Full Immunization Of Children Research Articles

Continuum of care in maternal and child health in Indonesia.

This paper aims to empirically analyze the socioeconomic and demographic correlates of maternal and child health (MCH) care utilization in Indonesia using the continuum of care (CoC) concept. The concept of CoC has emerged as an important guiding principle in reproductive, maternal, newborn, and child health. Indonesia's maternal mortality rate, neonatal mortality, and under-five mortality rates are among the highest in the Southeast Asian region. Using pooled data from four successive waves of the nationally representative Indonesian Demographic and Health Survey (IDHS) conducted in the years 2002, 2007, 2012, and 2017, we use multivariate regression models to analyze care across four components of the continuum: antenatal care (ANC), institutional delivery, postnatal care for children, and full immunization (IM). CoC at each stage of MCH care has improved continuously over the period 2002-2017 in Indonesia. Despite this, just less than one out of two children receive all four components of the CoC. The overall coverage of CoC from its second stage (four or more ANC visits) to the final stage (full child IM) is driven by the dropouts at the ANC visit stage, followed by the loss of postnatal checkups and child IM. We find that the probability of a child receiving CoC at each of the four stages is significantly associated with maternal age and education, the household's socioeconomic and demographic characteristics, and economic status. Complete CoC with improved, affordable, and accessible MCH care services has the potential to accelerate the progress of Sustainable Development Goal 3 by reducing maternal and childhood mortality risks. Our findings show that in Indonesia, the CoC continuously declines as women proceed from ANC to other MCH services, with a sharp decline observed after four ANC visits. Our study has identified key socioeconomic characteristics of women and children that increase their probability of failing to access care.

Household Vulnerability and Childhood Immunization Status in Nigeria

Immunization is considered one of the most cost-effective public health interventions for reducing childhood morbidity, mortality, and disability globally. However, while global achievement of over 70% coverage rates was sustained in 1990s, wide variations exist between and within countries. In some developing countries, immunization rates increased substantially, but in sub-Saharan Africa, immunization rates plummeted, leaving millions of children vulnerable to life-threatening diseases. In Nigeria, coverage rates for routine immunization for all antigens still fall below 50%. The study examined the overall influence of household vulnerability dimensions, maternal health practices on childhood immunization status in Nigeria. The study used secondary data from 2013 Nigeria Demographic and Health Surveys (NDHS). The analytical weighted sample size was 5,824women of reproductive ages (15–49 years) with a live birth in the past 3 years, whose children were within age 12 to 23 months at the time of the survey. The data was analyzed using frequency distribution, chi-square test, and binary logistic regression. The results showed a decreasing regional variation in the proportion of fully immunized children from high of 23.6% in South-West, to a low of 9.1% in North-East. The overall household vulnerability status showed that children in more and most vulnerable households were 62% (OR = 0.38; p < .001; CI [0.32-0.46]) and 89%less likely (OR = 0.11; p < .001; CI [0.08-0.14]) to receive full vaccination compared with their counterpart in non-vulnerable households. The study revealed significant relationship between mothers’: (i) number of antenatal visits (OR = 1.66; p < .05; CI [0.25-1.77]); (ii) quality of antenatal care (OR = 2.61; p < .05; CI [1.45-4.67]); (iii) place of delivery (OR = 0.62; p < .05; CI [0.45-0.86]); (iv) assistance during delivery (OR = 0.41; p < .001; CI [0.28-0.57]); (v) time of postnatal check (OR = 1.81; p < .001; CI [1.49-2.19]) and full childhood immunization status.

