Intern
ati
o
n
a
l
Jo
urn
a
l
o
f
P
u
b
lic Hea
l
th Science (IJ
P
HS)
V
o
l.3
,
No
.3
, Sep
t
em
b
e
r
20
14, pp
. 185
~193
I
S
SN
: 225
2-8
8
0
6
1
85
Jo
urn
a
l
h
o
me
pa
ge
: h
ttp
://iaesjo
u
r
na
l.com/
o
n
lin
e/ind
e
x.ph
p
/
IJPHS
Predi
c
t
o
rs of Im
munizati
on De
f
a
ulting among Children Age
12-23 M
o
nths in Hawassa Zuria Di
strict of Southern Ethiopia
Fikru Tesfaye
1
, Alemu Tam
i
so
2
, Yem
a
ne Birhan
2
, T
a
ri
ku Tadele
3
1
Depa
rt
m
e
nt
of
Pu
bl
i
c
Heal
t
h
/
U
ni
t
of
Epi
d
e
m
i
o
l
ogy
and
B
i
o
s
tatistics, Colleg
e
of Med
i
ci
n
e
an
d Health
Sci
e
nces,
A
r
ba
M
i
nch
U
n
i
v
e
r
si
t
y
, Ar
ba M
i
n
c
h,
Et
hi
o
p
i
a
2
Add
i
s C
o
n
tin
en
tal In
stitu
te of Pub
lic Healt
h
, Ad
d
i
s
Ab
ab
a,
Eth
i
op
ia
3
Depa
rt
m
e
nt
of
I
n
t
e
rnal
M
e
di
ci
ne, C
o
l
l
e
ge
o
f
M
e
di
ci
ne
an
d
Heal
t
h
Sci
e
nc
e, Ha
wassa
U
n
i
v
ersi
t
y
, Et
hi
o
p
i
a
Article Info
A
B
STRAC
T
Article histo
r
y:
Received
J
u
l 28, 2014
Rev
i
sed
Au
g
21
, 20
14
Accepted Aug 26, 2014
As
part of the overal
l
pack
age
of m
a
ternal an
d child hea
lth
s
e
rvices
in
Ethiopia, all children are provided with
free im
muniza
tion servic
es and it is
available
in all government
health facilities
, both in rural
and u
r
ban areas
.
But significant number of children
was d
e
faulted from Immunization
s
c
hedule
,
even
a
f
ter the h
eal
th e
x
tens
ion program was launched. Ther
efore,
the stud
y
w
a
s as
sessed predictors of im
m
unizat
io
n defau
lting
am
ong child
ren
age r
a
nge of 12
-23 months, in
Hawassa
Zuria
district of south
e
rn Ethiopia.
Unmatched case control stud
y
was c
onducted
in six Kebeles
which were
selected from 26 kebeles b
y
simple random sampling
techn
i
ques. Cases
wer
e
childr
e
n in th
e age rang
es of 12 - 23 months
who did not co
mplete th
e
recommended immunization.
All cases
(105) and controls (209) in th
e
kebel
e
s were id
entifi
e
d b
y
usin
g h
ealth posts
Vaccin
e
registr
a
tion book.
Bivari
able
and m
u
ltiple log
i
sti
c
regression m
odel were used
to ident
i
f
y
important predictor of immunization de
faultin
g. P-value of less than 0.05
was
cons
idered
as
the lev
e
l of s
i
gnifi
cances
. The stud
y
id
entif
ied
educational
status, p
l
ace of
deliv
er
y
,
immun
i
zation r
e
lated
k
nowledge, ANC follow up
and household wealth status as
signi
ficant predictors of defau
lting from
immunization schedules. Sustain
e
d hea
lth edu
cation on vaccination related
knowledge
and
i
n
stitution
a
l d
e
l
i
v
e
r
y
servi
ces u
til
i
zat
ion wil
l
b
e
needed. Th
e
household liter
acy
and econom
i
c
status
should also get em
phasis so as to
decreases def
a
ulting of
children
f
r
om immunizat
ion schedule.
Keyword:
C
a
se co
nt
r
o
l
st
udy
Imm
u
n
i
zatio
n
d
e
fau
ltin
g
Pred
icto
rs
So
ut
he
rn
Et
hi
o
p
i
a
Copyright ©
201
4 Institut
e
o
f
Ad
vanced
Engin
eer
ing and S
c
i
e
nce.
