Abstract
IntroductionAn increasing trend of routine immunization performance has generally been observed over the past decade in Ethiopia. However, the improvement is irregular with wide disparity among and within regions. This study analyzes health facility characteristics contribution to immunization performance in Ethiopia.MethodsWe conducted a cross-sectional study and compared characteristics of health facilities in good and poor performing zones. We used administrative coverage reports and Personal Digital Assisted (PDA) supervisory data collected by WHO EPI field officers using a standardized structured checklist. We selected 48 zones and 302 health facilities based on immunization performance data and supervisory data on potential variables.ResultsLogistics regression was used to identify independent contributors to good immunization performance. On logistics regression we found that: actions by higher levels in conducting supervision (Odds Ratio (OR) =4.15. 95% Confidence Interval (CI) = 1.85, 9.32, p value <0.01] and providing written feedback (Odds Ratio (OR) =4.35. 95% Confidence Interval (CI) = 2.27, 8.33, p value <0.01) , and provision of immunization services by the health facility itself for catchment population under each health unit (Odds Ratio (OR) =20.15. 95% Confidence Interval (CI) = 2.24, 181.38, p value =0.01) and absence of stock out of vaccines (Odds Ratio (OR) =0.44. 95% Confidence Interval (CI) = 0.23, 0.83, p value =0.01) are the likely significant factors contributing to good immunization performance in Ethiopia.ConclusionEnsuring availability of immunization services in all health facilities, regular supervision and written feedback and improved stock management are essential factors contributing to good immunization performance.
Highlights
Immunization is one of the most effective public health interventions known so far [1,2]
On logistics regression we found that: actions by higher levels in conducting supervision (Odds Ratio (OR) =4.15. 95% Confidence Interval (CI) = 1.85, 9.32, p value
In our analysis of factors associated with good performance of routine immunization (RI), we found availability of immunization sessions, supervision, written feedback, performance monitoring and stock out of vaccines to be strong predictors of immunization coverage in Ethiopia [9,14,15,16]
Summary
Immunization is one of the most effective public health interventions known so far [1,2]. The Government of Ethiopia incorporated childhood vaccination in the Health Sector Development Plan (HSDP) as one of the key interventions to improve child health outcomes [4]. Progress was measured by proportion of under 1 year old children vaccinated with a third dose of diphtheria, pertussis and tetanus containing vaccine (DPT3) coverage which is the reference indicator of coverage for Expanded Programme on Immunization (EPI) [4,5]. Ethiopia adopted the Global Vaccine Action Plan (GVAP) targets to reach 90% DPT3 coverage nationally and 80% coverage at district level by 2015 [6]. Between 2004 and 2014 improvement in immunization coverage was observed globally and in Africa [7]. The DPT3 administrative coverage in Ethiopia increased reports from 66% to 87% in 2004 and 2014 respectively [8]
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