23 Months in Arba Minch Town and Zuria District, Southern Ethiopia, 2013 Worku Animaw1*, Wondimagegn Taye2, Behailu Merdekios3, Marilign Tilahun3 and Gistane Ayele3

Animaw et al. BMC Public Health 2014, 14:464 http://www.biomedcentral.com/1471-2458/14/464 RESEARCH ARTICLE Open Access Expanded program of immunization coverage and associated factors among children age 12 – 23 months in Arba Minch town and Zuria District, Southern Ethiopia, 2013 Worku Animaw1*, Wondimagegn Taye2, Behailu Merdekios3, Marilign Tilahun3 and Gistane Ayele3 Abstract Background: Immunization averts an estimated 2 to 3 million deaths every year globally. In Ethiopia only quarter of children are fully immunized; the rest are remained at risk for vaccine-preventable mortality. To increase the immunization, its coverage and predictors has to be identified. This study has measured immunization coverage and identified the predictors. Methods: Cross-sectional community based study has been conducted within 630 age 12–23 months children in 15 districts of Arba Minch town and Arba Minch Zuria district, Southern Ethiopia in March 2013. Census was done to identify eligible children. The 2005 world health organization expanded program of immunization cluster sampling method has been used. Data were collected using semi-structured pretested Amharic version questionnaire by interviewing index children’s mothers/caretakers, copying from vaccine card and observing BCG vaccine scar. Data were processed using SPSS version 16. Associations between dependent and independent variables has been assessed and presented using three consecutive logistic regression models. Result: Nearly three fourth (73.2%) of children in Arba Minch Town and Arba Minch Zuria district were fully immunized. The rest 20.3% were partially immunized and 6.5% received no vaccine. Mother education, mothers’ perception to accessibility of vaccines, mothers’ knowledge to vaccine schedule of their site, place of delivery and living altitude were independent predictors of children immunization status. Conclusion: Expanded program of immunization (EPI) coverage at Arba Minch town and Arba Minch Zuria district is better than the national immunization coverage but still below the goal. Educating mother, promoting institution delivery could help to maintain and enhance current immunization coverage. More emphasis should be given to the highland areas of the area. Keywords: Child immunization, Immunization coverage, Ethiopia Background likely to die by his or her fifth birthday than a child in Worldwide about 29,000 children under the age of five Western Europe [1,2]. die every day, mainly from preventable causes. Every Ethiopia placed sixth among the countries of the year around 8 million children in developing countries world in terms of child death as about 472,000 Ethiopian die before they reach their fifth birthday; many during children die each year before their fifth birthday. Most the first year of life. An Ethiopian child is 30 times more of these deaths occur from few preventable and curable diseases and conditions [3]. During 2010–2011, a total of 9,756 measles cases were reported in Ethiopia; more than three fourth of it occurred * Correspondence: [email protected] 1Bahir Dar University, College of Medicine and Health Sciences, PO Box 79, among children age <5 years. Cases occurred predomin- Bahir Dar, Ethiopia antly in unvaccinated persons. Keffa was one of the zones Full list of author information is available at the end of the article © 2014 Animaw et al.; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly credited. Animaw et al. BMC Public Health 2014, 14:464 Page 2 of 10 http://www.biomedcentral.com/1471-2458/14/464 experienced a large measles outbreak between October of the recommended vaccines. Vaccination coverage is 2011 and February 2012 where over 3,000 measles cases more than double in urban areas than in rural areas of the were confirmed and thousands of unimmunized children country (48% versus 20%) [13,14]. In contrast with this registered in the Zone [4,5]. national survey other studies; a 2006 survey reported Immunization currently averts an estimated 2 to 3 49.9% in nationwide, a 2008 survey in Wonago district million deaths every year. However, the proportion of 41.7% and in 2011 at Ambo district 36% of the children the world’s children who receive recommended vaccines were fully vaccinated [2,7,15]. has remained steady for the past few years [4]. The study in Wonago district also identified knowledge According to guidelines developed by the World Health of the mothers about child immunization, monthly family Organization (WHO), children are considered fully vacci- income, postponing child immunization and perceived nated when they have received a vaccination against tuber- health institution support were the predictors of defaulting culosis Bacillus Calmette Guerin (BCG), three doses each from completion of child immunization [2]. of diphtheria, pertussis and