All rights re
se
rve
d
.
Co
rresp
ond
i
ng
Autho
r
:
Alem
u Tam
i
so
Add
i
s C
o
n
tin
en
tal In
stitu
te of Pub
lic Healt
h
Ad
dis Aba
b
a
,
Ethio
p
ia
Em
a
il: ta
miso
d
e
b
i
so@g
m
a
il.co
m
1.
INTRODUCTION
Im
m
uni
zat
i
on i
s
t
h
e p
r
o
cess
whe
r
e
b
y
a pe
rs
on
i
s
m
a
de im
m
une or
resi
st
ant
t
o
a
n
i
n
fect
i
ous
di
sease,
typically by the adm
i
nistration of a
va
ccine.
Vaccines stim
ulate the body’s
own imm
une syste
m
to prote
c
t the
pers
o
n
agai
nst
subse
q
ue
nt
i
n
fect
i
on
or
di
se
ase [1]
.
T
h
ere
were
bet
w
ee
n
2 an
d 3 m
i
ll
ion
deat
hs
occ
u
r
r
e
d
during eac
h ye
ar by
vaccine
preve
n
table
dise
ases alone.
To
reduce t
h
is figures of
m
o
rtality and m
o
rbi
d
ity, the
Wo
rl
d
Heal
t
h
Or
ga
ni
zat
i
on
(
W
H
O
)
l
a
u
n
c
h
ed E
x
pan
d
e
d
Pro
g
r
am
on i
m
m
uni
zat
i
on (
E
PI
) i
n
1
9
7
4
,
l
e
ss t
h
an
5
%
of th
e
wo
rld
'
s ch
ild
ren
were imm
u
n
i
zed
d
u
ring
th
ei
r
fi
rst year of life ag
ain
s
t six
k
iller d
i
seases; po
lio
,
di
p
h
t
h
e
r
i
a
, t
u
b
e
rcul
osi
s
,
per
u
ses, m
easl
e
s and t
e
t
a
nus
. T
o
day
,
83%
o
f
t
h
e wo
rl
d'
s chi
l
d
ren l
e
ss t
h
a
n
o
n
e y
e
a
r
of age have
rec
e
ived these life
-
savi
ng
vaccinations. As a
result, in the
World m
o
re th
an 2.5 million dea
t
hs of
childre
n pre
v
ented eac
h
year from
vaccine prev
e
n
table diseas
es [2]. Inc
r
easing
num
bers of
countries,
incl
udi
ng de
veloping
countries
,
are
ad
ding
new a
n
d under-use
d
vaccine
s, like
Hepati
tis B,
Evaluation Warning : The document was created with Spire.PDF for Python.
I
S
SN
:
2
252
-88
06
I
J
PH
S Vo
l. 3
,
N
o
. 3
,
Sep
t
emb
e
r
201
4
:
1
85
–
19
3
18
6
Haem
ophilia’s influenza type b (H
ib) and yellow feve
r vaccine to t
h
eir routine i
n
fa
nt i
m
m
unization
sche
dul
es [
3
]
.
Eth
i
op
ia as one o
f
th
e m
e
m
b
er
states, ado
p
t
ed
EPI
in
1
980 w
ith
th
e aim
o
f
r
e
du
cing
mo
rb
id
ity and
m
o
rtality of children
from
vaccine prev
e
n
ta
ble diseases
. Here EPI ha
d its ob
jective t
o
c
ont
rol
high de
aths of
infa
nt and inc
r
ease imm
uni
za
tion covera
ge
by 10% an
nua
lly and reach
100% in
1990. Unfortunately, the
program
had not succee
ded a
s
the plan
; howeve
r
, c
u
rrent
EPI covera
ge
in
creases significantly
[4],[5]. The
cou
n
t
r
y
has a
d
apt
e
d a
nd
us
ed t
h
e R
eac
hi
ng
Eve
r
y
Di
st
rict (RED) a
n
d the
Sustai
na
ble Outreac
h
Services
(SO
S
)
ap
pr
oac
h
t
o
en
ha
nce i
m
m
uni
zat
i
on c
ove
ra
ge si
nce
20
0
3
. C
u
r
r
e
n
t
l
y
, E
t
h
i
o
p
i
a
i
s
s
h
o
w
i
n
g
p
r
o
g
ress
to
ward
s m
o
re
co
un
try wise co
v
e
rag
e
b
y
bu
i
l
d
i
n
g
and
staffi
n
g
m
o
re th
an
15
,0
00
p
e
ri
p
h
e
ral h
ealth
facilities in
o
r
d
e
r to
realized
its obj
ectiv
e
o
f
red
u
c
i
n
g child
and
in
fan
t
m
o
rtali
t
y as well as millen
n
i
u
m
d
e
v
e
lop
m
e
n
t go
als
(
M
DG
)
of
2
015
[2
].
