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Individual and community level factors associated with defaulting of immunization among 12-59 months children in Ethiopia: Multilevel modeling analysis using 2011Ethiopia demographic and health survey.

Birhanu Jikamo Bago, Wondwossen Terefe, Gebremeskel Mirutse

Introduction: Currently immunization prevents an estimated 2 to 3 million deaths every year. However; in 2012, 22.6 million children under one year of age who received first dose of diphtheria, pertussis, tetanus (DPT1) did not receive third dose of (DPT3) vaccine. Out of this 70% of children live in ten countries and Ethiopia is one of those countries. Objective: The aim of this study was to determine individual and community level factors associated with defaulting of immunization among 12-59 months children in EDHS, 2011. Methods: Source of data for this study was EDHS 2011. Sample from 592 clusters of 6,497 unweighted children and 6,666 weighted children among age group of 12-59 months. Multilevel regressions were used to identify predictors of defaulting of child immunization. Possible model diagnostic tests were addressed while building the model by stepwise forward. Four models were built to estimate both fixed effects of the individual and community-level factors and random effects between-cluster variation on defaulting of child immunization. Presence of confounders and interaction effects was investigated by computing relative changes on ß coefficients at a cutoff point 15%. A p<0.05 was used to identify significantly associated factors with defaulting of child immunization. Results: The current study found that more than three-fourth (78%) of children among age group of 12-59 months were missed one or more doses of recommended vaccine. Perceived problem of distance to reach a health facility (AOR=1.24; 95% CI: 1.01, 1.52) and nonexposure to media (AOR=1.53; 95% CI: 1.21, 1.93) had higher association with defaulting of child immunization. With regard to the community-level factors, communities living in Affar region (AOR=8.69, 95% CI: 4.33, 17.42) and communities living in Oromia region (AOR=3.82, 95% CI: 2.27, 6.44) had a positive influence on defaulting of child immunization. Conclusion and recommendation: In Ethiopia significant proportion of children was missed one or more doses of immunization. The current study found that, perceived problem of distance to reach a health facility, mother’s exposure to media, religion, child’s vaccination cards, birth order, mother’s empowerment in major decision on household issue and regions have association with defaulting of immunization. Thus, efforts to decrease the proportion of defaulter rate better to focus both on individuals and communities.