Continuum of care of mothers and immunization status of their children: A secondary analysis of 2015–2016 Myanmar Demographic and Health Survey

ObjectiveTo assess the association between the continuum of care of mothers and the immunization status of their 12–23 months old children. Study designA secondary data analysis using the Myanmar Demographic and Health Survey (2015–16) data, a cross-sectional, household-based, nationally representative survey conducted during 2015–2016. MethodsWe included 1669 pairs of mothers and their children in this analysis. We categorized the children into fully immunized and no/not fully immunized children and define a continuum of care (CoC) of the mother if women received antenatal care ≥ four times, delivered with skilled birth attendances, and received postnatal care within 48 h after delivery. We used the multivariable binary logistics regression using STATA version 15.1 with the survey command (svy) and reported the results by adjusted odds ratios (aORs) with 95% confidence intervals (CIs). ResultsThe mother's CoC prevalence was 42.5%, and that of fully immunized children was 33.5%. However, only one-fifth of mothers and their children received the continuum of care services altogether. The children of mothers who received CoC were more likely to be fully vaccinated than those who did not (aOR = 1.60, 95%CI: 1.21, 2.13, P < 0.001). The child's birth order, employment status, and wealth status of the households are independent predictors of the full immunization of children. ConclusionsWe concluded that receiving the CoC in mothers influenced their children's vaccination status. Hence, integrating maternal health programs and immunization programs is essential to achieving sustainable development goals in Myanmar.

Wealth and Education Inequities in Maternal and Child Health Services Utilization in Rural Ethiopia.

As part of the 2030 maternal and child health targets, Ethiopia strives for universal and equitable use of health services. We aimed to examine the association between household wealth, maternal education, and the interplay between these in utilization of maternal and child health services. Data emanating from the evaluation of the Optimizing of Health Extension Program intervention. Women in the reproductive age of 15 to 49 years and children aged 12–23 months were included in the study. We used logistic regression with marginal effects to examine the association between household wealth, women’s educational level, four or more antenatal care visits, skilled assistance at delivery, and full immunization of children. Further, we analyzed the interactions between household wealth and education on these outcomes. Household wealth was positively associated with skilled assistance at delivery and full child immunization. Women’s education had a positive association only with skilled assistance at delivery. Educated women had skilled attendance at delivery, especially in the better-off households. Our results show the importance of poverty alleviation and girls’ education for universal health coverage.

Full childhood immunization coverage and incidence of vaccine preventable disease in Nigeria: a regression analysis

Background: Childhood immunization contributes significantly in the reduction of cases of vaccine preventable diseases in children. DHIS2 data showed that only 60.59% of children under one were fully immunized in 2020. This implies that 39.41% did not receive all recommended vaccinations therefore at risk of contracting vaccine preventable diseases. This study therefore examined the effect of full immunization coverage on incidence of vaccine preventable diseases.Methods: Full childhood immunization coverage and incidence of vaccine preventable disease was examined using simple linear regression model at 5% level of significance and 95% confidence interval. Measles new case for children under five was the dependent variable while children under one fully immunized was the independent variable. Data was retrieved from DHIS2 for the period 2017-2020.Results: The study showed a negative relationship between full immunization coverage and incidence of under-five measles new cases. The study found that any unit increase in full immunization coverage would lead to decrease in measles cases by 6%.Conclusions: Full immunization coverage is still low (below WHO target of 80%) despite effort by government and partners. This implies that a lot of children are at risk of contracting vaccine preventable diseases. In order to avert this risk, health authorities and partners should devise appropriate means of educating the populace on the importance of childhood immunization.

