Geographical variation and associated factors of childhood measles vaccination in Ethiopia: a spatial and multilevel analysis |
Authors: |
Tesfahun Taddege Geremew, Lemma Derseh Gezie, and Ayenew Negesse Abejie |
Source: |
BMC Public Health, 19: 1194; DOI: 10.1186/s12889-019-7529-z |
Topic(s): |
Child health GIS/GPS Immunization
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Country: |
Africa
Ethiopia
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Published: |
AUG 2019 |
Abstract: |
Background: In Ethiopia, despite considerable improvemen t of measles vaccination, measles outbreaks is occurring
in most parts of the country. Understanding the neighborhood variation in childhood measles vaccination is crucial
for evidence-based decision-making. However, the spatial pattern of measles-containing vaccin e (MCV1) and its
predictors are poorly understood. Hence, this study aimed to explore the spatial pattern and associated factors of
childhood MCV1 coverage.
Methods: An in-depth analysis of the 2016 Ethiopia demographic and health survey data was conducted, and a
total of 3722 children nested in 611 enume ration areas were included in the analysis. Global Moran’s I statistic and
Poisson-based purely spatial scan statistics were employed to explore spatial patterns and detect spatial clusters of
childhood MCV1, respectively. Multilevel logistic regression models were fitted to identify factors associated with
childhood MCV1.
Results: Spatial hetrogeniety of childhood MCV1 was observed (Global Moran’s I = 0.13, p-value < 0.0001), and
seven significant SaTScan clusters of areas with low MCV1 coverage were detected. The most likely primary SaTScan
cluster was detected in the Afar Region, secondary cluster in Somali Region, and tertiary cluster in Gambella Region.
In the final model of the multilevel analysis, individual and community level factors accounted for 82% of the
variance in the odds of MCV1 vaccination. Child age (AOR = 1.53; 95%CI: 1.25–1.88), pentavalent vaccination first
dose (AOR = 9.09; 95%CI: 6.86 –12.03) and third dose (AOR = 7.12; 95%CI: 5.51–9.18, secondary and above maternal
education (AOR = 1.62; 95%CI: 1.03–2.55) and media exposure were the factors that increased the odds of MCV1
vaccination at the individual level. Children with older maternal age had lower odds of receiving MCV1. Living in
Afar, Oromia, Somali, Gambella and Harari regions were factors associated with lower odds of MCV1 from the
community-level factors. Children far from health facilities had higher odds of receiving MCV1 (AOR = 1.31, 95%CI =
1.12–1.61).
Conclusion: A clustered pattern of areas with low childhood MCV1 coverage was observed in Ethiopia. Both
individual and community level factors were significant predictors of childhood MCV1. Hence, it is good to give
priority for the areas with low childhood MCV1 coverage, and to consider the identified factors for vaccination
interventions.
Keywords: Measles, Vaccination, Spatial, Multilevel, Ethiopia |
Web: |
https://link.springer.com/epdf/10.1186/s12889-019-7529-z?author_access_token=y8-w7MJ0OzLHcpXAqjouim_BpE1tBhCbnbw3BuzI2RNcmCYtvDh14cnA4w1giPMJaSJB5YRGqcZSSzLi2z4ua3DT1wQEsE2S0XPUBHR19k3vD0KWL8qnjbnu5Db |
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