Skip to main content

Advertisement

SpringerLink
Log in

Minding the Immunization Gap: Family Characteristics Associated with Completion Rates in Rural Ethiopia

  • Original Paper
  • Published:
Journal of Community Health Aims and scope Submit manuscript

Abstract

To examine risk factors for lack of immunization, we tested the impact of maternal, paternal, and household variables on child immunization status in children ≥1 year in a rural area of Ethiopia. Data collected by face-to-face interview on maternal, paternal, household and child variables from cross-sectional random sample community-based study on health and well-being in rural Ethiopia was used to test hypotheses on immunization status of children (n = 924). Bivariate and multivariate logistic regression models were used for two immunization outcomes: record of at least one vaccination, and record of DPT3, indicating completion of the DPT series. Complete data were available for 924 children ≥1 year of which 79% had at least one vaccination. Of those, 64% had DPT3/Polio3; below recommended coverage level. Children were more likely to be vaccinated if the mother reported antenatal care (ANC), and less likely to be vaccinated if the mother had a history of stillbirth, and no opinion of health center. Children were more likely to have DPT3 if: mother had ≥1 year of education, mother reported ANC, or older paternal age. Children were less likely to have DPT3 in households with food insecurity and no maternal opinion of health center. The study had three findings with implications for immunization programming: (1) Mothers completing the recommended ANC visits is strongly associated with receiving at least one vaccination and with completing a vaccination series; (2) Maternal education is associated with a completed vaccination series; (3) Paternal characteristics may affect vaccination series completion.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. The World Bank. (2003). Public health at a glance: Immunization. Retrieved Dec 19, 2008 from http://go.worldbank.org/A0E6J0XVO0.

  2. De, P., & Bhattacharya, B. N. (2002). Determinants of child immunization in four less-developed states of North India. Journal of Child Health Care, 6(1), 34–50.

    Article  Google Scholar 

  3. Basu, A. M., & Stephenson, R. (2005). Low levels of maternal education and the proximate determinants of childhood mortality: A little learning is not a dangerous thing. Social Science & Medicine, 60(9), 2011–2023.

    Article  Google Scholar 

  4. Parashar, S. (2005). Moving beyond the mother–child dyad: Women’s education, child immunization, and the importance of context in rural India. Social Science & Medicine, 61(5), 989–1000.

    Article  Google Scholar 

  5. Alemu, W., Woldeab, M., & Meche, H. (1991). Factors influencing non-attendance in the immunization of children in 3 selected regions, Ethiopia, July 1988. Ethiopian Medical Journal, 29(2), 49–55.

    PubMed  CAS  Google Scholar 

  6. Elliott, C., & Farmer, K. (2006). Immunization status of children under 7 years in the Vikas Nagar area, North India. Child Care Health and Development, 32(4), 415–421.

    Article  CAS  Google Scholar 

  7. Nath, B., Singh, J., Awasthi, S., Bhushan, V., Kumar, V., & Singh, S. (2007). A study on determinants of immunization coverage among 12–23 months old children in urban slums of Lucknow district, India. Indian Journal of Medical Sciences, 61, 598–606.

    Article  PubMed  Google Scholar 

  8. Chhabra, P., Nair, P., Gupta, A., Sandhir, M., & Kannan, A. T. (2007). Immunization in urbanized villages of Delhi. Indian Journal of Pediatrics, 74(2), 131–134.

    Article  PubMed  Google Scholar 

  9. Desai, S., & Alva, S. (1998). Maternal education and child health: Is there a strong causal relationship? Demography, 35(1), 71–81.

    Article  PubMed  CAS  Google Scholar 

  10. Streefland, P. H., Chowdhury, A. M. R., & Ramos-Jimenez, P. (1999). Patterns of vaccination acceptance. Social Science & Medicine, 49(12), 1705–1716.

    Article  CAS  Google Scholar 

  11. Gedlu, E., & Tesemma, T. (1997). Immunization coverage and identification of problems associated with vaccination delivery in Gondar, north west Ethiopia. East African Medical Journal, 74(4), 239–241.