DETERMINATION OF THE FACTORS THAT AFFECT MOTHERS’ ATTITUDE TOWARDS IMMUNIZATION IN THE SOUTH-SOUTH REGION OF NIGERIA

Vaccination demand and acceptance depends on several factors that are quite broad and complex. The knowledge and attitude of a mother to childhood immunization play a key role in immunization coverage. Low immunization coverage in Nigeria is mostly attributed to poor knowledge, compliance, accessibility and inappropriate attitude among other factors. Poor compliance with full immunization is believed to be the most significant reason for low immunization coverage in the country due to socio-cultural obstacles to the acceptance of immunization. Aim: This study aims to assess the factors that determine the attitude of mothers towards immunization. Methodology: A hundred (100) mothers were recruited into this cross-sectional descriptive study using a simple random sampling technique. Data collection was performed by using a structured questionnaire. This study was carried out in Ukpenu community in Ekpoma, Edo State, Nigeria. This study was carried out in the Ukpenu community in Ekpoma, Edo State, Nigeria. 100 mothers were recruited into the study using a simple random sampling technique. Result: The results showed that the respondents have a positive attitude towards immunization. This was evident in the immunization report. Their record revealed that most of their children were fully immunized. This is seen in their readiness to fully immunize their children against childhood vaccine-preventable diseases (VPDs), their willingness to recommend full immunization of children to their friends, relatives and other women, and their readiness to purchase the vaccines if they are no longer available free of charge to ensure that their children are fully immunized. It was discovered that educational status plays a contributory role in the knowledge and attitude of mothers towards immunization. Conclusion: Maternal health education should be sustained to ensure continuous compliance and a positive attitude of mothers towards immunization.

Leaving No Child Behind: Decomposing Socioeconomic Inequalities in Child Health for India and South Africa.

Background: The United Nations’ 2030 Agenda for Sustainable Development argues for the combating of health inequalities within and among countries, advocating for “leaving no one behind”. However, child mortality in developing countries is still high and mainly driven by lack of immunization, food insecurity and nutritional deficiency. The confounding problem is the existence of socioeconomic inequalities among the richest and poorest. Thus, comparing South Africa’s and India’s Demographic and Health Surveys (DHS) of 2015/16, this study examines socioeconomic inequalities in under-five children’s health and its associated factors using three child health indications: full immunization coverage, food insecurity and malnutrition. Methods: Erreygers Normalized concentration indices were computed to show how immunization coverage, food insecurity and malnutrition in children varied across socioeconomic groups (household wealth). Concentration curves were plotted to show the cumulative share of immunization coverage, food insecurity and malnutrition against the cumulative share of children ranked from poorest to richest. Subsequent decomposition analysis identified vital factors underpinning the observed socioeconomic inequalities. Results: The results confirm a strong socioeconomic gradient in food security and malnutrition in India and South Africa. However, while full childhood immunization in South Africa was pro-poor (−0.0236), in India, it was pro-rich (0.1640). Decomposed results reported socioeconomic status, residence, mother’s education, and mother’s age as primary drivers of health inequalities in full immunization, food security and nutrition among children in both countries. Conclusions: The main drivers of the socioeconomic inequalities in both countries across the child health outcomes (full immunization, food insecurity and malnutrition) are socioeconomic status, residence, mother’s education, and mother’s age. In conclusion, if socioeconomic inequalities in children’s health especially food insecurity and malnutrition in South Africa; food insecurity, malnutrition and immunization in India are not addressed then definitely “some under-five children will be left behind”.

Maternal and Child Health Benefits of the Mamata Conditional Cash Transfer Program in Odisha, India.

Conditional cash transfers (CCTs) are demand-side interventions that link cash receipt to fulfilment of health-promoting conditions such as regular health check-ups and investment in human capital. In 2011, the Indian state of Odisha, implemented a statewide CCT program-the Mamata Scheme-towards improving maternal/child health outcomes and promoting health-seeking behavior. Mamata targets pregnant and lactating women aged ≥19 y, and provides a sizable financial incentive relative to household income levels. We aimed to longitudinally examine whether, and to what extent, initiation of the Mamata scheme corresponded with changes in health and nutrition outcomes in Odisha, relative to comparison states in India. Outcomes included maternal health service utilization [antenatal care (ANC), iron-folic acid supplementation, breastfeeding counseling, full child immunization, tetanus vaccination, vitamin A supplementation] and nutrition [anemia during pregnancy and stunting, anemia in children <5 y old (U5)]. Data on outcomes and covariates were obtained from 3 waves of India's National Family Health Surveys corresponding to the years 1999, 2006, and 2016. We used difference-in-differences (DID) estimation strategy to estimate the impact of the program. The pooled sampled size comprised >200,000 mother-child dyads. Tests of parallel trends indicated that preintervention trends were similar across all outcomes in Odisha with the exception of anemia. When comparing Odisha with other states for health services, DID models indicated that exposure to Mamata corresponded with increased odds of counseling for breastfeeding (OR: 2.74; 95% CI: 1.97, 3.80), ANC receipt (OR: 1.51; 95% CI: 1.15, 1.99), and full immunization (OR: 1.69; 95% CI: 1.37, 2.08). DID models also indicated decline in stunting (OR: 0.92; 95% CI: 0.84, 1.02) and anemia (OR: 0.62; 95% CI: 0.54, 0.71) among U5 children in Odisha following Mamata, relative to comparison states. Models comparing poor with nonpoor groups indicated the presence of heterogeneous effects. This study provides proof-of-concept for potential improvements in maternal and child nutrition outcomes following CCTs that incentivize health care utilization in India.

