Background: Vaccination is one of the best cost-effective public health interventions to safeguard children from vaccine-preventable diseases. In Ethiopia, the prevalence of default to the full completion of child immunization is high. However, the determinants of default to full completion have not been thoroughly investigated in this study area. Therefore, this study assessed the determinants of default to the full compilation of vaccination among children between 12 and 23 months old in Yilmana Densa District, west Gojam, northwest Ethiopia. Methods: A community-based unmatched case-control study design was employed in the Yilmana Densa district among 343 (111 cases and 232 controls) randomly selected 12–23 months old children. Face-to-face interviews were used to collect data using a multistage sampling method. For analysis, data were entered into epidata version 3.1 and exported to SPSS 23 software. Descriptive analysis followed by binary and multivariable logistic regression analysis was conducted. The statistical significance was declared at a p-value of 0.05. Result: This study identified that mothers who had not attended ANC follow-up [AOR = 5.55, 95% CI: (1.789–17.217)], mothers who had not gotten information about vaccinations [AOR = 8.589, 95% CI: (4.414–16.714)], and mothers whose time taken to reach vaccination site is more than 39 min were at higher risk to default from completion of vaccination [AOR = 3.252, 95% CI: (1.952–5.417)]. Furthermore, maternal waiting time (>45 min) for child vaccination [AOR = 2.674, 95% CI: (1.517–4.714)] and home delivery [AOR 3.19, 95% CI: (1.751–5.814)] were risk factors to default child from full completion of vaccination. Conclusion: Mothers delivered at home, mothers not attending ANC follow-up, mothers who did not get health information about the vaccine, mothers taking longer time to reach the vaccination site, and staying longer time for child vaccination are causes of default. Motivated institutional delivery services utilization is recommended. The district office should consider the distribution of vaccination sites by the opening of new outreach site to reduce the waiting time of mothers.
An unmatched community-based case-control study design was used. This study was conducted in Yilmana Densa, West Gojam zone, Ethiopia, from 30 March to 15 May 2019. Yilmana Densa district is the second-most populated district in the west Gojam Zone with an estimated number of 275,187 populations. Of which, 136,218 (49.5%) were female and 5,200 (5.1%) were children between 12 and 23 months of age. The district has 5 urban and 30 rural kebeles. EPI is provided by all health centers, health posts, and outreach sessions. Health service coverage was 89%. According to the 2017/18 district health office report, the full completion vaccination coverage was 66%, which is below the WHO standard (80%). All children between 12 and 23 months of age, and who had started at least one dose of the routine immunization program in the Yilmana Densa district were the source population. All children between 12 and 23 months of age residing in randomly selected kebeles were the study population. All children aged 12–23 months lived in the study area for the past 2 years and the children at least received one vaccination exposure. All children aged 12–23 months have completed all the recommended vaccines. Children whose parents or guardians struggle to communicate immunization information about their child succinctly. The sample size was calculated using EPI info version 7.2.1.0 and is based on the following assumptions: A power of 80% with a 95% confide level (CL), a maximum tolerable error of 5%, and the one case to two control (1:2) ratio with Odds ratio of 5.7. With a 10% non-response rate, 345 people were the estimated sample size (115 cases and 230 controls). Proportions of maternal health service utilization among cases (97.7%) and controls (88.1%) were obtained from the previous literature (13). The study participants were selected using a stratified sampling technique. The district was classified into two strata: urban and rural residents. Then, one urban and seven rural kebeles were chosen at random to provide valid study subjects. Cases and controls in the kebeles were identified using child vaccination cards and a vaccine registration book from the health posts. Cases were children aged 12–23 months who have missed at least one dose from the recommended schedule (except for polio zero). The total sample size of 345 (115 cases and 230 controls) was allocated proportionally to each selected kebele. Finally, the study participants were selected randomly by the lottery method from all the selected kebeles and households. A data extraction checklist form was used to extract secondary data. Primary data were collected using a structured and interviewer-administered questionnaire. Defaulting from full completion of vaccination (Yes/No) were the dependent variables. Whereas, the independent variables were socio-demographic factors such as age of mother, pregnancy status, residency, caretaker, maternal occupation, sex of the child, birth order, child’s father, and paternal behavior; government-related factors: health budget policy and vaccine demand/vaccine supply; health service accessibility: time taken to get health post, waiting time for vaccination, place of delivery, antenatal care service, vaccine mode of transport to health facility/outreach site, and stock out vaccination place/time; maternal health service utilization: ANC/PNC, TT vaccination, antenatal conference participation, and inconvenient vaccination place/time, waiting time, appointment, and getting of health education about vaccination. Secondary data were extracted using a data extraction checklist form. Face-to-face interviews were used to collect primary data using a structured and pretested Amharic version questionnaire. The questionnaire was first prepared in English and then translated to Amharic. The questionnaire had designed to measure socio-demographic characteristics, maternal health service utilization, health facility access, paternal behavior, vaccination status of a child, and reasons for defaulting from full completion of vaccination. Children’s vaccination cards were used to collect information about their vaccination status. The questionnaire was pretested on 5% of the study participants in another area. Data collectors and supervisors each received 1 day of training to ensure that they all had a common understanding of the study’s objectives and each of the questionnaire’s questions. Daily, data were checked for completeness, consistency, accuracy, and clarity. Communication with data collectors, supervisors, and principal investigators was maintained throughout the study period. Before data entry, the data collectors, supervisors, and principal investigator checked the returned collected data for completeness. The data were cleaned, coded, and entered into Epi data version 3.1 and exported to SPSS version 23 for analysis. The simple frequency with percentage, figure, and tables were used to display the descriptive part of the result. A bivariable logistic regression model was used to identify the determinant variables. A variable with p ≤ 0.2 in bivariable logistic regression was eligible for the multivariable logistic regression analysis model to control the confounding effect. Both bivariable and multivariable logistic regression models were used to identify the determinant factors of default to full completion vaccination. Odds ratio (OR) with a 95% confidence interval was used to identify the strength of associations. A p < 0.05% was considered a statistically significant association.
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