Mapping geographical inequalities of incomplete immunization in Ethiopia: a spatial with multilevel analysis.

Background: Immunization is one of the most cost-effective interventions, averting 3.5-5 million deaths every year worldwide. However, incomplete immunization remains a major public health concern, particularly in Ethiopia. The objective of this study is to investigate the geographical inequalities and determinants of incomplete immunization in Ethiopia. Methods: A secondary analysis of the mini-Ethiopian Demographic Health Survey (EDHS 2019) was performed, utilizing a weighted sample of 3,865 children aged 12-23 months. A spatial auto-correlation (Global Moran's I) statistic was computed using ArcGIS version 10.7.1 to assess the geographical distribution of incomplete immunization. Hot-spot (areas with a high proportion of incomplete immunization), and cold spot areas were identified through Getis-Ord Gi* hot spot analysis. Additionally, a Bernoulli probability-based spatial scan statistics was conducted in SaTScan version 9.6 software to determine purely statistically significant clusters of incomplete immunization. Finally, a multilevel fixed-effects logistic regression model was employed to identify factors determining the status of incomplete immunization. Results: Overall, in Ethiopia, more than half (54%, 95% CI: 48-58%) of children aged 12-23 months were not fully immunized. The spatial analysis revealed that the distribution of incomplete immunization was highly clustered in certain areas of Ethiopia (Z-score value = 8.379419, p-value < 0.001). Hotspot areas of incomplete immunization were observed in the Afar, Somali, and southwestern parts of Ethiopia. The SaTScan spatial analysis detected a total of 55 statistically significant clusters of incomplete immunization, with the primary SaTScan cluster found in the Afar region (zones 1, 3, and 4), and the most likely secondary clusters detected in Jarar, Doola, Korahe, Shabelle, Nogob, and Afdar administrative zones of the Somali region of Ethiopia. Indeed, in the multilevel mixed-effect logistic regression analysis, the respondent's age (AOR: 0.92; 95% CI: 0.86-0.98), residence (AOR: 3.11, 95% CI: 1.36-7.14), living in a pastoralist region (AOR: 3.41; 95% CI: 1.29-9.00), educational status (AOR: 0.26; 95% CI: 0.08-0.88), place of delivery (AOR: 2.44; 95% CI: 1.15-5.16), and having PNC utilization status (AOR: 2.70; 95% CI: 1.4-5.29) were identified as significant predictors of incomplete immunization. Conclusion and recommendation: In Ethiopia, incomplete immunization is not randomly distributed. Various factors at both individual and community levels significantly influence childhood immunization status in the country. It is crucial to reduce disparities in socio-demographic status through enhanced collaboration across multiple sectors and by bolstering the utilization of maternal health care services. This requires concerted efforts from stakeholders.

Incomplete immunization and its determinants among children in Africa: Systematic review and meta-analysis.

Immunization is one of the most cost-effective measures to prevent morbidity and mortality in children. Therefore, the purpose of this systematic review and meta-analysis was to determine the pooled prevalence of incomplete immunization among children in Africa as well as its determinants. PubMed, Google Scholar, Scopus, Science Direct, and online institutional repository homes were searched. Studies published within English language, with full text available for searching, and studies conducted in Africa were included in this meta-analysis. A pooled prevalence, Sub-group analysis, sensitivity analysis and meta-regression were conducted. Out of 1305 studies assessed, 26 met our criteria and were included in this study. The pooled prevalence of incomplete immunization was 35.5% (95% CI: 24.4, 42.7), I2 = 92.1%). Home birth (AOR=2.7; 95% CI: 1.5-4.9), rural residence (AOR = 4.6; 95% CI: 1.1-20.1), lack of antenatal care visit (AOR = 2.6; 95% CI: 1.4-5.1), lack of knowledge of immunizations (AOR=2.4; 95% CI: 1.3-4.6), and maternal illiteracy (AOR = 1.7: 95%CI: 1.3-2.0) were associated with incomplete immunization. In Africa, the prevalence of incomplete immunization is high. It is important to promote urban residency, knowledge of immunization and antenatal follow up care.

Knowledge and attitude towards Covid-19 vaccine in Ethiopia: Systematic review and meta-analysis.

The biggest threat to the effectiveness of vaccination initiatives is a lack of information about and trust in immunization. This study aimed to determine the prevalence of knowledge of and positive attitudes toward the COVID-19 vaccine in Ethiopia. PubMed, Web of Science, Google Scholar, EMBASE, and the Ethiopian University online library were searched. To look for heterogeneity, I2 values were computed and an overall estimated analysis was carried out. Although 2108 research articles were retrieved, only 12 studies with a total of 5,472 participants met the inclusion criteria for this systematic review and meta-analysis. The pooled estimates of participants with good knowledge of and positive attitudes toward the COVID-19 vaccine were found to be 65.06% (95% CI: 56.69-73.44%; I2 = 82.3%) and 60.15% (95% CI: 45.56-74.74%; I2 = 89.4%), respectively, revealing that there is a gap in knowledge of and positive attitudes toward the COVID-19 vaccine in Ethiopia. A holistic and multi-sectoral partnership is necessary for a successful COVID-19 vaccination campaign.

