Behavioral determinants of immunization service utilization in Ethiopia: a cross-sectional community-based survey.

INTRODUCTION: According to the Ethiopian Health Sector Development Plan IV annual performance report (HSDP IV), Ethiopia targeted to reach 90% coverage with DPT-Hib-HepB 3 (Pentavalent3) vaccine and 86% coverage with measles vaccine in 2010- 2011. However, the actual performance fell-short of the intended targets due to several reasons. Therefore, a nationwide comprehensive study was conducted to examine the behavioral determinants of immunization practices in the Ethiopian context. The study employed the Modified Steps of Behavioral Change (SBC) Model as a theoretical lens. METHODS: A cross-sectional study was conducted in May 2012 in all the nine regions and the two city administrations of Ethiopia. The study used a community-based quantitative survey design comprising of multistage cluster sampling to draw relevant data from a sample of 2,328 caretakers whose children were 12-23 months of age at the time of data collection. RESULTS: Overall, the multivariate analysis findings revealed that caretakers, who had high knowledge were 2.24 times more likely to vaccinate their children than participants had low knowledge (OR= 2.24, 95%CI: 1.68-2.98). Participants who had high approval were 2.45 times more likely to vaccinate their children than participants who had unfavorable approval (OR= 2.45, 95%CI: 1.67-3.59); and participants who had high intention were 6.49 times more likely to vaccinate their children with pentavalent3 vaccines than participants who had low intention(OR= 6.49, 95%CI: 4.83-8). Also, it was clear from the regression analysis that aspects of caretakers' demographic characteristics were significant predictors of their immunization practice for the sample group. CONCLUSION: We identified that caretakers' knowledge, approval, intention, parents' residence, and religious backgrounds were associated with immunization service utilization. To achieve sustainable behavioral change on immunization service utilization of the caretakers in Ethiopia, this study suggests investing in activities that enhance caretakers' knowledge, approval, intention, and practice components represented in the behavioral change model.

Factors contributing to routine immunization performance in Ethiopia, 2014.

INTRODUCTION: An increasing trend of routine immunization performance has generally been observed over the past decade in Ethiopia. However, the improvement is irregular with wide disparity among and within regions. This study analyzes health facility characteristics contribution to immunization performance in Ethiopia. METHODS: We conducted a cross-sectional study and compared characteristics of health facilities in good and poor performing zones. We used administrative coverage reports and Personal Digital Assisted (PDA) supervisory data collected by WHO EPI field officers using a standardized structured checklist. We selected 48 zones and 302 health facilities based on immunization performance data and supervisory data on potential variables. RESULTS: Logistics regression was used to identify independent contributors to good immunization performance. On logistics regression we found that: actions by higher levels in conducting supervision (Odds Ratio (OR) =4.15. 95% Confidence Interval (CI) = 1.85, 9.32, p value <0.01] and providing written feedback (Odds Ratio (OR) =4.35. 95% Confidence Interval (CI) = 2.27, 8.33, p value <0.01) , and provision of immunization services by the health facility itself for catchment population under each health unit (Odds Ratio (OR) =20.15. 95% Confidence Interval (CI) = 2.24, 181.38, p value =0.01) and absence of stock out of vaccines (Odds Ratio (OR) =0.44. 95% Confidence Interval (CI) = 0.23, 0.83, p value =0.01) are the likely significant factors contributing to good immunization performance in Ethiopia. CONCLUSION: Ensuring availability of immunization services in all health facilities, regular supervision and written feedback and improved stock management are essential factors contributing to good immunization performance.

Factors and misperceptions of routine childhood immunization service uptake in Ethiopia: findings from a nationwide qualitative study.

INTRODUCTION: While the routine childhood immunization program might be affected by several factors, its identification using qualitative evidence of caretakers is generally minimal. This article explores the various factors and misperceptions of routine childhood immunization service uptake in Ethiopia and provides possible recommendations to mitigate them. METHODS: In this study, we used a qualitative multiple case study design collecting primary data from 63 focus group discussions (FGDs) conducted with a purposefully selected sample of children's caretakers (n = 630). RESULTS: According to the results of this study, the use of routine childhood immunization is dependent on four major factors: caretakers' behavior, family characteristics, information and communication and immunization service system. In addition, the participants had some misperceptions about routine childhood immunization. For example, immunization should be taken when the child gets sick and a single dose vaccine is enough for a child. These factors and misperceptions are complex and sometimes context-specific and vary between categories of caretakers. CONCLUSION: Our interpretations suggest that no single factor affects immunization service uptake alone in a unique way. Rather, it is the synergy among the factors that has a collective influence on the childhood immunization system. Therefore, intervention efforts should target these multiple factors simultaneously. Importantly, this study recommends improving the quality of existing childhood immunization services and building awareness among caretakers as crucial components.

Factors and misperceptions of routine childhood immunization service uptake in Ethiopia: findings from a nationwide qualitative study

Introduction: while the routine childhood immunization program might be affected by several factors, its identification using qualitative evidence of caretakers is generally minimal. This article explores the various factors and misperceptions of routine childhood immunization service uptake in Ethiopia and provides possible recommendations to mitigate them.Methods: in this study, we used a qualitative multiple case study design collecting primary data from 63 focus group discussions (FGDs) conducted with a purposefully selected sample of children's caretakers (n = 630).Results: according to the results of this study, the use of routine childhood immunization is dependent on four major factors: caretakers' behavior, family characteristics, information and communication and immunization service system. In addition, the participants had some misperceptions about routine childhood immunization. For example, immunization should be taken when the child gets sick and a single dose vaccine is enough for a child. These factors and misperceptions are complex and sometimes context-specific and vary between categories of caretakers.Conclusion: our interpretations suggest that no single factor affects immunization service uptake alone in a unique way. Rather, it is the synergy among the factors that has a collective influence on the childhood immunization system. Therefore, intervention efforts should target these multiple factors simultaneously. Importantly, this study recommends improving the quality of existing childhood immunization services and building awareness among caretakers as crucial components