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Vaccination dropout and associated factors among children in Ethiopia: a systematic review and meta-analysis
Eyasu Bamlaku Golla1, Habtamu Geremew2, Alegntaw Abate3
1College of Health Sciences, Oda Bultum University, Chiro, Ethiopia. eyabamla21@gmail.com.
Insights
Vaccination dropout in Ethiopia affects 16.93% of children, exceeding WHO recommendations. Key factors include not attending antenatal care (ANC), postponed schedules, and distance to facilities, necessitating targeted interventions for improved immunization coverage.
Area of Science:
- Public Health
- Pediatrics
- Epidemiology
Background:
- Sub-Saharan Africa, particularly Ethiopia, faces significant child mortality from vaccine-preventable diseases (VPDs).
- Vaccination dropout, defined as failure to complete subsequent vaccine doses, is a major challenge to achieving full immunization coverage.
- This review addresses the critical issue of vaccination dropout rates and associated factors in Ethiopian children.
Purpose of the Study:
- To determine the pooled magnitude of vaccination dropout among children in Ethiopia.
- To identify significant factors associated with vaccination dropout in the Ethiopian context.
Main Methods:
- A systematic meta-analysis was conducted, involving a comprehensive literature search of international databases and Ethiopian university repositories.
- Seventeen articles comprising 9152 children aged 12-23 months were included.
- Data analysis utilized STATA 17 with a random-effects model to estimate pooled dropout rates and assess heterogeneity and publication bias.
Main Results:
- The pooled vaccination dropout rate from BCG to measles was 16.93% and from Penta-1 to Penta-3 was 13.16% among children aged 12-23 months.
- Significant factors contributing to dropout included mothers not attending antenatal care (ANC), postponed immunization schedules, distance to healthcare facilities, and home deliveries.
- These dropout rates exceed the World Health Organization's (WHO) recommended threshold of less than 10%.
Conclusions:
- The high pooled vaccination dropout magnitude in Ethiopia underscores a critical public health concern.
- Interventions should focus on counseling women to attend ANC, promoting facility-based deliveries, and extending mobile/outreach immunization services.
- Addressing identified factors is crucial to improving complete immunization coverage and reducing VPDs in Ethiopian children.
Background:
Children in sub-Saharan Africa, particularly in Ethiopia, continue to suffer from vaccine-preventable diseases (VPDs), contributing to child mortality. One of the key challenges is vaccination dropout, where children fail to receive subsequent doses after the initial vaccine, leading to incomplete immunization coverage. Hence, our review aimed to determine the pooled magnitude of vaccination dropout and the factors associated with it among children in Ethiopia.
Method:
A comprehensive search of relevant studies was conducted through electronic web-based international databases and the institutional repository of Ethiopian universities. Data were extracted via a Microsoft Excel spreadsheet and then exported to STATA 17 for statistical analysis. A checklist from the Joanna Briggs Institute was utilized to assess the quality of the studies. A random-effects model was employed to estimate the pooled magnitude of vaccination dropout. Heterogeneity between studies was evaluated via the I-square test. Funnel plots and Egger's regression test were utilized to assess publication bias.
Results:
Seventeen articles with a total sample size of 9152 children (12-23 months old) were included in this meta-analysis. Consequently, the pooled magnitude of vaccination dropout from BCG to measles and Penta-1 to Penta-3 among children aged 12-23 months in Ethiopia was 16.93% (95% CI: 12.43, 21.44) and 13.16% (95% CI: 8.37, 17.96) respectively. Mothers who did not attend ANC (AOR = 3.58, 95% CI = 1.99, 6.44), postponed immunization schedule (AOR = 2.73, 95% CI = 1.53, 4.87), distance from the health care facility (AOR = 2.46, 95% CI = 2.01, 17.18), and home delivery (AOR = 2.78, 95% CI = 2.28, 3.38) were identified as significant factors associated with vaccine dropout.
Conclusion:
The overall pooled magnitude of vaccination dropout among children in Ethiopia is greater than the WHO recommendation of less than 10%. Therefore, our findings suggest the necessity of counseling and educating women to attend antenatal care (ANC) follow-ups, give birth at healthcare facilities, and provide mobile and outreach immunization services for remote areas.
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