Desp
ite,
EPI serv
ices ex
ists i
n
all k
e
b
e
les an
d d
e
liv
ered
by h
ealth
ex
ten
s
io
n
wo
rk
ers to
co
mm
u
n
ity,
still th
ere is
h
i
g
h
nu
m
b
er
o
f
d
e
fau
lters, du
e to
t
h
e
m
a
j
o
r
d
e
term
in
an
ts to
ach
i
ev
i
n
g univ
e
rsal imm
u
n
i
zatio
n
includi
ng l
o
w
access to servi
ces, ina
d
equate
aware
n
ess
of
caregi
v
ers, m
i
s
s
ed opportu
nities, and hi
gh dropout
rates that ha
ve
been rec
o
gnize
d
since t
h
e ea
rly years of
EP
I eff
o
rt [4]
,
[6]
.
But
after health
exte
nsio
n pr
og
ram
was l
a
unc
he
d exact
fact
or
s f
o
r i
m
m
uni
zat
ion
defa
ul
t
i
ng
was n
o
t
assess
ed i
n
so
ut
he
rn
Et
hi
o
p
i
a
, so t
h
e st
udy
assessed
pre
d
i
c
t
o
rs
of i
m
m
u
ni
zat
i
on
defa
ul
t
i
ng am
ong c
h
i
l
d
re
n age
12
-
2
3 m
ont
hs i
n
H
a
wasa Z
u
ri
y
a
di
st
ri
ct
of
so
ut
he
r
n
Et
hi
o
p
i
a
.
2.
R
E
SEARC
H M
ETHOD
Study desi
gn
Po
pul
at
i
o
n bas
e
d unm
at
ched case-co
nt
r
o
l
st
udy
desi
gn
wa
s
d
o
n
e
am
ong
chi
l
d
re
n
Stud
y are
a
Thi
s
st
udy
wa
s co
n
duct
e
d at
Ha
wassa
Zu
r
i
y
a
Di
st
ri
ct
i
n
Si
dam
a
Zon
e
, S
out
her
n
Et
h
i
opi
a.
It
i
s
lo
cated
2
2
Km
’s fro
m
sou
t
h
o
f
Hawassa t
o
wn (cap
ital o
f
so
u
t
h
e
rn
n
a
tion
,
n
a
tion
a
lity an
d p
e
op
le reg
i
o
n
) an
d
29
2 Km
’s so
ut
h fr
om
Et
hi
opi
an capi
t
a
l
,
A
d
d
i
s Aba
b
a. T
h
e Di
st
ri
ct
has 2
6
ke
bel
e
s;
3 ur
ba
n and
23
rura
l
kebel
e
s
.
In t
h
e
Di
st
ri
ct
m
a
jori
t
y
of pop
ul
at
i
on l
i
v
es i
n
r
u
r
a
l
areas and i
t
have
5 heal
t
h
cent
r
es an
d 2
2
heal
t
h
p
o
s
ts. Th
e t
o
tal co
v
e
rag
e
o
f
h
ealth
in
th
e
district was 8
4
%. Th
e estim
a
t
ed
to
tal p
opu
latio
n
of th
e
d
i
stricts
w
e
r
e
151
,31
0
(7
6,260
(
5
0
.
4
%
)
an
d
7
5
,050
(4
9.6%)
ar
e f
e
males an
d
m
a
l
e
s r
e
sp
ectiv
ely
)
. Th
e to
tal num
b
e
r
o
f
ch
ild
ren
elig
i
b
le fo
r imm
u
n
i
zatio
n
o
f
201
3 was 575
0.
