Abstract
BackgroundImmunization is essential to prevent between 2 and 3 million deaths globally each year and it is widely accepted that it is one of the most cost-effective health interventions. Despite all its advantages, immunization in Ethiopia is still far from the target set by the United Nations Sustainable Development Goals to achieve universal immunization by all countries in 2030. The 2016 Ethiopian Demographic and Health Survey (EDHS) reported an overall full immunization rate of only 38.3%. The objective of this study was to evaluate the spatial distribution of under immunization in 12 to 23 months old children and further identify the determinants of under immunization clustering in the Butajira Health and Demographic Surveillance Site (HDSS).MethodsWe conducted a community based sectional survey from March to April, 2016 in Butajira HDSS. We collected data on immunization status from a total of 482 children between the age of 12 to 23 months. We randomly selected household and interviewed mothers and /or observed vaccination cards when available to collect data on child’s immunization status. We also collected the geographic location of all villages within the ten Kebeles using a Handheld Global Positioning System (GPS) (Garmin GPSMAP®). We analyzed the spatial distribution of under immunization and clustering using the SatScan® software which employs a purely spatial Bernoulli’s model. We also ran a logistic regression model to help evaluate the causes of clustering.ResultsWe found that only 22.4% [95% CI: 18.9, 26.4%] of children were fully immunized. This study identified one significant cluster of under immunization among children 12–23 months of age within the Butajira HDSS (relative risk (RR) = 1.24,P < 0·01). We found that children residing in this cluster had more than 1.24 times risk of under immunization compared with children residing outside of the identified cluster. We found significant differences with regard to Maternal Tetanus Toxoid immunization status and place of delivery between cases found within a spatial cluster and cases found outside the cluster. For example, the odds of home delivery is more than two times [AOR 2.21: 95%CI; 1.06, 4.63] among children within an identified spatial cluster than the odds among children found outside the identified cluster.ConclusionsUnder immunization of 12–23 months old children and under immunization with specific vaccines such as Polio, BCG, DPT (1–3) and Measles clustered geographically. Spatial studies could be effective in identifying geographic areas of under immunization for targeted intervention like in this study to gear health education to the specific locality.
Highlights
According to the center for disease control and prevention (CDC), Vaccination is defined as the act of introducing a vaccine into the human body to produce immunity to a specific disease [1]
The Butajira Health and Demographic Surveillance Site (HDSS) site includes 10 Kebeles, which are located in two zones in the Southern Nations Nationalities and Peoples Region (SNNPR) [25]
We further evaluated the cause of the clustering of under immunization and found out that giving birth at home or with TBA was the major predictor of under immunization clustering, this could be explained due to the fact that those who deliver at health institutions are given advice about child immunization which affects their practice positively, since institutional delivery is associated with increased health service utilization,whereas those mothers who gave birth at home or by a TBA lack such advice and so are more likely to under immunize their child [34,35,36]
Summary
According to the center for disease control and prevention (CDC), Vaccination is defined as the act of introducing a vaccine into the human body to produce immunity to a specific disease [1]. The World Health Organization (WHO), reports that immunization helps to prevent between 2 and 3 million deaths globally each year [2]. The Ministry of Health (FMOH) has set ambitious targets [4] to achieve above 95% coverage of Pentavalent 3 and Measles vaccination and it has set a goal of nationally eradicating polio and measles by the year 2020. Recent figures for the Ethiopian national immunization coverage level in 2013 and 2014 showed that immunization coverage rose to 87 and 83% coverage, respectively [4], for Pentavalent 3 and Measles vaccination, but still the EDHS 2011 report [5] showed that the overall country level Full immunization is relatively low at 24% with a similar 24% Full immunization coverage for the SNNPR. The objective of this study was to evaluate the spatial distribution of under immunization in 12 to 23 months old children and further identify the determinants of under immunization clustering in the Butajira Health and Demographic Surveillance Site (HDSS)
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