and hot SPOT analysis of vaccine-preventable diseases. ISPRS Annals of the Photogrammetry, Remote Sensing and Spatial. Inf Sci. 2017;4:167.
18.
Srikanth J, Kumar P, Upadhya KG, Rajanna P. A comparative study on vaccination default rates among children aged 9-24 months attending a static immunization clinic in urban and rural area of Bangalore. Int J Community Med Public Health. 2018;6(1):248–52.CrossRef
19.
Uthman OA, Sambala EZ, Adamu AA, Ndwandwe D, Wiyeh AB, Olukade T, et al. Does it really matter where you live? A multilevel analysis of factors associated with missed opportunities for vaccination in sub-Saharan Africa. Human Vaccin Immunotherapeutics. 2018;14(10):2397–404.CrossRef
20.
Acharya P, Kismul H, Mapatano MA, Hatløy A. Individual-and community-level determinants of child immunization in the Democratic Republic of Congo: a multilevel analysis. PLoS One. 2018;13(8):e0202742.PubMedPubMedCentralCrossRef
21.
Adedokun ST, Uthman OA, Adekanmbi VT, Wiysonge CS. Incomplete childhood immunization in Nigeria: a multilevel analysis of individual and contextual factors. BMC Public Health. 2017;17(1):236.PubMedPubMedCentralCrossRef
22.
Kidane T, Tekie M. Factors influencing child immunization coverage in a rural district of Ethiopia, 2000. Ethiop J Health Dev. 2003;17(2):105–10.
23.
Roy SG. Risk factors for childhood immunization incompletion in Ethiopia; 2010.
24.
Ibnouf A, Van den Borne H, Maarse J. Factors influencing immunisation coverage among children under five years of age in Khartoum State, Sudan. S Afr Fam Pract. 2007;49(8):14–f.CrossRef
25.
Belete H, Kidane T, Bisrat F, Molla M, Mounier-Jack S, Kitaw Y. Routine immunization in Ethiopia. Ethiop Jo Health Dev. 2015;29(1).
26.
Abadura SA, Lerebo WT, Kulkarni U, Mekonnen ZA. Individual and community-level determinants of childhood full immunization in Ethiopia: a multilevel analysis. BMC Public Health. 2015;15(1):972.PubMedPubMedCentralCrossRef
27.
Bago BJ, Terefe W, Mirutse G. Individual, and community-level factors associated with defaulting of immunization among 12-59 months children in Ethiopia: multilevel modeling analysis using 2011 Ethiopia Demographic and Health Survey. Curr Pediatr Res. 2018;22(1).
28.
29.
30.
Ethiopia Demographic and Health Survey 2016. Addis Ababa and Calverton: Central Statistical Agency and ICF International. 2017.
31.
Central Statistical Agency [Ethiopia] and ICF International. Ethiopia Demographic and Health Survey. 2011.
32.
33.
34.
Alebachew A, Waddington C. Improving health system efficiency: Ethiopia: human resources for health reforms: World Health Organization; 2015.
35.
Ethiopian Ministry Of Health. Health Sector Development Program IV 2010/11–2014/15. 2010.
36.
Kassebaum NKH, Zoeckler L, Olsen HE, Thomas K, et al. Global Burden of Disease Child and Adolescent Health findings from the global burden of diseases, injuries, and risk factors 2015 study. JAMA Pediatr. 2017;1(71):573–92.
37.
Central statistical agency (CSA)[Ethiopia] and ICF. Ethiopia Demographic and Health Survey. Addis Ababa and Calverton; 2016.
38.
World Health Organization. Immunization, vaccines, and biologicals: implementation research in immunization. 2017.
39.
World Health Organization. WHO recommendations on antenatal care for a positive pregnancy experience: World Health Organization; 2016.
40.
Snijders TA, Bosker RJ. Multilevel analysis: an introduction to basic and advanced multilevel modeling: Sage; 2011.
41.
Huang L, Pickle LW, Das B. Evaluating spatial methods for investigating global clustering and cluster detection of cancer cases. Stat Med. 2008;27(25):5111–42.PubMedPubMedCentralCrossRef
42.
