Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress 2023 EHA Congress 2023 ASCO Annual Meeting
Clinical Collections
Advances in Alzheimer’s

At a glance: The ONWARDS insulin icodec trials

A round-up of the ONWARDS phase 3 clinical trials evaluating the novel weekly insulin icodec in people with diabetes.
ADVANCED SEARCH
Log in
Top
BMC Public Health
Published in: BMC Public Health 1/2015

Open Access 01-12-2015 | Research article

Individual and community level determinants of childhood full immunization in Ethiopia: a multilevel analysis

Authors: Samir A. Abadura, Wondwosen T. Lerebo, Usha Kulkarni, Zeleke A. Mekonnen

Published in: BMC Public Health | Issue 1/2015

Login to get access

Abstract

Background

Expanded program on immunization is one of the most successful and cost effective public health interventions that protect children against vaccine preventable diseases. The full childhood immunization coverage in many parts of Ethiopia is far from optimal. Hence, the main objective of this study was to assess factors associated with childhood full immunization in Ethiopia.

Methods

The data source for this study was the 2011 Ethiopian Demographic and Health Survey. Multilevel regression analysis techniques were used to conduct the analysis. Accordingly a two level multilevel regression analysis model was built with individuals (level 1) nested with in communities (level 2).

Results

A total of 4983 children aged 12–59 months nested within 520 clusters were included in the analysis. According to the analysis results, in the year 2011, 26 % of children less than 5 years old were fully immunized in Ethiopia. Being born at health institutions, higher level of maternal education, media exposure, region of residence and residing in communities possessing higher maternal antenatal care services utilization were positively associated with childhood full immunization. In contrary to this, the number children aged less than 5 years in the household was negatively associated with childhood full immunization. The random effect results indicated that 21 % of the variation among the communities was due to community level factors.