Stud
y population
All ch
ildren liv
ing
in th
e ag
e ran
g
e
of
1
2
-23
m
o
n
t
h
s
, tho
s
e wh
o liv
ed the p
a
st
2
years i
n
th
ese stud
y
areas a
n
d the c
h
ildre
n at least
ha
d single e
x
pos
ure to
be
vaccinated
was
include
d i
n
the
study a
n
d. C
h
ildren
w
h
o
star
ted
imm
u
n
i
zatio
n
and
d
e
f
a
u
lt later
an
d
t
h
o
s
e ch
il
d
r
en
w
h
o
f
ound
in
ag
e
r
a
ng
e o
f
12
-23
m
o
n
t
h
s
an
d
who c
o
m
p
lete
d all rec
o
mme
nde
d
vaccines
were i
n
cluded
as case and c
o
ntrol res
p
ectively. Childre
n
whose
gua
r
d
i
a
n/
m
o
t
h
er c
o
n
f
us
ed t
o
desc
ri
be c
o
nc
i
s
el
y
abo
u
t in
fo
rm
atio
n
of ch
ild
related
to i
m
m
u
n
i
zatio
n was
excluded from
the study.
Sa
mp
le size
d
e
termina
tio
n
Th
e sam
p
le size calcu
latio
n for
d
e
term
in
an
t of
i
m
m
uni
zat
i
on de
fa
ul
t
e
rs we
re
d
o
n
e
by
usi
n
g
unm
at
ched cas
e cont
r
o
l
f
o
rm
ul
a, usi
ng ST
ATC
A
LC
pr
o
g
r
am
of EPI i
n
f
o
ve
rsi
o
n 3.
5.
1
wi
t
h
con
s
i
d
e
r
i
ng t
h
e
fol
l
o
wi
n
g
ass
u
m
p
ti
ons;
c
o
n
f
i
d
ence
l
e
vel
of 95
%, po
we
r of
8
0
%, ca
se t
o
c
ont
rol
rat
i
o
of
1:
2.
O
d
ds
rat
i
o
of
3
.
7
an
d its pr
opo
r
t
i
o
n ob
tain
ed
f
r
om
p
r
ev
iou
s
Lit
e
r
a
tu
r
e
[6
].
n = (Z
α
/2
√
(1+1/
r)
P(1-P) +
Z
β
√
(P
1(1
-
P1)
+
P2
((
1-
P2
)
/
r
)
)
2
(P1
-
P2)
2
As it can be s
een from
the table, the sam
p
le
size calcula
tion for the
determinants are based
on
si
gni
fi
ca
nt
fact
ors at
di
f
f
ere
n
t
st
udi
es, t
h
e r
e
sul
t
i
n
cl
u
d
es
no
n
-res
p
on
de
n
t
10%
. Am
on
g a l
o
t
of
ex
p
o
su
re
v
a
riab
les, Mo
t
h
ers Ed
u
c
atio
n co
n
c
er
n
e
d
wi
th
Illiteracy was th
e h
i
g
h
e
st sa
m
p
le size
wh
en
co
m
p
ared
with
othe
r ass
u
m
e
d factor
s.
Fo
r m
o
re in
fo
rm
ation loo
k
(Table
1
)
.
Evaluation Warning : The document was created with Spire.PDF for Python.
I
J
PH
S I
S
SN
:
225
2-8
8
0
6
Pred
icto
rs o
f
Immun
i
za
tion
Defa
u
ltin
g Among
C
h
ild
ren Ag
e 12
-23
mon
t
h
s
in
Ha
w
a
ssa .... (Fikru
Tesf
a
y
a
)
18
7
Tabl
e1
. T
h
e
Sa
m
p
l
e
si
ze cal
cul
a
t
i
on
f
o
r t
h
e
Pre
d
i
c
t
o
rs
,
by
usi
n
g si
gni
fi
cant
fact
ors
f
r
om
di
f
f
ere
n
t
st
u
d
y
,
2
0
1
4
No
Significant
Predic
tors
Cita
ti
on
CI
Pow
er
Case:
Control
Exposure of
OR
Sa
m
p
les si
ze
case
Control
case
Controls
Total
1
M
o
ther
s E
ducation
( Illite
rate
m
o
ther)
(4
, 7
)
95%
80%
½
94.
