Childhood Immunization in Ethiopia: Accuracy of Maternal Recall Compared to Vaccination Cards

Health surveys conducted in low- and middle-income countries typically estimate childhood vaccination status based on written vaccination cards, maternal recall (when cards are not available), or a combination of both. This analysis aimed to assess the accuracy of maternal recall of a child's vaccination status in Ethiopia. Data came from a 2016 cross-sectional study conducted in the Southern Nations, Nationalities, and Peoples' (SNNP) Region of Ethiopia. Vaccine doses received by a given 12-23-month-old child were recorded from both a vaccination card and based on maternal recall and then compared. Concordance, sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and Cohen's Kappa were calculated. Estimates of full immunization coverage were similar when collected via vaccination card (75%) and maternal recall (74%). For fully vaccinated children, comparison of maternal recall versus vaccination card showed high concordance (96%), sensitivity (97%), specificity (93%), PPV (98%), NPV (92%), and Kappa (90%). Accuracy of maternal recall of a child's vaccination status is high in the SNNP region of Ethiopia. Although determination of vaccination status via vaccination card is preferred since it constitutes a written record, maternal recall can also be used with confidence when vaccination cards are not available.