    PubMed  CAS  Google Scholar 

  12. Berhanel, Y., Bekele, A., & Tesfaye, F. (2000). Immunization (EPI) in Ethiopia: Acceptance, coverage, and sustainability. Ethiopian Medical Journal, 38(Suppl 1), 1–63.

    PubMed  Google Scholar 

  13. Topuzoglu, A., Ay, P., Hidiroglu, S., & Gurbuz, Y. (2007). The barriers against childhood immunizations: a qualitative research among socio-economically disadvantaged mothers. European Journal of Public Health, 17(4), 348–352.

    Article  PubMed  Google Scholar 

  14. Bhattacharyya, K., & Murray, J. (2000). Community assessment and planning for maternal and child health programs: A participatory approach in Ethiopia. Human Organization, 59(2), 255–266.

    Google Scholar 

  15. USAID. (2003). Immunization essentials: A practical field guide. Office of Health, Infectious Diseases, and Nutrition, Bureau for Global Health.

  16. Brugha, R. F., Kevany, J. P., & Swan, A. V. (1996). An investigation of the role of fathers in immunization uptake. International Journal of Epidemiology, 25(4), 840–845.

    Article  PubMed  CAS  Google Scholar 

  17. Torun, S. D., & Bakirci, N. (2006). Vaccination coverage and reasons for non-vaccination in a district of Istanbul. BMC Public Health, 6, 125.

    Article  PubMed  Google Scholar 

  18. Chowdhury, A. M. R., Bhuiya, A., Mahmud, S., Salam, A., & Karim, F. (2003). Immunization divide: Who to get vaccinated in Bangladesh? Journal of Health Population and Nutrition, 21(3), 193–204.

    Google Scholar 

  19. Choi, J. Y., & Lee, S. H. (2006). Does prenatal care increase access to child immunization? Gender bias among children in India. Social Science & Medicine, 63(1), 107–117.

    Article  Google Scholar 

  20. Bishai, D., Suzuki, E., McQuestion, M., Chakraborty, J., & Koenig, M. (2002). The role of public health programmes in reducing socioeconomic inequities in childhood immunization coverage. Health Policy and Planning, 17(4), 412–419.

    Article  PubMed  Google Scholar 

  21. Borooah, V. K. (2004). Gender bias among children in India in their diet and immunisation against disease. Social Science & Medicine, 58(9), 1719–1731.

    Article  Google Scholar 

  22. Butz, A. M., Funkhouser, A., Caleb, L., & Rosenstein, B. J. (1993). Infant health-care utilization predicted by pattern of prenatal-care. Pediatrics, 92(1), 50–54.

    PubMed  CAS  Google Scholar 

  23. Gill, J. M., Saldarriaga, A., Mainous, A. G., & Unger, D. (2002). Does continuity between prenatal and well-child care improve childhood immunizations? Family Medicine, 34(4), 274–280.

    PubMed  Google Scholar 

  24. Fantahun, M., Berhane, Y., Wall, S., Byass, P., & Hogberg, U. (2007). Women’s involvement in household decision-making and strengthening social capital—crucial factors for child survival in Ethiopia. Acta Paediatrica, 96(4), 582–589.

    Article  PubMed  Google Scholar 

  25. Nichter, M. (1995). Vaccinations in the third-world—a consideration of community demand. Social Science & Medicine, 41(5), 617–632.

    Article  CAS  Google Scholar 

  26. Streefland, P. H., Chowdhury, A. M. R., & Ramos-Jimenez, P. (1999). Quality of vaccination services and social demand for vaccinations in Africa and Asia. Bulletin of the World Health Organization, 77(9), 722–730.

    PubMed  CAS  Google Scholar 

  27. World Health Organization. (2008). Expanded Programme on Immunization: Ethiopia. Retrieved April 2, 2008 from http://www.who.int/countries/eth/areas/immunization/en/.