4
82
3.
7
105
209
314
2
ANC f
o
llow UP
(
N
o visit)
(7
)
“
“
“
65.
6
41.
6
2.
6
63
124
187
3
Ar
ea of Resides
(Ru
r
al)
(8
)
“
“
“
51.
9
12.
5
7.
6
21
41
62
4
Im
m
unization
r
e
lated knowledge
(
P
oor
)
(7
)
“
“
“
48.
4
26.
7
2.
5
70
140
210
5
Delivery site
(At h
o
m
e
)
(8
)
“
“
“
49
15.
3
5.
3
28
55
83
Sampling procedures
Th
e stud
y was co
ndu
cted
in
six
k
e
b
e
les (si
m
ilar with
s
m
all v
illag
e
s) wh
ich
were selected
fro
m
2
6
kebel
e
s
by
sim
p
l
e
ran
d
o
m
sam
p
li
ng t
ech
ni
q
u
es.
Al
l
cases
and c
o
nt
rol
s
of
t
hose sel
ect
ed
kebel
e
s i
d
e
n
t
i
f
i
e
d by
using ke
beles health posts Vaccine
re
gistra
tion book.
Sa
m
p
ling fram
e
was
pre
p
a
r
ed
from
this regis
t
ration
book. The total
sam
p
le size 314 (105 cas
es
and
209 controls) was distribute
d to each se
lected Kebeles
’
base
d
on
p
r
op
ort
i
ona
l
t
o
si
ze al
l
o
ca
t
i
on.
Fi
nal
l
y
, t
h
e st
udy
i
n
di
v
i
dual
s
we
re c
h
ose
n
by
sy
st
em
at
i
c
sam
p
l
i
ng
wi
t
h
usi
n
g i
n
t
e
rval
of
eve
r
y
6
th
hou
seh
o
l
d
s
.
On
ly m
o
th
er was interv
iewed
after we
were reached
th
e hou
seh
o
ld
s.
Opera
tio
n
al d
e
finition
Fully Immuni
z
e
d:
A child betwee
n age
range
s of 12-23 m
ont
hs who received all recommende
d vaccine
base
d on
EPI program
sche
dule
up to Measle
s vacci
ne.
Immuniz
a
tion
defaulter
s
:
Occurs
whe
n
the child m
i
ssed at
least
one
of
the
recom
m
ended vac
c
ine.
U
n
v
a
ccinat
e
d:
A
c
h
ild who doe
s not receive
any dose of
t
h
e recomm
ended vaccines
Vaccinated:
A ch
ild
wh
o tak
e
at least on
e
d
o
se of th
e reco
mmen
d
e
d v
a
ccines
Co
ver
age
b
y
card onl
y
:
C
o
vera
ge cal
c
u
l
a
t
e
d wi
t
h
n
u
m
e
rat
o
r
bas
e
d
o
n
l
y
on
d
o
cum
e
nt
ed
d
o
se e
x
cl
udi
ng
fr
om
t
h
e num
erat
or
t
h
ose
vac
c
i
n
at
ed
by
hi
st
ory
.
Knowledge of immuniz
a
tion
: Assessed
usin
g
eigh
t imm
u
n
i
zatio
n
related
kn
owledge assessing
facto
r
s
pr
o
v
i
d
e
d
t
o
re
spo
n
d
e
n
t
s
. Th
ose w
h
o ha
d answe
r
e
d
f
o
u
r
or m
o
re assi
gn
ed as ha
vi
n
g
s
a
t
i
s
fact
ory
k
n
o
w
l
e
d
g
e
and
t
h
ose bel
o
w
as ha
vi
n
g
p
o
o
r
k
n
o
wl
e
dge
.