Determinants of full childhood immunization among children aged 12\u201323 months in sub-Saharan Africa: a multilevel analysis using Demographic and Health Survey Data

BackgroundSub-Saharan Africa is one of the highest under-five mortality and low childhood immunization region in the world. Children in Sub-Saharan Africa are 15 times more likely to die than children from high-income countries. In sub-Saharan Africa, more than half of under-five deaths are preventable through immunization. Therefore, this study aimed to identify the determinant factors of full childhood immunization among children aged 12–23 months in sub-Saharan Africa.MethodsData for the study was drawn from the Demographic and Health Survey of nine sub-Saharan African countries. A total of 21,448 children were included. The two-level mixed-effects logistic regression model was used to identify the individual and community-level factors associated with full childhood immunizationResultThe prevalence of full childhood immunization coverage in sub-Saharan Africa countries was 59.40% (95% CI: 58.70, 60.02). The multilevel logistic regression model revealed that secondary and above maternal education (AOR = 1.38; 95% CI: 1.25, 1.53), health facility delivery (AOR = 1.51; 95% CI: 1.41, 1.63), fathers secondary education and above (AOR = 1.28, 95% CI: 1.11, 1.48), four and above ANC visits (AOR = 2.01; 95% CI: 1.17, 2.30), PNC visit(AOR = 1.55; 95% CI: 1.46, 1.65), rich wealth index (AOR = 1.26; 95% CI: 1.18, 1.40), media exposure (AOR = 1.11; 95% CI: 1.04, 1.18), and distance to health facility is not a big problem (AOR = 1.42; 95% CI: 1.28, 1.47) were significantly associated with full childhood immunization.ConclusionThe full childhood immunization coverage in sub-Saharan Africa was poor with high inequalities. There is a significant variation between SSA countries in full childhood immunization. Therefore, public health programs targeting uneducated mothers and fathers, rural mothers, poor households, and those who have not used maternal health care services to promote full childhood immunization to improve child health. By enhancing institutional delivery, antenatal care visits and maternal tetanus immunization, the government and other stakeholders should work properly to increase child immunization coverage. Furthermore, policies and programs aimed at addressing cluster variations in childhood immunization need to be formulated and their implementation must be strongly pursued.

Socio-economic and demographic factors associated with reproductive and child health preventive care in Mozambique: a cross-sectional study