  28. World Health Organization. (2007). Immunization Profile: Ethiopia. Retrieved April 2, 2008 from http://www.who.int/vaccines/globalsummary/immunization/countryprofileresult.cfm.

  29. Central Stastical Agency [Ethiopia] & ORC Macro. (2006). Ethiopia demographic and health survey 2005. Addis Ababa, Ethiopia and Calverton, Maryland, USA: Central Statistical Agency and ORC Macro.

  30. Perez-Escamilla, R., Segall-Correa, A. M., Maranha, L. K., Sampaio, M. D. A., Marin-Leon, L., & Panigassi, G. (2004). An adapted version of the US department of agriculture food insecurity module is a valid tool for assessing household food insecurity in Campinas, Brazil. Journal of Nutrition, 134(8), 1923–1928.

    PubMed  CAS  Google Scholar 

  31. Villar, J., & Bergsjo, P. (2002). WHO antenatal care randomized trial: Manual for the implementation of the new model. Geneva: WHO.

    Google Scholar 

  32. D’Agostino, R. (1998). Biostatistics tutorial: Propensity score methods for bias reduction in the comparison of a treatment to a non-randomized control group. Statistics in Medicine, 17(19), 2265–2281.

    Article  PubMed  Google Scholar 

  33. Xie, J. P., & Dow, W. H. (2005). Longitudinal study of child immunization determinants in China. Social Science & Medicine, 61(3), 601–611.

    Article  Google Scholar 

  34. Luman, E. T., McCauley, M. M., Shefer, A., & Chu, S. Y. (2003). Maternal characteristics associated with vaccination of young children. Pediatrics, 111(5), 1215–1218.

    PubMed  Google Scholar 

  35. Racine, A. D., & Joyce, T. J. (2007). Maternal education, child immunizations, and public policy: Evidence from the US national immunization survey. Social Science & Medicine, 65(8), 1765–1772.

    Article  Google Scholar 

  36. Kidane, T., & Tekie, M. (2003). Factors influencing child immunization coverage in a rural District of Ethiopia, 2000. Ethiopian Journal of Health and Development, 17(2), 105–110.

    Google Scholar 

Download references

Acknowledgments

The authors are grateful to the local staff of GGGDS and colleagues at Jimma University for their support and work during data collection and manuscript preparation, and to the community of Gilgel Gibe for their on-going support and participation in this study. Funding for the Gilgel Gibe Growth and Development Study (GGGDS) study is provided by the Michigan Interdisciplinary Center on Social Inequality, Mind and Body (R24 HD047861) and start up funds. Conflict of Interest: None declared.

Author information

Authors and Affiliations

  1. Hubert Department of Global Health, Rollins School of Public Health, Emory University, 1518 Clifton Rd., Atlanta, GA, 30322, USA

    Mary-Christine Sullivan

  2. Yale School of Nursing, 100 Church St. South, New Haven, CT, 06519, USA

    Mary-Christine Sullivan

  3. Department of Biostatistics and Epidemiology, Jimma University, P.O. Box 1348, Jimma, Ethiopia

    Ayalew Tegegn & Fasil Tessema

  4. University of Michigan School of Public Health, 109 Observatory St, Rm 3663, Ann Arbor, MI, 48109, USA

    Sandro Galea

  5. Department of Anthropology, Emory University, 1557 Dickey Dr., Atlanta, GA, 30322, USA

    Craig Hadley

Authors
  1. Mary-Christine Sullivan
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Ayalew Tegegn
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Fasil Tessema
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Sandro Galea
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Craig Hadley
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Mary-Christine Sullivan.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Sullivan, MC., Tegegn, A., Tessema, F. et al. Minding the Immunization Gap: Family Characteristics Associated with Completion Rates in Rural Ethiopia. J Community Health 35, 53–59 (2010). https://doi.org/10.1007/s10900-009-9192-2

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10900-009-9192-2

Keywords

Search

Navigation