Child vaccination coverage and dropout rates in pastoral and semi-pastoral regions in Ethiopia: CORE Group Polio Project implementation areas

Abstract

Background: Vaccination programs are one of the priority health interventions, and all children in every country should be vaccinated. The World Health Organization (WHO) aims for 90% coverage of the Expanded Program on Immunization (EPI) by the age of 12 months. The CORE Group Polio Project (CGPP) Ethiopia implemented interventions in pastoral and semi-pastoral regions to increase routine immunization coverage and support supplemental immunization campaigns.

Objective: Assess vaccination coverage, estimate dropout rates and identify associated factors. Methods: A cross-sectional study using the modified WHO EPI cluster survey method was conducted as part of the mid-term evaluation in 2015 in six pastoral and semi-pastoral zones in Ethiopia. A sample of 600 children age 12 to 23 months was selected, and mothers/caregivers were interviewed at home using face-to-face interviews, supported by mobile data collection using the Open Data Kit (ODK) system. Data were exported from the server, cleaned, and analysed using STATA 12.0.Both descriptive analytical methods were used and p-values less than 0.05 were used to declare statistical significance.

Results: Of the estimated sample, 577 (96.6%) children were included in the analysis. The overall rate of full vaccination was estimated to be 44.0% (21.2% in pastoral areas and 71.6% in semi-pastoral areas). With vaccine specific coverage of 53.7% for Bacillus Calmette-Guérin (BCG); 58.8% for oral polio vaccine 3 (OPV 3); 58.8% for pentavalent 3; 56.3% for OCV 3 and 53.6% for measles. Mothers’/caregivers’ residence, age and education were found to be significant predictors for children not being fully vaccinated, i.e. children of mothers living in pastoralist communities, young age, and with no education were at a significantly higher risk of being not fully vaccinated. Among those children who had at least one vaccine, 20.5% failed to take at least one of the next higher doses. Specifically, among those who took BCG and pentavalent 1, 10.1% and 14.1%, respectively, failed to take the measles vaccination. 

Conclusions and recommendations: The proportion of children who were fully vaccinated in pastoral and semipastoral zones was low. Dropout rates for measles, BCG and pentavalent 1 immunization were above the acceptable rate of less than 10%. Therefore, efforts should focus on mobilizing the community to complete all child vaccinations, and community-based approaches with the integration of community volunteers, health extension workers and health center staff should be strengthened so that dropout children can be traced so that they can complete their vaccinations. More information is also required on why mothers/caregivers fail to ensure that their children take all available vaccinations. [Ethiop.J. Health Dev. 2019;33(Special issue):3-9]

Key words: Vaccination coverage, vaccination dropout, pastoralist, semi-pastoralist, CGPP, Ethiopia