Knowledge, Attitude, and Associated Factors towards Colostrum Feeding among Antenatal Care Attendant Mothers in Gununo Health Centre, Wolaita Zone, Ethiopia 2019: Cross-Sectional Study.

BACKGROUND: The role of colostrum in promoting the growth and development of the newborn as well as fighting infections is widely acknowledged. In Ethiopia, there are differences in cultures in the acceptability of colostrum and the prevalence of colostrum feeding. Although breastfeeding is a common practice in Ethiopia, there is a difference in the awareness and attitude of pregnant mothers regarding colostrum feeding. OBJECTIVES: To assess knowledge, attitude, and associated factors towards colostrum feeding among antenatal care attendant mothers in Gununo Health Center, South Ethiopia, 2019. METHODS: Facility-based cross-sectional study design was conducted among 342 ANC (antenatal care) attendant mothers in Gununo Health Center from April to May 2019. Data was collected by using structured interviewer questionnaires and the subjects were selected through systematic random sampling. Data template was prepared by Epi data-manger version 4.2 and SPSS version 23 was used for analysis. Bivariate and multivariate analysis with 95% CI was employed. Variables found to have a p-value < 0.2 in the binary logistic regression were entered into multivariate analysis and strength of association was declared at p-value < 0.2 in the binary logistic regression were entered into multivariate analysis and strength of association was declared at. RESULTS: Among the study participants 226 (66.1%) were knowledgeable and 39 (11.4%) were not knowledgeable on colostrum feeding. From the respondents, 239 (69.9%) had a positive attitude and the rest 103 (30.1%) mothers had a negative attitude towards colostrum feeding. Respondents who had more than four children (AOR = 1.21, 95% CI [1.31, 2.47], ANC visit (four times and above) (AOR=2.8, 95% CI [2.23, 4.49]), and counseled about colostrum feeding (AOR = 2.29, 95% CI [2.34, 3.74]), were some variables that significantly associated with knowledge of colostrum feeding. Those who had been counseled about breastfeeding (AOR = 1.16, 95% CI [1.59-3.96]), ANC visit (AOR = 11.32, 95% CI [1.14, 112.64]), and multiparas (AOR = 5.68, 95% CI [1.57, 20.53]) were some variables that significantly associated with attitude. Conclusion and Recommendation. Even though the mothers' knowledge and attitude seem higher than from previously conducted articles in Ethiopia, still gaps were seen clearly on colostrum feeding in the area. It is recommended to set strategies to promote colostrum feeding.

Acceptance Of HIV Testing And Associated Factors Among Pregnant Women Attending Antenatal Care In Gunino Health Center, Southern Ethiopia 2019: An Institutional Based Cross-Sectional Study.

BACKGROUND: Acceptance of human immune virus testing is an entry point of intervention to end mother to child transmission of the virus among pregnant women. METHODS: Institutional based cross-sectional study design with a sample size of 340 was conducted from May 20 to June 15, 2019. The data were collected by using systematic random sampling technique of interviewer administered questionnaire. Those candidate variables at bivariate analysis with a p-value <0.25 were moved to the multivariate logistic regression model to control for potential confounding variables, and P-value <0.05 at multivariate analysis was considered as cutoff point. RESULT: Among the total of 340 pregnant women who participated with a response rate of 96%, 234 (68.8%) accepted testing. The odds of acceptance of human immune virus testing was higher among respondents who had awareness about mother to child transmission (AOR=2.602, 95%; CI:1.408-4.809) than their counterparts. It was also higher among respondents who had perceived the benefit of testing (AOR=1.838, 95%; CI:1.089-3.104) than those who did not perceive the benefit of testing. Participants who were knowledgeable about the prevention of mother to child transmission were more likely to accept testing (AOR=1.715, 95%; CI:1.030-2.855) than their counterparts. Besides, the odds of acceptance of testing among pregnant women who attended two and above antenatal appointments were higher (AOR= 2.485, 95%; CI:1.462-4.224) than participants who attended only one appointment. Participants who had no formal education (AOR=0.393, 95%; CI:0.160-0.967) and had a primary level of education (AOR=0.357,95%; CI:0.152-0.842) were less likely to accept human immune virus testing than women who had a diploma and above level of educational status. CONCLUSION: Acceptance of human immune virus testing among pregnant women attending antenatal care clinics was relatively low. Antenatal caregivers should place emphasis on reducing barriers to testing, like lack of awareness, knowledge, and educational background.