Anselin L, Bera AK, Florax R, Yoon MJ. Simple diagnostic tests for spatial dependence. Reg Sci Urban Econ. 1996;26(1):77–104.CrossRef
43.
Kulldorff M, Nagarwalla N. Spatial disease clusters: detection and inference. Stat Med. 1995;14(8):799–810.PubMedCrossRef
44.
Ekouevi DK, Gbeasor-Komlanvi FA, Yaya I, Zida-Compaore WI, Boko A, Sewu E, et al. Incomplete immunization among children aged 12–23 months in Togo: a multilevel analysis of individual and contextual factors. BMC Public Health. 2018;18(1):952.PubMedPubMedCentralCrossRef
45.
Shamsul Azhar S, Nirmal K, Nazarudin S, Rohaizat H, Azimatun Noor A. Factors influencing childhood immunization defaulters in Sabah, Malaysia. Int Med J Malaysia. 2012;11:17–22.
46.
Bogale T. Assessment of incomplete vaccination and associated risk factors among children under one year at Guder Hospital, West Shoa Zone, Oromia Regional State, Ethiopia. Assessment. 2017;45.
47.
Zewdie A, Letebo M, Mekonnen T. Reasons for defaulting from childhood immunization program: a qualitative study from Hadiya zone, Southern Ethiopia. BMC Public Health. 2016;16(1):1240.PubMedPubMedCentralCrossRef
48.
Lakew Y, Bekele A, Biadgilign S. Factors influencing full immunization coverage among 12–23 months of age children in Ethiopia: evidence from the national demographic and health survey in 2011. BMC Public Health. 2015;15(1):728.PubMedPubMedCentralCrossRef
49.
Tamirat KS, Sisay MM. Full immunization coverage and its associated factors among children aged 12–23 months in Ethiopia: further analysis from the 2016 Ethiopia demographic and health survey. BMC Public Health. 2019;19(1):1019.PubMedPubMedCentralCrossRef
50.
Shifti DM, Chojenta C, G. Holliday E, Loxton D. Individual, and community-level determinants of short birth interval in Ethiopia: a multilevel analysis. PLoS One. 2020;15(1):e0227798.PubMedPubMedCentralCrossRef
51.
Aychiluhm SB, Tadesse AW, Mare KU, Abdu M, Ketema A. A multilevel analysis of short birth interval and its determinants among reproductive-age women in developing regions of Ethiopia. PLoS One. 2020;15(8):e0237602.PubMedPubMedCentralCrossRef
52.
Reading R, Surridge H, Adamson R. Infant immunization and family size. J Public Health. 2014;26(4):369–71.CrossRef
53.
Kapuru W. Factors Associated with immunization drop-out among children of two months to five years of age in Kwanza, Trans-Nzoia District, Kenya: International Health Sciences University; 2016.
54.
Wiysonge C, Uthman O, Ndumbe P, Hussey G. Individual and contextual factors associated with low childhood immunisation coverage in Sub-Saharan Africa: a multilevel analysis. PLoS One. 2012;7:e37905.PubMedPubMedCentralCrossRef
55.
Mesfin G, Schluter W, Gebremariam A, Benti D, Bedada T, Beyene B, et al. Polio outbreak response in Ethiopia. East Afr Med J. 2008;85(5):222–31.PubMedCrossRef
Metadata
Title
Geographical variations and associated factors of defaulting from immunization among children aged 12 to 23 months in Ethiopia: using spatial and multilevel analysis of 2016 Ethiopian Demographic and Health Survey
Authors
Mukemil Awol
Zewdie Aderaw Alemu
Nurilign Abebe Moges
Kemal Jemal
Publication date
01-12-2021
Publisher
BioMed Central
Published in
Environmental Health and Preventive Medicine / Issue 1/2021
Print ISSN: 1342-078X
Electronic ISSN: 1347-4715
DOI
https://doi.org/10.1186/s12199-021-00984-8

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