| Abstract |
Immunization is a proven tool for controlling and even eradicating infectious diseases and averts childhood deaths. World Health Organization (WHO) launched the Expanded Program on Immunization (EPI) in 1974. Ethiopia also launched the EPI program in 1980 with the objective of achieving 100% immunization coverage of all children under two by 1990. The EPI programs including Supplemental Immunization Activities (SIAs), Reaching Every District (RED), and Enhanced routine Immunization Activities (ERIA) have been implemented to further expand vaccination services. Measurements of vaccination coverage levels and trends are used to monitor the performance of routine vaccination services at subnational and national levels and measure the effectiveness of interventions to increase coverage.
The Last Ten Kilometres (L10K) Project of the John Snow, Inc. (JSI) Research and Training Institute is supporting the Federal Ministry of Health (FMoH) in implementing the routine immunization improvement plan in six selected zones and a Special Woreda with high numbers of unvaccinated children. This mid-term study was conducted to assess changes in immunization coverage and quality in terms of dropout, timing, and missed opportunities compared to the baseline survey after the implementation of the project interventions. In this study, the assessment was also done to look at immunization service availability and readiness of health posts and health centers. In addition, health extension workers and health center staff readiness in immunization services delivery was also assessed.
In the mid-term evaluation study, both quantitative and qualitative methods were used and data collection was conducted starting from December 2016 and January 2017. For the quantitative study, a cross-sectional design for household survey, facility observation, and immunization service providers’ assessment were used. From the targeted sample of 2,406 mothers with children 12-23 months of age interviewed, 2,076 were included for analysis. All health centers (237) and three health posts (711) for each health center catchment were included for facility observation and three health staff (head, EPI focal person, a staff involved in vaccination delivery), and a health extension worker was selected for providers’ assessment.
For the household survey, mothers/caretakers were interviewed face-to-face by trained data collectors who have at least first-degree education who speak the local language from the respective project area. SurveyCTO mobile app system was used for data collection. For the health professionals’ assessment survey, selected professionals were asked to complete a self-administered interview and an observation checklist was filled by an assigned health professional for health facilities assessment. For health professionals and facility-related assessment, all dimensions of immunization service availability and health professionals’ readiness measurements including additional practical incidents on immunization service delivery were included.
Vaccination sites were reported available in 79.7% of the kebeles. Mothers/caretakers identified measles (54.0%) and Polio (35.3%) vaccines to prevent childhood diseases and they knew measles (43.5%), polio (34.1%), and diarrhea (30.1%) as vaccine-preventable childhood diseases. To use immunization services at the health facilities, mothers/caretakers value short waiting time (48.8%), respecting the starting and ending time of vaccination (48.2%) most.
Vaccination coverage rates increased from baseline to the mid-term across all vaccines with more than 10% increase observed for Penta 3 (12.8%) and BCG (10.6%) with the lowest (1.3%) for OPV 3 and also rate of invalid dose during the mid-term was significantly lower than that of the baseline. The other indicator was the rate of age-related vaccine validity between the two periods that showed a significant reduction. In this regard, the proportion of children who received vaccination after one year during the baseline ranged between 3.0% for BCG to 11.4% for measles whereas during the midterm except for Measles (7.3%) in the other vaccine it was less than one percent. Vaccination coverage showed improvement from baseline to mid-term with a rate ranging between 1.3% and 12.6%. Dropout and invalid vaccine rates showed a significant decline from baseline to mid-term.
For quality and accurate information generation on immunization coverage, dropout, missed opportunity, and age-related validity measures of vaccination, measures should be taken to increase the availability of vaccination cards at home and improve proper recording keeping at health centers and health posts. There are issues on the accuracy of date registration on vaccination cards and HF registry including date of birth of the child. Therefore, HEWs and health center staff should be oriented and advised on the importance of data quality and careful and proper recording of dates. |
| Description |
This dataset was produced by a quantitative study, cross-sectional design for household survey, facility observation, and immunization service providers’ assessment among 2,406 mothers with children of 12-23 months, and the data collection was conducted starting from the last week of December 2016 to January 2017. The dataset contains information on demand for immunization including awareness on the importance of immunization, information on date and site of vaccination, influencer’s reminder, distance, respectfulness of the health worker, fear of side effect, supply for immunization: policy, planning, and management, human resource, vaccine cold chain and supply, service strategy and reliability, linking with the community, and monitoring finance. It also presents socio-demographic factors as age of the mother, marital status, income, occupation, education, sex of the child, birth order, place of birth, and the number of siblings. Data set on health service utilization include ANC, delivery assisted by the skilled person, PNC, and Vaccination Providers related factors: Knowledge Skill Attitude.
To access the data, questions by standard WHO and Ethiopian Demographic and Health Survey (EDHS) EPI were used. Hence, the mothers were asked to show vaccination cards for the child and the dates of vaccination were read and recorded. If vaccination cards were lost, the maternal report of vaccinations was recorded and verified from facility registers. In addition to that, the presence of a BCG scar was recorded in surveyed children. Parallel to that, the survey questionnaires were administered with three local languages - Amharic (in Afar, Amhara, and SNNP), Oromia (in Oromia), and Tigrigna (in Tigray). In cases when respondents couldn’t speak their local languages, interviewers were translating the questions into local languages. On the other hand, facility-level data was obtained through observation, record review, and interviews of service providers. During the follow-up survey, selected professionals were asked to complete a self-administered interview and an observation checklist was filled by an assigned health professional for health facilities assessment. In general, the objective of this study was to determine the magnitude and associated factors for immunization-related service use and service availability, and providers' readiness in JSI L10K project zones in Ethiopia. |