Conclusions

It was found that various individual and contextual factors were associated with childhood full immunization. In addition, significant community level variation remains after having controlled individual and community level factors which is an indicative of a need for further research on community level factors. Hence, utilizing multilevel modeling in determining the effect of both individual and contextual level factors simultaneously had brought an important output which may help planners, policy and decision makers to emphasize on both individuals and communities in which they live.
Literature
1.
2.
3.
4.
WHO. Vaccine preventable diseases monitoring system global summary: immunization, vaccines and biologicals. Geneva: WHO Headquarters; 2010.
5.
Federal Ministry of Health Ethiopia. Ethiopia expanded program on immunization 2006–2010 multiyear plan. Addis Ababa. 2006.
6.
7.
Kidane T, Tekie M. Factors influencing child immunization coverage in rural district of Ethiopia, 2000. Ethiop J Health Dev. 2003;17(2):105–10.
8.
World Health Organization Country Office. Annual report, Ethiopia. 2011.
9.
CSA [Ethiopia], ICF International. Ethiopia demographic and health survey 2011. Addis Ababa, Ethiopia and Calverton, Maryland, USA: Central Statistical Agency and ICF International; 2012.
10.
Ndiritu M, Cowgill KD, Ismail A, Chiphatsi S, Kamau T, Fegan G, et al. Immunization coverage and risk factors for failure to immunize with expanded programme on immunization in Kenya after introduction of new haemophilus influenza type 6 virus and hepatitis 6 virus antigens. BMC Public Health. 2006;6:132.CrossRefPubMedPubMedCentral
11.
Edmunds WJ, Brisson M, Melegaro A, Gay NJ. The potential cost effectiveness of a cellular pertussis booster vaccination in England and Wales. Vaccine. 2002;20:1316–30.CrossRefPubMed
12.
13.
Department of Health and Social Services. Gert Sibande District 1st Quarter Review 2007/2008. District Health Office. Ermelo: Department of Health and Social Services, Mpumalanga.
14.
Babalola S. Determinants of the uptake of the full dose of DPT in northern Nigeria: a multi level analysis Maternal Child Health Journal. Baltimore: Johns Hopkins University; 2008.
15.
16.
Odiit A, Amuge B. Comparison of vaccination status of children born in health units and those born at home. East Afr Med J. 2003;80(1):3–6.PubMed
17.
Etana B, Deressa W. Factors associated with complete immunization coverage in children aged 12–23 months in Ambo Woreda, Central Ethiopia. BMC Public Health. 2012;12:566.CrossRefPubMedPubMedCentral
18.
Haque SMR, Bari W. Positive role of maternal education on measles vaccination coverage in Bangladesh. Int J Psychol Behav Sci. 2013;3(1):11–7.
19.
Wiysonge CS, Uthman OA, Ndumbe PM, Hussey GD. Individual and contextual factors associated with low childhood immunization coverage in Sub-Saharan africa: a multilevel analysis. PLoS One. 2012;7(5):e37905.CrossRefPubMedPubMedCentral
20.
Ibnouf A, Vanden B, Maarse J. Factors influencing immunization coverage among children under five years of age in Khartoum State, Sudan: University of Maastricht. S Afr Fam Pract. 2007;49(8):14.CrossRef
21.
22.
23.
24.
International Institute for Population Sciences and Macro International (IIPS). National family health survey, 2005–2006. India. Mumbai: IIPS; 2008.
25.
Luman ET, McCauley MM, Shefer A, Chu SY. Maternal characteristics associated with vaccination of young children. Paediatrics. 2003;111:1215.
26.
Lerebo W. Religion, education and child immunization in Ethiopia: the impact of maternal religion and education level on the uptake of child immunization in Ethiopian community. 2010. p. 17.
27.
Tagbo BN, Onwuasigwe C. Missed immunization opportunities among children in Enugu. Niger J Paediatr. 2005;32(4):73–6.
28.
Sanou A, Simboro S, Kouyaté B, Dugas M, Graham J, Bibeau G. Assessment of factors associated with complete immunization coverage in children aged 12–23 months: a cross-sectional study in Nouna district, Burkina Faso. BMC Int Health Hum Right. 2009;9 Suppl 1:S10. doi:10.​1186/​1472-69-9-S1-S10.CrossRef
29.
Kidane T, Yigzaw A, Sahilemariam Y, Bulto T, Mengistu H, Malay T, et al. National EPI coverage survey report in Ethiopia, 2006. Ethiop J Health Dev. 2008;22(2):148–57.
30.
Mathew JL. Inequality in childhood immunization in India: a systematic review. Indian Pediatr. 2012;49:203–23.CrossRefPubMed
31.
World Health Organization. State of the world’s vaccines and immunization 2002. Geneva: WHO; 2002.
32.
Antai D. Rural urban inequalities in childhood immunization in Nigeria: the role of community contexts. Afr J Prm Health Care Fam Med. 2011;3(1):Art #238. doi:10.​4102/​phcfm.​v3i1.​238. 8 pages.
33.
Aremu O, Lawoko S, Dalal K. Childhood vitamin A capsule supplementation coverage in Nigeria: a multilevel analysis of geographic and socioeconomic inequities. The Scientific World Journal: TSW Child Health & Human Development. 2010;10:1901–14. doi:10.​1100/​tsw.​2010.​188.CrossRef
34.
Snijders T, Bosker R. Multilevel analysis an introduction to basic and advanced multilevel modeling. 2003. p. 223–6.
35.
Goldstein H. Multilevel statistical models. University of Bristol, UK. 2011;4:1–21.
36.
37.
Darmawan I, Keeves JP. Suppressor variables and multilevel mixture modeling. Int Educ J. 2006;7(2):160–73.
38.
39.
Akaike H. A New look at the statistical model identification. IEEE Trans Autom Control. 1974;19(6):716–23.CrossRef
40.
Angela O, Babatunde F, Akinwumi F, Edet E. Immunization coverage in selected communities in the Niger Delta, Nigeria. World J Vaccine. 2012;2:21–6.CrossRef
41.
Kumar D, Aggarwal A, Gomber S. Immunization status of children admitted to a tertiary-care hospital of north India: reasons for partial immunization or non-immunization. J Health Popul Nutr. 2010;28(3):300–4.PubMedPubMedCentral
42.
43.
Llena-Nozal A, van der Klaauw B, Lindebooma M. Parental education and child health: evidence from a schooling reform. J Health Econ. 2009;28:109–31.CrossRefPubMed
44.
Bloom SS, Wypij D, Das GM. Dimensions of women’s autonomy and the influence on maternal health care utilisation in a north Indian city. Demography. 2001;38:67–78.CrossRefPubMed
45.
Ndirangu J, Bärnighausen T, Tanser F, Tint K, Newell M-L. Levels of childhood vaccination coverage and the impact of maternal HIV status on child vaccination status in rural KwaZulu-Natal, South Africa. Trop Med Int Health. 2009;14(11):1383–93.CrossRefPubMedPubMedCentral
46.
Case A, Lubotsky M, Paxson C. Economic status and health in childhood: the origins of the gradient. Am Econ Rev. 2002;92:1308–34.CrossRef
47.
Case A, Lee D, Paxson C. The income gradient in children’s health: a comment on Currie, Shields and Wheatley price. J Health Econ. 2008;27:801–7.CrossRefPubMed
Metadata
Title
Individual and community level determinants of childhood full immunization in Ethiopia: a multilevel analysis
Authors
Samir A. Abadura
Wondwosen T. Lerebo
Usha Kulkarni
Zeleke A. Mekonnen
Publication date
01-12-2015
Publisher
BioMed Central
Published in
BMC Public Health / Issue 1/2015
Electronic ISSN: 1471-2458
DOI
https://doi.org/10.1186/s12889-015-2315-z

Other articles of this Issue 1/2015

BMC Public Health 1/2015 Go to the issue

Research article

Risky sexual networks and concentrated HIV epidemics among men who have sex with men in Wenzhou, China: a respondent-driven sampling study

Research article

Impact of unstable housing on all-cause mortality among persons who inject drugs

Research article

Patterns and risk factors for deaths from external causes in rural Malawi over 10 years: a prospective population-based study

Research article

Do body mass index trajectories affect the risk of type 2 diabetes? A case–control study

Research article

Determinants of suboptimal breastfeeding practices in Nigeria: evidence from the 2008 demographic and health survey

Research article

Prevalence of cardiovascular risk factors across six African Immigrant Groups in Minnesota