BackgroundReproductive and child health interventions are essential to improving population health in Africa. In Mozambique, although some progress on reproductive and child health has been made, knowledge of social inequalities in health and health care is lacking.ObjectiveTo investigate socio-economic and demographic inequalities in reproductive and child preventive health care as a way to monitor progress towards universal health coverage.MethodsA cross-sectional study was conducted, using data collected from the 2015 Immunization, AIDS and Malaria Indicators Survey (IMASIDA) in Mozambique. The sample included 6946 women aged 15 to 49 years. Outcomes variables were the use of insecticide treated nets (ITN) for children under 5 years, full child immunization and modern contraception use, while independent variables included age, marital status, place of residence, region, education, occupation, and household wealth index. Prevalence ratios (PR) with 95% confidence intervals (95% CI) were calculated by log binomial regression to assess the relationship between the socio-economic and demographic characteristics and the three outcomes of interest.ResultsThe percentage of mothers with at least one child under 5 years that did not use ITN was 51.01, 46.25% of women had children aged 1 to 4 years who were not fully immunized, and 74.28% of women were not using modern contraceptives. Non-educated mothers (PR = 1.33; 95% CI: 1.16–1.51) and those living in the Southern region (PR = 1.36; 95% CI: 1.17–1.59) had higher risk of not using ITN, while the poorest quintile (PR = 1.34; 95% CI: 1.04–1.71) was more likely to have children who were not fully immunized. Similarly, non-educated women (PR = 1.17; 95% CI: 1.10–1.25), non-working women (PR = 1.09; 95% CI: 1.04–1.16), and those in the poorest quintile (PR = 1.13; 95% CI: 1.04–1.24) had a higher risk of not using modern contraceptives.ConclusionOur study showed a low rate of ITN utilization, immunization coverage of children, and modern contraceptive use among women of reproductive age. Several socio-economic and demographics factors (region, education, occupation, and wealth) were associated with these preventive measures. We recommend an equity-oriented resource allocation across regions, knowledge dissemination on the importance of ITN and contraceptives use, and an expansion of immunization services to reach socio-economically disadvantaged families in order to achieve universal health coverage in Mozambique.

Do the dynamics of vaccine programs improve the full immunization of children under the age of five in Cameroon?

BackgroundAmong the eight Millennium Development Goals (MDGs), three were devoted to health. Two amongst which MDG4 in relation to the reduction of infant mortality has not been achieved in Least Developed Countries (LDC). In Africa, a significant part of infant mortality is due to vaccine-preventable diseases administered free of charge by the Extended Program on Immunization (EPI). As such, in the “social equity” pillar of Sustainable Development Goals (SDG), the MDGs related to health have yet been taken into account. The achievement of these objectives requires an understanding of the immunization behavior of children under 5 years of age through an analysis of immunization dynamics between 1991 and 2011.MethodsWe use data from Demographic and Health Surveys (DHS) of 1991, 1998, 2004 and 2011 carried out by the National Institute of Statistics (NIS). The module concerning EPI vaccines was administered to 3350, 2317, 8125 and 25,524 under 5 in 1991, 1998, 2004 and 2011 respectively. The Immunization analysis was made from the logistic model for complete immunization and the Oaxaca’s decomposition to assess the contribution of the unexplained part, which is that of the strategies/programs implemented between 1991 and 2011 by the EPI to improve immunization.ResultsIn general, children with vaccination card are more than 7 times likely to be fully immunized than their counterparts who do not have any. This result was higher in 1991 (approximately 57) and lowest in 2011 (5). In addition, the child’s birth order reduces his/her probability of being fully immunized and the impact increases with the latter’s birth order. On the other hand, the mother’s age as well as her level of education increase the child’s likelihood of receiving all basic vaccines. Moreover, the contributions of EPI partners in terms of immunization support as well as strategies to promote immunization through communication for development are of a particular importance in increasing immunization coverage. They significantly explain 67.62% of the 0.105 gain recorded within the 2011–2004 period and 72.46% of the 0.069 gain recorded within the 2004–1998 period.ConclusionThe contribution of EPI partner organizations is fundamental for the achievement of EPI objectives. Since they contribute to increase the likelihood of fully immunized children. The link with child immunization is done through the specific characteristics to the mother.

Assessment of Complete Coverage of Expanded Program on Immunization in Children at Mayo Hospital Lahore, Pakistan

