Geographical variation and associated factors of childhood measles vaccination in Ethiopia: a spatial and multilevel analysis

Tesfahun Taddege Geremew,Ayenew Negesse Abejie,Lemma Derseh Gezie

doi:10.1186/s12889-019-7529-z

Tesfahun Taddege Geremew, Ayenew Negesse Abejie + Show 1 more

Open Access

https://doi.org/10.1186/s12889-019-7529-z

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Abstract

BackgroundIn Ethiopia, despite considerable improvement of measles vaccination, measles outbreaks is occurring in most parts of the country. Understanding the neighborhood variation in childhood measles vaccination is crucial for evidence-based decision-making. However, the spatial pattern of measles-containing vaccine (MCV1) and its predictors are poorly understood. Hence, this study aimed to explore the spatial pattern and associated factors of childhood MCV1 coverage.MethodsAn in-depth analysis of the 2016 Ethiopia demographic and health survey data was conducted, and a total of 3722 children nested in 611 enumeration areas were included in the analysis. Global Moran’s I statistic and Poisson-based purely spatial scan statistics were employed to explore spatial patterns and detect spatial clusters of childhood MCV1, respectively. Multilevel logistic regression models were fitted to identify factors associated with childhood MCV1.ResultsSpatial hetrogeniety of childhood MCV1 was observed (Global Moran’s I = 0.13, p-value < 0.0001), and seven significant SaTScan clusters of areas with low MCV1 coverage were detected. The most likely primary SaTScan cluster was detected in the Afar Region, secondary cluster in Somali Region, and tertiary cluster in Gambella Region. In the final model of the multilevel analysis, individual and community level factors accounted for 82% of the variance in the odds of MCV1 vaccination. Child age (AOR = 1.53; 95%CI: 1.25–1.88), pentavalent vaccination first dose (AOR = 9.09; 95%CI: 6.86–12.03) and third dose (AOR = 7.12; 95%CI: 5.51–9.18, secondary and above maternal education (AOR = 1.62; 95%CI: 1.03–2.55) and media exposure were the factors that increased the odds of MCV1 vaccination at the individual level. Children with older maternal age had lower odds of receiving MCV1. Living in Afar, Oromia, Somali, Gambella and Harari regions were factors associated with lower odds of MCV1 from the community-level factors. Children far from health facilities had higher odds of receiving MCV1 (AOR = 1.31, 95%CI = 1.12–1.61).ConclusionA clustered pattern of areas with low childhood MCV1 coverage was observed in Ethiopia. Both individual and community level factors were significant predictors of childhood MCV1. Hence, it is good to give priority for the areas with low childhood MCV1 coverage, and to consider the identified factors for vaccination interventions.

Highlights

In Ethiopia, despite considerable improvement of measles vaccination, measles outbreaks is occurring in most parts of the country
We found that children who have received the first dose of pentavalent vaccine (AOR = 9.09; 95% Confidence intervals (CI): 6.86–12.03) and third dose of pentavalent vaccine (AOR = 7.12; 95% CI: 5.51–9.18) were more likely to receive First dose of measles-containing vaccine (MCV1)
This study revealed that children who lived in areas where distance from health facility is not a big problem were more likely to receive childhood MCV1 that is consistent with a study finding in sub-Saharan Africa [60]

Summary

Introduction

In Ethiopia, despite considerable improvement of measles vaccination, measles outbreaks is occurring in most parts of the country. In the era of expanded immunization program, the global measles deaths declined by three-fourth from 2000 to 2014 [2, 6, 7], but measles is still considered as a public health emergency that requires immediate notification and rapid public health response [5]. World Health Organization (WHO) has targeted a global elimination of measles to reduce annual incidence rates (IRs) to less than five cases per million population, which requires more than 90% coverage of at least one dose of Measles-Containing Vaccine (MCV1) by the end of 2015 and more than 95% coverage by 2020 in all countries [5]. In 2015, MCV1 coverage had reached 85% globally, and the measles deaths declined by 79% as compared to 2000 [4].

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