Ethics approval and consent to participate: The Research Ethics Review Committee (WHO ERC) approved the protocol (reference no. ERC.0002843). Besides, the Scientific and Ethics Review Committee under the Ethiopian Public Health Institute approved the protocol.
Participants were given a copy (unsigned) of the informed consent statement that included contact information for research team members. The informed consent forms were written at a readability level appropriate for the target populations. Additionally, the consent statement included the purpose of the research; clarified the expected duration of their participation; how the research benefited the children, the caregivers, and the community; there were no costs for participating; the caregiver`s participation was voluntary and that refusal to participate had no consequences.
No subjects were interviewed without providing informed consent. Written informed consent was obtained prior to the interview, and consent was verified orally at the beginning of the interview. The consent form was read aloud by interviewers to the caregivers, after which the caregivers were asked if they understood and agreed to participate. The caregivers and the person obtaining consent/assent signed the form. Caregivers unable or unwilling to sign their name were made a mark, and a witness of the consent/assent procedures were signed on their behalf.
Consent for Publication: the plan for sharing findings through publications and conferences had been incorporated within the informed consent and the caregivers and other key informants of the study agreed to publish any of their given responses without indicating their names.
Availability of data and materials: The datasets used and analyzed during the current study are available from the corresponding author upon reasonable request.
Competing interests: The authors declare that they have no competing interests.
Funding: The full amount of the payments was made by GAVI for WHO/Alliance for Health Policy and Systems Research (AHPSR), DELIR Initiative. Meanwhile, the consortium members-GAVI, UNICEF and AHPSR provided technical support in refining the research proposal to feasible protocol, monitoring the process at all levels of the implementation, reviewing the final reports and disseminating the major findings. They also developed an instructional guide for developing manuscripts and some relevant reporting guidelines. Further, they designated two internal reviewers from the Alliance and UNICEF to review the manuscript and provide with feedback. The guide and feedback from the internal review has been used to revise and further develop the manuscript prior to submission to BMC supplement.
Costs for Publication: publication costs are funded by WHO, Alliance for Health Policy and System Research (AHPSR), Decision-Maker Led Implementation Research (DELIR) initiative.
Authors’ contributions: Y.T.; Collected secondary data and other health profiles from Lideta Sub-City Health Bureau and fed for protocol development. T.Z., D.B.; Developed the protocol and required tools, submitted for WHO ERC and local IRB and addressed the comments given by review committee. T.Z.; Followed the WHO ERC process. T.Z., A.T.; Facilitated the local IRB processes. T.Z., D.B., A.T., Y.T.; Conceptualized the study, provided pre-data collection trainings for facilitators of the IDIs, KIIs and FGDs, oversaw data collection at field level, monitored the transcription process, supported the data analysis and interpretation of the findings. T.Z., D.B., A.T., Y.T.; Wrote the main report of the study and contributed to the write-up of the draft and final versions of the manuscript. T.Z., D.B., A.T., Y.T.; Made all the major and minor changes in the manuscript. On the other hand, all authors have read and approved the final manuscript to publish.
Acknowledgements: The authors would like to acknowledge the hard work, dedication, and lively spirit of collaboration from everyone involved in completing this decision-maker–led research to address high-priority immunization issues. We acknowledge the intellectual contributions of the vaccinators, medical directors, EPI focal persons, coordinators, supervisors, UHEWs, and caregivers who participated in in-depth interviews, key informant interviews, and focus group discussions. We also wish to sincerely express our gratitude and indebtedness to the core group of experts and research assistants that made the field assessment a success. We thank Wogayehu Tadele, Munit Legesse, Yosef Sultan, Sintayehu Abate, and Ibrahim Kedir for their technical guidance during the planning of the assessment and in selecting interviewees and discussants and for effectively coordinating and facilitating fieldwork. We also extend our gratitude to the MERQ consultancy office’s admin staffs for their coordination, and to the study respondents, who willingly lent their time to the study. Finally, we wish to acknowledge the following partners: GAVI, WHO/Alliance for Health Policy and Systems Research, UNICEF for first protocol review and approval and also overall technical advice in the report write-up, manuscript preparation and revision; EPHI for reviewing the protocol and for their observations during trainings and data collection processes; the FMOH, Addis Ababa health bureau, and Lideta sub-city health bureau for accepting the EPHI approval and permission; and district health offices and health facilities for assigning guides and arranging interviews.