Incomplete immunization coverage among children aged 12–23 months and associated factors in Togo in 2017

Abstract

Introduction Inadequate immunization coverage remains a public health problem in Africa. In Togo, only 62% of children under one year of age were fully immunized as assessed by the third Demographic and Health Survey conducted in 2013, hence not achieving the 90% or more immunization target for national coverage as set by the World Health Organization (WHO). In view of this, it appears necessary to carry out operational research to identify obstacles to complete immunization coverage in Togo. Methods A cross-sectional survey was conducted from February 27th to March 5th 2017 in the six health regions of Togo. A modified WHO Epi Cluster sampling method was used for sample selection. Children aged 12 to 23 months who were living with one of the parents or guardians from selected households were recruited for the study. Data was collected using a pre-tested questionnaire through door-to-door visits and face-to-face interviews. Interviewers assessed immunization status of selected children based on immunization cards or parent's recall. Multilevel logistic regression analysis was performed to assess factors associated with incomplete immunization coverage. Results A total of 1261 households were included. Respondents were predominantly women (91.9%) and 22.8% had secondary or higher education level. Immunization cards were available for 85.3% of children. Complete immunization coverage was 72.3% (95% confidence interval, 95% CI: [69.7–74.8%]) and 90.7% of the children were vaccinated against tuberculosis. Main barriers to children's full immunization reported by parents or guardians were: long distance to the health center (32.2%), poor road conditions (13.3%), lack of means of transport (10.5%) and lack of time (9.0%). After controlling for both individual and contextual level variables, children whose mothers attended secondary school or above were 33%, adjusted odds ratio (aOR) = 0.67, CI [0.47–0.94] less likely to have an incomplete immunization coverage compared to those with no education level. The likehood of incomplete immunization in children decreased with the increase household's income (aOR = 0.73, 95% CI [0.58–0.93]). In addition, children who did not have an immunization card (aOR = 13.41, 95% CI [9.19–19.57]) and those whose parents did not know that children immunization was free of charge (aOR = 1.82, 95% CI [1.00–3.30]) were more likely to have an incomplete immunization. Finally, children whose parents had to walk a half hour and one hour to the health center were 57% more likely to have an incomplete immunization coverage (aOR = 1.57, 95% CI [1.15–2.13]) than those whose parents had to walk less than half an hour. Conclusion This study confirms that the goal of 90% coverage at the national level has not been achieved in 2017 and the factors associated with incomplete coverage of immunization were identified. Innovative strategies such as using electronic cards and the strengthening of sensitization must be initiated for a complete immunization coverage in Togo.