Ethiopia was planned to achieve at least 80% of immunization coverage in all district by the year 2015(16). However the immunization coverage among children aged 12-23 months is still low, accordingly 2016 Demographic Health Survey(EDH), only 39% of national wide, children aged 12-23 months were fully immunized (one dose of Bacillus Calmette-guerin(BCG), three doe of penta-valant and polio, one dose of measles vaccine received before one year of age) and immunization coverage by DPT3 was 53% , has not been completed in Ethiopia as planned (10). This analysis was aimed to identify the barriers for full immunization in Ethiopia based on national wide survey data. Binary and multiple analysis was done to identify the factors associated with fully immunization. This analysis revealed that there were significant regional difference in full immunization coverage in Ethiopia. The odds of having fully immunized children among who lived in Afar, Somlia, Gambella and Oromia regional administration, were less likely compared to children in Tigray regional administration. Conversely, the odds of having fully immunized children among who lived in Dire Dewa city administration were 3.5 times higher compared to Tigray regional administration. The association between region and fully immunization is consistent with other study in Ethiopia (18). This finding is also consistent with the synthesis of DHS data in Pakistan and Mozambique (5, 9, 19). The reason, have very low routine immunization coverage might be most people at those areas (Afar, Somlia, Gambella and Oromia regional administration) are nomadic. It is obvious that in the area people live sparse and nomadic way the health infrastructure is weak and health service coverage is low. So in these regions eligible children most likely lived in remote areas without access to health services. Whereas in Dire Dewa city administration health service coverage is high, women are more educated, have different media access and better awareness about immunization.
The odds of having fully immunized children among whose mothers had primary education and secondary level were 1.7 and 2.8 times higher respectively compared to children whose mothers not educated. The finding of Fully immunization associated with mother’s education is consistent with a study done in Ethiopia (20). The association between maternal education and fully immunization also consistent with other studies done out of Ethiopia, in Senegal(8), Congo (21), Nigeria(22), Pakistan (5, 9), Philippines(23), Greece(24) and Lome(25).
This could be explained that educated mothers are generally more aware of the importance of available health and immunization service, have better communication skill and tends to better utilize available service. Educated mothers using very simple language and understand easily the information found on immunization cards. Due to this literate mothers having better knowledge of vaccine preventable disease and recognizing the importance of immunization (5, 17, 26, 27). Mother’s low education may influence her general health literacy and lessen their ability to properly understand the benefits of timely and complete immunization (20, 23).
From this analysis 63% of mothers or respondents were not educated. Therefore, the policy-maker should assess the obstacles of girls or women obtaining of education access in Ethiopia to solve educational or literacy related problems. Develop strategies’ to increase educational access (increase the number of school, community awareness about female education, preventing child labor and early marriage etc)
The odds of having fully immunized children among whose mothers who had at least one ANC follow up were 2.3 times higher compared to whose mothers who didn’t have ANC follow up. The association of fully immunization with ANC service is consistent with other study done in Ethiopia (18). This finding also consistent with other studies done in Congo(21), Senegal(8) Nigeria(22) and Philippines(23).
ANC visits may be important signal to show mothers, ready access to a health facility (a short distance from a health facility, or having transportation options). It is possible that increase contact with health facilities during pregnancy, could cause of good information toward vaccination. Increased contact with the healthcare providers for obtaining of ANC improve the full immunization rate of children because mothers would have more opportunity to be informed about child health including full immunization. Furthermore, important information received by mothers during ante natal promote health care utilization of institutional delivery, post-natal acre and immunization service. This might be equipped mothers with the necessary knowledge on child vaccination (23, 27, 28). This analysis revealed that 37% of mothers didn’t receive antenatal care service during the index child. So the Ethiopian ministry of health, should assess the difficulties of receiving of antenatal care and develop strategies to increase antennal care service (improve accessibility of health facility by increase number of health facilities and compassion health care providers, free public transportation for pregnant and laboring women), which may increase the institutional delivery and child immunization coverage.
The odds of having child fully immunized children, among whose mothers had a history of smoking, were 89% less likely compared to mothers didn’t have a history of smoking.
This could be explained as good relationship among providers and mothers is very important for adherence of vaccination service. However, smokers experienced with emotional behavioral problems than of non-smokers, and they are rule barkers. This might be a reason to drop the immunization services(29). On the other hand, information and knowledge about immunization is important things to use vaccination service. However, health and information seeking behavior among smokers are low(30).
As this analysis revealed, fully immunization was associated with source of information about vaccination history. The vaccination card is a paper used to record and track vaccination coverage. In this analysis immunization card available was only 34%. The odds of having child with fully basic immunization among children whose mothers showed the vaccination card during interview were 1.6 times higher compared to children whose mothers verbally reported. The association between source of information from card and fully immunization is consistent with other studies (18, 25, 31). This could be explained that as mothers might be equipped with the necessary information about immunization and the purpose kept immunization card. Kept the immunization card indicates they gave attention to immunization or had awareness about immunization. In this analysis most educated mothers Education kept their child immunization cards. Literate mothers having better knowledge of vaccine preventable disease and recognizing the importance of immunization(26). From this analysis Place of delivery and decision maker for health care were positively associated with fully immunization.
Conclusion and recommendation
Fully immunization coverage among children was positively associated with children of mothers had primary and secondary educational level, at least one ANC visit of index child, live in Dire Dewa city administration and source of information from card. However, fully immunization status negatively associated with children of mothers had smoking history, live in Afar, Somlia, Gambella and Oromia regional administration. Encourage women education, antenatal care use, keep the immunization card and avoid smoking. At the area of pastoralist and sparse population the government should be considered other than the traditional static and outreach strategy. To ensure timely and complete immunization encourage the use of mobile and mass immunization strategy to reach children whose families are mobile and those in hard to reach area with immunization service.