Department of Health Systems and Policy, Institute of Public Health, University of Gondar, Gondar, Ethiopia.
Department of Health Education and Behavioral Sciences, Institute of Public Health, University of Gondar, Gondar, Ethiopia.
Biomed Res Int. 2020 Sep 30;2020:6907395. doi: 10.1155/2020/6907395. eCollection 2020.
Childhood vaccination continues to increase dramatically. In spite of the success of immunization programs to date, millions of children continued to die each year, and sub-Saharan Africa (SSA) accounted for the world's highest neonatal deaths. Childhood vaccination was designed as one of the most effective ways to reduce child mortalities from fatal vaccine-preventable diseases. Therefore, this study is aimed at investigating the individual- and community-level determinants of childhood complete vaccination in Ethiopia.
A secondary data analysis was done based on the 2016 Ethiopian Demographic and Health Survey (EDHS). A total weighted sample of 1,984 children aged 12-23 months was included for analysis. Considering the hierarchical nature of EDHS data, a two-level multilevel analysis for assessing individual- and community-level determinants of childhood complete vaccination was done. The intraclass correlation coefficient (ICC), Median Odds Ratio (MOR), Proportional Change in Variance (PCV), and deviance (-2LL) were used for model comparison and for checking model fitness. Variables with value < 0.2 in the bivariable multilevel analysis were considered for the multivariable multilevel analysis. In the multivariable multilevel logistic regression analysis, the Adjusted Odds Ratio (AOR) with 95% Confidence Interval (CI) was reported to declare significant determinants of complete childhood vaccination.
Overall complete vaccination status among children aged 12-23 months was 39% (95% CI: 36.8, 41.2). In the multilevel analysis, secondary or above educated mothers (AOR = 2.48; 95% CI: 1.41, 4.36), richest wealth status (AOR = 2.24; 95% CI: 1.16, 4.32), ≥four ANC visits (AOR = 2.77; 95% CI: 1.90-4.02), employed mothers (AOR = 1.66; 95% CI: 1.26, 2.18), urban residence (AOR = 1.84; 95% CI: 1.00, 3.51), and children in city administration (AOR = 2.66; 9% CI: 1.53, 4.62) were positively associated with vaccination status. On the other hand, children with a female household head (AOR = 0.68; 95% CI: 0.48, 0.96) were negatively associated.
Overall, childhood full vaccination status was low compared with the WHO targets. Maternal education, wealth status, ANC visit, maternal occupation, residence, region, and sex of household head were significant predictors of childhood complete vaccination. As a result, it is better to design a compensation mechanism to the costs associated with childhood vaccination for the poor households and strengthen awareness creation for rural residents to improve the access, utilization, and continuum of vaccination service.
儿童疫苗接种持续大幅增加。尽管免疫规划计划迄今取得了成功，但每年仍有数百万名儿童死亡，撒哈拉以南非洲（SSA）占全球新生儿死亡人数最多。儿童疫苗接种被设计为降低致命疫苗可预防疾病导致儿童死亡率的最有效方法之一。因此，本研究旨在调查埃塞俄比亚儿童完全疫苗接种的个体和社区水平决定因素。
根据 2016 年埃塞俄比亚人口与健康调查（EDHS）进行了二次数据分析。总共纳入了 1984 名年龄在 12-23 个月的加权样本进行分析。考虑到 EDHS 数据的层次性质，对儿童完全疫苗接种的个体和社区水平决定因素进行了两级多水平分析。使用组内相关系数（ICC）、中位数优势比（MOR）、方差比例变化（PCV）和偏差（-2LL）来比较和检查模型拟合度。在双变量多水平分析中， 值 < 0.2 的变量被认为是多变量多水平分析的候选变量。在多变量多水平逻辑回归分析中，报告了调整后的优势比（AOR）及其 95%置信区间（CI），以确定完全儿童疫苗接种的显著决定因素。
12-23 个月儿童的总体完全疫苗接种率为 39%（95%CI：36.8，41.2）。在多水平分析中，母亲受过中等或高等教育（AOR=2.48；95%CI：1.41，4.36）、最富裕的财富状况（AOR=2.24；95%CI：1.16，4.32）、至少接受过 4 次 ANC 访问（AOR=2.77；95%CI：1.90-4.02）、母亲就业（AOR=1.66；95%CI：1.26，2.18）、城市居住（AOR=1.84；95%CI：1.00，3.51）和城市行政区的儿童（AOR=2.66；95%CI：1.53，4.62）与疫苗接种状况呈正相关。另一方面，女户主家庭的儿童（AOR=0.68；95%CI：0.48，0.96）与疫苗接种状况呈负相关。
总体而言，与世界卫生组织的目标相比，儿童完全疫苗接种率较低。母亲的教育程度、财富状况、ANC 就诊、母亲的职业、居住地点、地区和家庭主妇的性别是儿童完全疫苗接种的重要预测因素。因此，最好为贫困家庭制定与儿童疫苗接种相关的成本补偿机制，并加强对农村居民的意识创造，以改善疫苗接种服务的获取、利用和连续性。
