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ADDIS ABABA UNIVERSITY Vaccination Incompletion Of ADDIS ABABA UNIVERSITY SCHOOL OF GRADUATE STUDIES COLLEGE OF NATURAL SCIENCE DEPARTMENT OF STATISTICS Vaccination Incompletion of Children Aged 12 to 59 Months in Ethiopia Kidanie Aragaw Alemu A Thesis Submitted to the Department of Statistics Presented in Partial Fulfillment of the Requirements for the Degree of Master of Science in Statistics June 2014 Addis Ababa University School of Graduate Studies This is to certify that the thesis prepared by Kidanie Aragaw Alemu, entitled: Vaccination Incompletion of Children Aged 12 to 59 Months in Ethiopia and submitted in partial fulfillment of the requirements for the Degree of Master of Science in Statistics compiles with the regulations of the University and meets the accepted standards with respect to originality and quality. Signed by the Examining Committee: Examiner__________________________signature____________Date_________________ Examiner__________________________signature____________Date_________________ Advisor___________________________signature____________Date_________________ _________________________________________________________________________ Chair of Department or Graduate Program coordinator ACKNOWLEDGEMENT I am particularly grateful to the Central Statistics Agency personnel for their cooperation in providing the research materials. I would like to express my deep appreciation to Wollo University, especially the staff of Statistics Department, for their support in every aspect. I also extend my sincere appreciation to the Department of Statistics, Addis Ababa University for their assistance in providing the research fund. Finally I would like to extend a special thanks to Shibru Temesgen (Dr.) for his constructive advice, suggestions, and comments. THANKS TO THE INFINITE! i ABSTRACT Vaccination Incompletion of Children Aged 12 to 59 Months in Ethiopia Kidanie Aragaw Alemu Addis Ababa University, 2014 More children in Ethiopia start and do not complete all expanded programme on immunization (EPI) recommended for routine immunization (RI) vaccines than those who complete their vaccine schedule. This group of defaulter is bigger than the group that has no vaccines. However, both groups of children that have no vaccines and those that have partial vaccination are in similar risk of acquiring vaccine preventable diseases. This study aims to assess demographic, socio economic, environmental and health service factors affecting childhood vaccination incompletion, and to determine the extent of incomplete vaccination within and between regions in Ethiopia based on EDHS 2011 data. In this study a total of 6797 children 12 to 59 months of age were included (mean age of 36 and standard deviation 13.655 months). Among these children 33.76% were completely immunized while 66.24% were partially vaccinated. Descriptive data analyses, binary logistic, and multilevel logistic regression analyses were used. This study identified that region, wealth index, sex of household head, birth order of a child, being of wise of a mother to have balanced family life, frequency of a mother listening to radio, and mothers’ getting of prenatal care and assistant from a health professional were statistically significant at 5% level for a child 12 to 59 month of age being partially immunized. The multilevel logistic regression analysis revealed that there was heterogeneity across regions. Between regional variations for vaccination incompletion of children 12 to 59 months of age was 1.0596 with standard error 0.4603. Intraclass correlation between two individual mothers in the same region was . A low ICC indicates relatively small between regional variations, but in this study it was 0.322067 high. Region Tigray, Afar, Oromia, Somali (at 10% significance level), Gambela, Addis Ababa and Dire Dawa were statistically significant regions for the variation of children vaccination defaulting in the country. The chance of a child 12 to 59 month of age being partially immunized was 67% on average in the country. The average probability of a child 12 to 59 months of age being under vaccinated was below the average (0.6661) in Tigray (0.3747), Addis Ababa (0.1773) and Dire Dawa (0.4596) while it was higher in Afar (0.8997), Oromia (0.7969), Somali (0.7809), and Gambela (0.8310) regions. ii ACRONYMS AGQ Adaptive Gaussian Quad rapture AHOTP Accelerated Health Officer Training Programme AIC Akaike Information Criterion AICC Burnham and Anderson Criterion AIDS Acquire Immune Deficiency Syndrome ANC Ante Natal Care AUC Area under the Curve BCG Bacillus Calmette-Guerin BIC Bayesian Information Criterion CAIC Bozdogan Criterion CDC Center for Disease Control CI Confidence Interval DF Degrees of Freedom DHS Demographic Health Survey DPT Diphtheria, Pertussis, Tetanus EA Enumerative Area EDHS Ethiopia Demographic Health Survey EMOH Ethiopia Ministry of Health EPI Expanded Programme on Immunization GAVI Global Alliance for Vaccine and Immunization HEP Health Extension Programme HEW Health Extension Worker HIB Haemophilus Influenza Type B iii HIV Human Immune Virus HO Heath Officer HQIC Hannan and Quinn Criterion HSDP Health Sector Development Plan ICC Intra Class Correlation IGLS Iterative Generalized Least Squares IMNC Integrated Management of Neonatal and Child Illness IPV Injective Polio Vaccine LR Likelihood Ratio MCMC Markov Chain Monte Carlo MDG Millennium Development Goal ML Maximum Likelihood MOH Ministry of Health MQL Marginal Quasi Likelihood NGO Nongovernmental Organization NHA Nutrition and Health Authority OLS Ordinary Least Square OOP Out-of-Pocket OPV Oral Polio vaccines OR Odds Ratio PHC Public Health Center PQL Penalized Quasi Likelihood RED Reaching Every District RHB Regional Health Bureau RHS Right Hand Side iv RI Routine Immunization RIGLS Reweighted Iterative Generalized Least Square ROC Receiver Operating Characteristic SAS Statistical Analysis System SC Schwarz Criterion SE Standard Error SI Supplemental Immunization SNNP South Nations Nationalities and People STD Standard Deviation TB Tuberculosis TT Tetanus Toxoid UN United Nations UNICEF United Nations Children Fund USAID United States Agency for International Development USD United States Dollar VPD Vaccine Preventable Disease WHO World Health Organization ZHD Zonal Health Department v Table of Contents Table of Contents ACKNOWLEDGEMENT .......................................................................................................................................... i ABSTRACT ............................................................................................................................................................ ii ACRONYMS ..........................................................................................................................................................iii Table of Contents ................................................................................................................................................ vi List of Tables ...................................................................................................................................................... viii List of Figures .................................................................................................................................................... viii CHAPTER ONE ...................................................................................................................................................... 1 INTRODUCTION ............................................................................................................................................... 1 1.1. Background ................................................................................................................................... 1 1.2. Statement of the Problem ............................................................................................................. 6 1.3. Objective of the Study ................................................................................................................... 7 1.3.1. General Objective ........................................................................................................................ 7 1.3.2. Specific Objectives ....................................................................................................................... 7 1.4. Significance of the Study ............................................................................................................... 8 CHAPTER TWO ................................................................................................................................................ 9 LITERATURE REVIEW .................................................................................................................................... 9 2.1. Immunization Coverage and EPI program in Ethiopia ................................................................. 9 2.2. Factors Affecting Uptake of Complete childhood Immunization ............................................... 10 2.2.1. Geography and Governance ...................................................................................................... 10 2.2.2. Socio-Demographic Characteristics of Parents/Caretakers ....................................................... 11 2.2.3. Parity, Birth Order and Sex of Child ......................................................................................... 13 2.2.4. Maternal Healthcare Utilization ...............................................................................................
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