Background: Goal of the expanded program on immunization (EPI) is to ensure full immunization of children under one year of age to globally eradicate poliomyelitis, tetanus, measles-related deaths and to extend all new vaccines and preventive health interventions to children in all parts of the world. Demographic and health survey 2012-13 showed that in Pakistan complete immunization coverage is very low (54%) to achieve this goal. The objective of this study was to assess any improvement in terms of vaccination coverage in Pakistan in the last 3-4 years.Material and Methods: This descriptive cross-sectional study was carried out at outpatient department of Pediatric Medicine of Mayo Hospital Lahore from May, 2016 till November, 2016. The non-probability purposive sampling technique was used to include patients after taking informed consent. Demographic details were collected and parents were questioned about different vaccinations received and confirmed through vaccination card. Data analysis was done through SPSS version 20 and results were presented as frequencies and percentages. Chi-square test was applied for association among categorical variables.Results: Complete coverage of expanded program on immunization was achieved in 86% children. A statistically significant difference was noted between mother’s education and immunization coverage of children (P-value 0.013).Conclusions: Education of mother and socioeconomic status were two significant factors affecting immunization coverage. In order to meet target of 95% immunization coverage rate set by WHO, more awareness should be created among people with low socioeconomic status along with improvement of immunization facilities in these areas.Key words: Children, Expanded Program on Immunization, Immunization Coverage

Effect of project-based experiential learning on the health service delivery indicators: a quasi-experiment study

BackgroundKenya’s new constitution passed in 2010 recognizes the right of quality care resulting in the devolution of health service delivery to the sub-national units called counties in 2013. However, the health system performance continues to be poor. The main identified challenge is poor health systems leadership. Evidence shows that addressing health system leadership challenges using different leadership intervention models has the potential to improve health outcomes. The purpose of this study is to report findings on the effect of project-based experiential learning on the health service delivery indicators addressed by 15 health management teams from 13 counties in Kenya, as compared to the non-trained managers.MethodsA quasi-experimental design without a random sample was used to evaluate the effectiveness of the leadership program. The health managers from the 13 Counties and 15 health facilities had previously undergone a 9-month leadership training, complimented with facility-based team coaching based on 15 priority institutional service improvement projects at the Strathmore University Business School. Pre-test and post-test data were collected in three-point periods (beginning, end of the training, and 24-to-60 months post-training). The control group comprised 14 other health institutions within the same counties.ResultsLeadership training and coaching built around priority institutional health service improvement projects in the intervention institutions showed: a) skilled birth attendance increased, on average, by 71%; b) full immunization of children, increased by 52%; c) utilization of in and out-patient services, which on average, increased by 90%; d) out-patient turn-around time reduced on average by 65% and; e) quality and customer satisfaction increased by 38.8% (in all the intervention facilities). These improvements were sustained for 60 months after the leadership training. In contrast, there were minimal improvements in service delivery indicators in the comparison institution over the same period of time. Ninety-three percent of the respondents attributed team-coaching built around priority institutional health service improvement projects as a key enabler to their success.ConclusionsThe study provides support that an intervention underpinned by challenge driven learning and team coaching can improve a range of health service delivery outcome variables.

Factors associated with full immunization of children 12-23 months of age in Ethiopia: A multilevel analysis using 2016 Ethiopia Demographic and Health Survey.

BackgroundOnly 40% of World Health Assembly member states achieved 90% national full vaccination coverage in 2015. In the African region, 79% of the countries had not achieved the target in 2015. In Ethiopia, only 39% of children 12–23 months of age were fully vaccinated. Though different studies were conducted in Ethiopia, they were limited in scope and used single level analysis. Therefore, this study aimed to assess individual and community level factors associated with full immunization among children 12–23 months of age in Ethiopia.MethodsThe data was obtained from Ethiopia Demographic and Health Survey 2016, conducted from January 2016 to June 2016. The sample was taken using two stage stratified sampling. In stage one, 645 Enumeration Areas and in stage two 28 households per Enumeration Area were selected systematically. Weighted sample of 1929 children 12–23 months of age were included in the study. Data was extracted from http://www.DHSprogram.com. Multilevel logistic regression was employed. Akaike Information Criteria was used to select best fit model.ResultsMother’s education, husband employment, mother’s religion, mother’s antenatal care visit, presence of vaccination document, region and community antenatal care utilization were significantly associated with children full vaccination. The odds of full vaccination were 2.5 [AOR = 2.48 95% CI: 1.35, 4.56] and 1.6 [AOR = 1.58 95% CI: 1.1, 2.28] times higher in children of mothers with secondary or higher and primary education respectively than children of mothers with no education.ConclusionThis study showed that children full vaccination is affected both by the individual and community level factors. Therefore, efforts to increase children full vaccination status need to target both at individual and community level.