tetanus toxoids (DPT),three In 2011 Belachew and his colleague reported 23.7% doses of polio vaccines, and a measles vaccination by the children of Ambo district were no vaccinated at all. They age of 12 months. Since Ethiopia included Haemophilus also identified factors affecting complete immunization influenza type B (HiB) and hepatitis B(HepB) as of as sex of child, antenatal care follow-up, being born in 2007; pentavalent vaccine (DPT plus Hep B and Hib) the health facility, and mothers’ knowledge about the has replaced the previous DPT vaccine [6,7]. age children start and complete vaccination [7]. World Health organization reports indicated by the year Ethiopian demographic and health survey (EDHS) 2011 2011 worldwide coverage of three doses of DTP, one dose also calculated coverage for specific vaccines, 66 percent of measles and three doses of polio vaccine were 83%, 84% of children received the BCG vaccine, and 56 percent had and 84% respectively. However, more than one-fifth of the received the measles vaccine. A relatively high percentage world’s children, especially those in low-income countries, of children received the first DPT dose (64%). However, were still not fully vaccinated at 12 months of age and only 37% went on to receive the third dose of DPT. More remained at risk for vaccine-preventable morbidity and than eight children of every ten (82%) received the first mortality [4,8]. dose of polio, but only 44% received the third dose [13]. Complete immunization coverage in Kenya by the year According to guidelines developed by the WHO and 2011 was 76.6% with 99.5% BCG and 77.4% measles shared by Ethiopia, a child is considered fully immunized coverage. Identified predictors were number of children when he/she has received one dose of BCG, three doses of within the family, place of birth of the child, and opinion DPT (since Ethiopia included HiB and HepB since 2007; on the health immunization services offered [9]. In 2005 pentavalent vaccine (DPT + HepB_Hib) has replaced the Indian complete status immunization was 44% almost previous DPT vaccine), three doses polio vaccines exclud- similar with Pakistan and factors identified were mother ing polio zero given at birth and a measles vaccination by education, mother religion and child birth order [10,11]. the age of 12 months. A child is considered as partially im- In Ethiopia, the vaccination policy calls for BCG vac- munized if received any vaccines but missed at least one cine given at birth or at first clinical contact, three doses dose of one BCG, three doses of pentavalent, three doses of pentavalent (DPT-HepB-Hib) vaccine and the newly of oral polio vaccine (OPV) and a measles vaccine. A child added pneumococcal conjugate vaccine (PCV) vaccine is considered as not immunized if he/she does not receive given at approximately 4, 8, and 12 weeks of age, four any dose of vaccines [12,16]. doses of oral polio vaccine given approximately at 0-2, Countries including Ethiopia are aiming to achieve 4, 8, and 12 weeks of age, and measles vaccine given at vaccination coverage of ≥90% nationally and ≥80% in or soon after reaching 9 months of age [6,12]. All these every district by the year 2020. Reports indicated percent- vaccines are recommended to be given within one year age of children who are fully vaccinated remains far below of a child age. the goal set in the fourth Ethiopian health sector develop- Ethiopian central statistics agency in its 2011 demo- ment plan (HSDP IV) [4,12]. Frequent measles outbreak graphic and health survey found that 24% of Ethiopian and high child morbidity and mortality rate in the country children 12–23 months age have received all recom- are among the consequences of low immunization cover- mended vaccines; one dose each of BCG and measles, age. Many children in Ethiopia do not get the benefits of and three doses each of DPT and polio (excluding polio immunization [3,17]. zero vaccine given at birth). The finding of this survey The Ethiopian government is striving to reduce child showed improved immunization coverage as compared mortality rate. One of the means is by increasing with similar survey in 2005 which revealed that only immunization coverage with several being implemented 20% of children 12–23 at the time. The 2011 survey also strategies. The Ethiopian ministry of health (EMoH) has reported fifteen percent of children did not receive any newlyincorporatedPCVvaccineinitsEPIprogramas Animaw et al. BMC Public Health 2014, 14:464 Page 3 of 10 http://www.biomedcentral.com/1471-2458/14/464 of 2011. One year earlier to the period of current study district was managed as a cluster. In the selected dis- when study subjects were expected to be immunized tricts, first enumeration was done to identify all eligible Ethiopian Ministry of Health with its partners had con- children. Determined samples (630) were proportionally ducting survey in the current study area.

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