Determinants of Immunization Uptake in Under Five Children in Amhara Region, Ethiopia

Abstract

Introduction: Vaccination is efficient and effective communal strategy because it is a long-term effort by humans to combat diseases that damage our health. Vaccination coverage is still a key determinant of child health outcomes in almost every country. Incomplete or non-vaccination of children is associated to further system-wide hurdles. Subsequently, full vaccination in children and its determinants must be the focus of stakeholders, including research and development – and this is the major goal of the current study. Objective: To analyze determinants of full vaccination uptake in under five children in Amhara region, Ethiopia. Methods: The study adopted a binary probit regression model that presupposes a linear association between the outcome variable and explanatory characteristics, as well as an inverted standard normal probability distribution. The EDHS 2016 was used to gather data for the study. Household characteristics, education and employment, marriage, religion, child health and survival were all collected as part of the 2016 survey, which provided essential information for this study. The EDHS supplied data on coverage of three doses of pneumococcal vaccine, which was incorporated into Ethiopia's routine immunization program, as well as percentage delivery in health facilities and proportions of no vaccination cases for various regions. Medical records (vaccination cards), HF visits or report from caregivers/mothers were used to determine the degree of vaccination coverage. The information available on medical records was directly entered; otherwise, the caregiver, primarily the biological mother, or father were approached to attempt to recollect if the kid had received a specific vaccination. Only full cases were examined in this study. The analysis considered VIF to test multicollinearity and get suitable resilient explanatory factors to fit for the analysis model, which fills variance parameter. Explanatory factors with a VIF greater than 10 was considered collinear. Cross-tabulations of the outcome variable and explanatory factors were conducted to see the overview of data that can lead to a model that is unstable. Heteroscedasticity, or observations with a higher variance, was found using plots for residual and the Breusch-Pagan test. Any non-normal residuals were converted to logs. The analysis carried out the Akaike and Bayesian information criterion, as well as the likelihood ratio test to examine model's goodness of fit. Results: Findings show that out of the 977 children in Amhara region of Ethiopia, 612 (62.6%) and 365 (37.3%) were fully and not fully vaccinated, respectively. Mothers who were aged from 30-34 (0.781), 35-39 (1.028), 40-44 (1.309) and 45-49 (1.657) received full vaccination relative to those children from mothers aged from 15-19 years. The negative coefficient of household size (-0.117) showed that as household size increases, the likelihood of getting full vaccination in children was low. Women with ANC follow up of >7 times (1.070) higher tendency to vaccinate their kids fully relative to those women without ANC visit(s). As birth order increases to >=6 (-0.596), the likelihood of getting their children fully vaccinated is low as compared to a birth order of 1. Those who delivered in a public facility (-0.394) did not vaccinate their children fully relative to those who delivered at home. The coefficients for poorer (0.407), middle (0.664), richer (0.630), and richest (0.871) wealth index were all positive, reflecting that households with a higher wealth index had lower likelihood of vaccinating their children full relative to the poorest households. Conclusion and recommendations: The study found that maternal age, birth order, wealth index, place of delivery, ANC visits and household size were significant determinants of full vaccine uptake among under five children. However, determinants like education of mothers, matrimonial characteristics, dwelling area (rural/urban) and household head age did not have any significant effect on vaccination coverage. Increasing demand for full vaccination uptake shall enable regions in Ethiopia to attain more vaccination coverage. According to this study findings, full uptake of vaccination was associated with mother’s age, parity, wealth quintile, ANC visits and household size. The government should intensify the sensitization of young mothers and women with low income on the importance of vaccination. This can be done during antenatal and/or post-natal care visits. Community health workers should increase door-to-door campaigns in order to ensure all children born to a woman has received all vaccines that he/she is eligible for. Demand for and uptake of full vaccination might be low in the lower wealth quintiles due to indirect costs related to vaccination, including transport to health facility. The government can increase demand for vaccination in the lowest wealth quintile households by offering incentives that will enable mothers to take their children for vaccination. Women from the poorest households should also be economically empowered which will increase their health seeking behavior and therefore increasing demand for vaccination.