Vaccine non-receipt and refusal in Ethiopia: The expanded program on immunization coverage survey, 2012

IntroductionRates of full childhood immunization in Ethiopia are well below the WHO global goal of 90% coverage by 2020. This study explores associations between sociodemographic characteristics and healthcare services utilization with experiences of not receiving a vaccine in Ethiopia. MethodsThis analysis uses data from Ethiopia’s 2012 Expanded Program on Immunization Coverage Survey. The relationships between explanatory variables, including sociodemographic and healthcare utilization factors, and various reasons a child was not vaccinated were assessed with Rao-Scott chi-square tests. Multivariable logistic regression analyses examined significant predictors of these experiences. ResultsThe sample includes the caregivers of 2,722 children. Experiences of not receiving a vaccine were characterized overall and by type of experience: whether a caregiver ever refused vaccination for their child (2.9%), ever decided to not take their child to a health center for vaccination (3.6%), and ever went to a health facility for vaccination but child was not vaccinated (12.0%). Region of residence, possession of a vaccination card, and the setting of the child’s last routine vaccination were predictors of not receiving a vaccine. Caregivers reported negative perceptions of vaccines were among their reasons for refusing a vaccine or declining to take their child to a health facility for vaccination. ConclusionPrior experiences with health facilities, such as where a child received their last routine vaccine, play a key role in future vaccination. Vaccine receipt at an outreach event is associated with not bringing a child to a health facility for vaccination, which may indicate an unwillingness to visit or difficulty accessing health centers. Further, negative perceptions of vaccines may result in vaccine refusal or delay. Findings of this study provide public health officials with a better understanding of factors related to vaccination experiences and can inform development of interventions that will improve childhood vaccination rates in Ethiopia.

Socio-demographic determinants of childhood immunization coverage in rural population of Bhojpur district of Bihar, India.

Introduction:Avoidable sickness, disabilities and death among under 5 children are prevented by routine immunization against some specific diseases. The percentage fully immunized children was 69.9% in Bihar, India, and was almost same in rural area. Immunization coverage is also associated with various socio-demographic factors. The aim of this study is to assess the immunization coverage among children in rural areas of Bhojpur district and identify socio-demographic factors associated with it.Methods:A cross-sectional study was conducted in rural areas of Bhojpur district during January to May 2015. 2 stage cluster sampling was done. 36 villages were selected randomly as primary selection units and within each village, 10 children of age 12-36 months were selected from the sampling frame of all eligible children in selected village. A pre-designed, pre-tested checklist was used by the trained investigators during their visits.Results:A total of 360 children of age 12-36 months were included in the study, of which 65% of children were fully immunized, 33.9% were partially immunized, and 1.1% were not immunized at all. Mother's education (AOR 2.28 (1.28-4.05), P value = 0.005), place of birth (AOR 29.04 (10.75-78.43), P value = 0.0001) and availability of immunization card (AOR 120.04 (15.82-916.47), P value = 0.001) were significantly associated with immunization status.Conclusion:Immunisation coverage in this area was lower. Socio-demographic factors like mother's literacy, place of birth and availability of immunization cards were significantly associated with full immunization of children. It is needed to focus on health related education among parents regarding immunizing services.

