A community-based cross-sectional study was conducted from July 1-30/ 2018 at Edagahamus city, Tigray regional state of Ethiopia. Edagahamus is founded in the eastern zone of Tigray, wereda Saesie Tsaida Amba; which is located 885 Km north of the Ethiopian capital city of Addis Ababa,105 Km east of the Tigray capital city Mekelle and around 20 Km near to Adigrat. Edagahamus is divided into four kebeles and the total population was 21,993; from those 10,031 were male and 11,962 were female (2006/2012 census). There is only one health center in Edagahamus and the total number of under two-year children is 795.
Sampled children aged 12 – 23 months old living in Edagahamus and who fulfill the inclusion criteria were taken as the study population. Households that have one living child aged between 12-23 months old who have the vaccination card are included, While Households who have children aged between 12-23 months old who do not complete their vaccination (drop out) were excluded.
Sample size determination and sampling technique
The sample size was calculated using a single population proportion formula with the following assumption: Prevalence of children’s who had delayed vaccination in Gambia =63.3% (1),95% of confidence interval(1.96), 5% margin of sampling error tolerated, 10% of non-response rate, then the final sample size are 393. A simple random sampling method was used to select study subjects using a sampling frame obtained from the health extension workers. The mothers' identity and the households' numbers that are used by the Health extension workers were used to identify the selected households. In the case of two or more mothers having a child’s in the same household, one mother was selected using the lottery method. First, a list of all eligible participants was prepared in excel after obtained from the health extension workers. Then, the random number was generated using OpenEpi software and marked the selected one against the excel. Finally, each eligible study participant was contacted through the house to house visits. A second visit was done in case a mother was absent in the house during the first visit. If the mother is not available for the second time, a neighbor's mother with a child was contacted. Samples were allocated to each kebeles using a proportion to the size allocation.
Socio-demographic and economic factors, Maternal/caregiver factors, Child’s factors, and Service-related factors.
Definition of terms
BCG (birth – 8 weeks), Penta1, PCV1, Rota1 and OPV1 (6 weeks – 14 weeks); Penta2, PCV2, Rota2 and OPV2 (10 weeks – 18 weeks); Penta3, PCV3 and OPV3 (14 weeks – 24 weeks)] and measles vaccine (9 months – 11months). Timeliness of vaccination of a particular antigen was assessed against the WHO recommended range as already indicated above and Children who have delayed at receiving at least one vaccine considered as delayed (1). Timely: if the vaccine was received within the recommended period above. Delayed: if received after the window period. Penta-1 to Penta-3 dropout rate: the % of children vaccinated for Penta-1who defaulted for Penta-3. BCG to Measles dropout rate: the % of children vaccinated for BCG who defaulted for measles.
Health Extension Worker: In Ethiopia, against a backdrop of acute physician shortage, Health Extension Workers are assigned to local health posts and provide a package of essential interventions to meet population health needs at this level. Through the national Health Extension Program, HEWs are recruited among high school graduates in local communities, and undergo a one-year training program to deliver a package of preventive and basic curative services that fall under four main components: hygiene and environmental sanitation; family health services; disease prevention and control; and health education and communication (34).
Data collection tools and techniques
Data was collected by using an interviewer-administered and structured questionnaire adapted from WHO survey questions and related pieces of literature according to the objectives (1, 19, 22, 23,30). The questionnaire includes Socio-demographic and economic factors, Maternal/caregiver factors, Child’s factors, and Service-related factors.
Data quality assurance and control
Five Midwife data collectors and supervisors were recruited from another area outside of the study site and they were given training for three days. The supervisors followed the process of data collection daily, checked the data completeness consistency and communicate with principal investigators daily.
Data Processing and Analysis
data was coded, cleaned, recorded and entered into Epi info 7and finally export to SPSS version 20.00 for analysis. Simple descriptive summary statistics were done. Tables, statements, charts, and graphs were used to present the result of the analyzed data. Associations between independent and dependent variables were analyzed first using bivariate logistic regression analysis. Variables that had p<0.2 on bivariate analysis were entered into multivariable logistic regression analysis. The statistical association between the different independent variables to the dependent variable was measured using OR, AOR, 95% CI and P-values <0.05 was considered statistically significant.