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Zero-Dose Childhood Immunization in Conflict-Affected PSNP Districts of Ethiopia: A Comparative Cross-Sectional Study
Fisseha Shiferie1, Gashaw Andargie Biks1, Kidist Negash1
1Project HOPE Ethiopia Country Office, Addis Ababa, Ethiopia.
Insights
Childhood immunisation remains a challenge in conflict zones, with 30% of children in intervention districts having zero doses. Factors like maternal education and distance to health facilities influence coverage, highlighting inequities in public health interventions.
Area of Science:
- Public Health
- Global Health
- Epidemiology
Background:
- Childhood immunisation prevents millions of deaths annually, representing a highly cost-effective public health strategy.
- Conflict-affected regions present unique challenges to healthcare access and service delivery, impacting routine immunisation programs.
- Ethiopia's Productive Safety Net Programme (PSNP) provides a framework for integrating health services in vulnerable populations.
Purpose of the Study:
- To assess the prevalence and determinants of zero-dose immunisation among children aged 12-35 months in conflict-affected PSNP districts.
- To determine the comparability of intervention and comparison PSNP districts regarding zero-dose immunisation before implementing an enhanced service-integration model.
- To establish baseline data for evaluating the impact of integrated health services within the PSNP.
Main Methods:
- A comparative cross-sectional survey involving 4,099 mothers and caregivers of children aged 12-35 months.
- Data collection through structured questionnaires administered by trained enumerators.
- Multivariable logistic regression analysis to identify factors associated with zero-dose immunisation status.
Main Results:
- Zero-dose immunisation prevalence was 30% in intervention districts and 27% in comparison districts, with significant regional variations (e.g., 39% in Tigray).
- Key determinants of zero-dose status included region, lack of maternal education, unmarried status, older child age (24-35 months), and distance to health facilities.
- Vaccination dropout rates and DTP3/MCV1 coverage varied considerably across regions, indicating persistent inequities.
Conclusions:
- Persistent inequities in immunisation coverage exist in conflict-affected settings, necessitating targeted interventions.
- Intervention and comparison PSNP districts demonstrated comparability in zero-dose prevalence and its determinants at baseline.
- The study provides essential baseline data for future assessments of enhanced health service integration within the PSNP framework.
Background:
Childhood immunisation is one of the most cost-effective public health interventions, preventing 4-5 million deaths annually. This study assessed the prevalence and determinants of zero-dose immunisation among children aged 12-35 months in conflict-affected districts implementing Ethiopia's Productive Safety Net Programme (PSNP) to determine whether intervention and comparison areas are comparable before rollout of the enhanced service-integration model.
Methods:
A comparative cross-sectional survey was conducted among 4,099 mothers and caregivers of children aged 12-35 months in intervention and comparison PSNP districts. Data were collected using a structured questionnaire administered by trained enumerators. Multivariable logistic regression was used to identify factors associated with zero-dose status.
Results:
Zero-dose prevalence was 30% in intervention districts and 27% in comparison districts, with notable regional disparities: 22.5% in Amhara, 23% in Afar, and 39% in Tigray. Vaccination dropout showed a different pattern, with the highest rate in Afar (57.6%) and the lowest in Tigray (13.6%). DTP3 coverage was lowest in Afar (42.9%) and highest in Amhara (69.4%), while MCV1 coverage was highest in Tigray (83.8%), followed by Amhara (79.6%) and Afar (49.1%). In intervention districts, zero-dose status was significantly associated with region (AOR = 1.5; 95% CI: 1.1-2.2), lack of maternal education (AOR = 1.7; 95% CI: 1.1-2.7), unmarried status (AOR = 1.8; 95% CI: 1.0-3.2), older child age (24-35 months) (AOR = 3.7; 95% CI: 2.6-5.3), and longer distance to health facilities (AOR = 1.4; 95% CI: 1.0-2.2). In comparison districts, region, maternal education, and older child age remained significant predictors.
Conclusions:
The study highlights persistent inequities in immunisation coverage in conflict-affected settings. It also demonstrates comparability between intervention and comparison PSNP districts in zero-dose prevalence and its determinants. These baseline findings provide a foundation for attributing future post-intervention improvements to enhanced integration of health services within the PSNP framework.
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