Childhood full and under-vaccination in Nigeria, 2013

BackgroundNigeria’s government is challenged with vaccinating the world’s third largest birth cohort within a culturally and socioeconomically diverse country. This study estimated full childhood immunization coverage in Nigeria and characterizes the association between vaccination status and urbanicity, region of residence, ethnicity, and other factors. MethodsIn 2013, households throughout Nigeria were enrolled in the Demographic and Health Survey which included questions about vaccination. We defined full vaccination of a child as having received a single dose of bacillus Calmete-Guerin (BCG), one dose of measles-containing vaccine (MCV), three doses of diphtheria, pertussis, tetanus (DPT), and four doses of oral polio vaccine (OPV). Using a multinomial logistic regression model, full vaccination and under-vaccination versus non-vaccination was regressed onto various demographic and socioeconomic characteristics. ResultsAmong 5759 children 1 year of age, 25.5% were fully vaccinated, 47.9% were under-vaccinated, and 26.6% had not received any vaccinations. Children were more likely to be fully vaccinated if they belonged to wealthier families, resided in southern regions of the country, were Christian, belonged to the Igbo or Yoruba ethnic group, had mothers who made ≥5 antenatal care visits, delivered at an institution, or were more highly educated. ConclusionsFull vaccination among children in Nigeria is exceptionally low by global standards and certain groups, such as Muslims and individuals in northern regions who are higher risk of non- or under-vaccination should be targeted by vaccination programs. Providing a wide range of health care services for mothers and pregnant women could improve full vaccination of children.

Individual- and community-level determinants of child immunization in the Democratic Republic of Congo: A multilevel analysis.

Understanding modifiable determinants of full immunization of children provide a valuable contribution to immunization programs and help reduce disease, disability, and death. This study is aimed to assess the individual and community-level determinants of full immunization coverage among children in the Democratic Republic of Congo. This study used data from the Demographic and Health Survey 2013–14 from the Democratic Republic of Congo. Data regarding total 3,366 children between 12 and 23 months of age were used in this study. Children who were immunized with one dose of BCG, three doses of polio, three doses of DPT, and a dose of measles vaccine was considered fully immunized. Descriptive statistics were calculated for the prevalence and distribution of full immunization coverage. Two-level multilevel logistic regression analysis, with individual-level (level 1) characteristics nested within community-level (level 2) characteristics, was used to assess the individual- and community-level determinants of full immunization coverage. This study found that about 45.3% [95%CI: 42.02, 48.52] of children aged 12–23 months were fully immunized in the DRC. The results confirmed immunization coverage varied and ranged between 5.8% in Mongala province to 70.6% in Nord-Kivu province. Results from multilevel analysis revealed that, four Antenatal Care (ANC) visits [AOR: 1.64; 95%CI: 1.23, 2.18], institutional delivery [AOR: 2.37; 95%CI: 1.52, 3.72], and Postnatal Care (PNC) service utilization [AOR: 1.43; 95%CI: 1.04, 1.95] were statistically significantly associated with the full immunization coverage. Similarly, children of mothers with secondary or higher education [AOR: 1.32; 95%CI: 1.00, 1.81] and from the richest wealth quintile [AOR: 1.96; 95%CI: 1.18, 3.27] had significantly higher odds of being fully immunized compared to their counterparts whose mothers were relatively poorer and less educated. Among the community-level characteristics, residents of the community with a higher rate of institutional delivery [AOR: 2.36; 95%CI: 1.59, 3.51] were found to be positively associated with the full immunization coverage. Also, the random effect result found about 35% of the variation in immunization coverage among the communities was attributed to community-level factors.The Democratic Republic of Congo has a noteworthy gap in full immunization coverage. Modifiable factors–particularly health service utilization including four ANC visits, institutional delivery, and postnatal visits–had a strong positive effect on full immunization coverage. The study underlines the importance of promoting immunization programs tailored to the poor and women with little education.

Correction to: Is the Urban Child Health Advantage Declining in Malawi?: Evidence from Demographic and Health Surveys and Multiple Indicator Cluster Surveys

The third from last sentence of the abstract, which reads: "However, U-5MR shows reversal to a significant urban advantage in 2015/2016, and slight increases in urban advantage are noted for infant mortality rate, underweight, full childhood immunization, and stunting rate in 2015/2016".

Knowledge, Attitude and Compliance with Full Immunization of Children Against Vaccine Preventable Diseases among Pregnant Mothers in Sokoto, Nigeria

Knowledge, Attitude and Compliance with Full Immunization of Children Against Vaccine Preventable Diseases among Pregnant Mothers in Sokoto, Nigeria