Immuniz
a
tion coverage
:
P
r
o
p
o
r
t
i
o
n of
c
h
i
l
dre
n
t
o
o
k
reco
m
m
e
nded vacc
i
n
at
i
on
Immuniz
a
tion
statu
s
:
Being fully/partially
vaccinate
d or unvacci
nated
Da
t
a
co
llectio
n p
r
o
c
ed
ures
A pretested
an
d
stru
ctu
r
ed q
u
estio
nn
aire was
p
r
ep
ared
based on
rev
i
ewed
literatu
res. Th
e
q
u
e
stio
nn
aire
were prep
ared in
En
g
lish
an
d
th
en
tr
anslated to local language
(Sid
am
u-af
fo
)
an
d
back
tran
slated
to
En
g
lish
to
m
a
in
tain
co
n
s
isten
c
y. Eig
h
t
h
ealth ex
ten
s
ion
work
ers sup
e
rv
ised
b
y
2
p
u
b
lic h
ealth
pr
ofe
ssi
o
n
al
s
were
rec
r
ui
t
e
d
an
d t
r
ai
ned
f
o
r t
h
ree
day
s
t
o
col
l
ect
S
o
ci
o-
dem
ogra
phi
c
an
d s
o
ci
oec
o
nom
i
c
characte
r
istics (Se
x
of c
h
ild, Avera
g
e fa
mily
incom
e
,
Area of
Resi
den
ce, Materna
l
education,
Mothers
o
ccup
a
tion
,
M
a
tern
al relig
ion
and
resid
e
n
c
es) and
h
ealth facility
relate
d
ch
aracteristics (Po
s
t
p
on
ing ch
ild
i
m
m
unization
sche
dule, Ante
natal care
(ANC) follows
up,
Distance
to
he
alth facility and
place of
delivery).
The dat
a
col
l
e
ct
i
on t
ool
wa
s pret
est
e
d
on t
h
e 3rd
day
of
t
r
ai
ni
ng i
n
a
not
h
e
r sim
i
l
a
r kebel
e
s and res
p
on
dent
s
were
sel
ect
ed
by
usi
n
g
si
m
ilar m
e
t
hod
wi
t
h
t
h
e
m
a
i
n
st
udy
w
h
i
c
h
was
i
n
cl
ude
1
0
%
(
3
2
)
of
pa
rt
i
c
i
p
ant
f
r
om
t
h
e t
o
t
a
l
,
i
n
or
d
e
r t
o
so
rt
out
l
a
ng
ua
ge
bar
r
i
e
r
s
an
d c
o
nt
ext
u
al
di
ffe
re
nces.
Da
t
a
Qua
lity
Assurances
To
assu
re
d
a
ta q
u
a
lity, d
a
ta co
llecto
r
s and
sup
e
rv
iso
r
was train
e
d
fo
r three d
a
ys b
y
p
r
in
ci
p
a
l
Researche
r’s a
nd
10% of the sam
p
le were pretested i
n
o
u
t
side of the stu
d
i
ed
area to
id
en
tify po
ten
tial
pr
o
b
l
e
m
s
t
h
at
was ari
s
e d
u
r
i
n
g t
h
e act
ual
dat
a
col
l
ect
i
on pe
ri
o
d
. T
h
e pri
n
c
i
pal
i
nvest
i
g
at
or a
nd t
h
e s
u
pe
rvi
s
or
were m
a
ki
ng
day
t
o
day
o
n
si
t
e
super
v
i
s
i
on
du
ri
n
g
t
h
e
wh
ol
e peri
o
d
of dat
a
c
o
l
l
ect
i
on. C
o
m
p
l
e
t
e
ness,
accuracy a
n
d
consistency of the c
o
llected data
were
checked on dail
y bases
duri
ng
data c
o
llection by
sup
e
r
v
i
s
o
r
a
n
d t
h
e
pri
n
ci
pa
l
i
nvest
i
g
at
or
.
Trai
ned
coll
ectors
we
re c
o
llecting t
h
e
data afte
r thoroughly
explaini
ng the
objective
of the study to eac
h st
ud
y subj
ect
an
d inf
o
r
m
ed
co
n
s
en
t was ob
tain
ed
.
Evaluation Warning : The document was created with Spire.PDF for Python.
I
S
SN
:
2
252
-88
06
I
J
PH
S Vo
l. 3
,
N
o
. 3
,
Sep
t
emb
e
r
201
4
:
1
85
–
19
3
18
8
Dat
a
pro
cessi
n
g
an
d an
al
ysi
s
:
The data we
re cleaned to che
c
k for its com
p
letene
ss, co
nsi
s
t
e
ncy
and t
h
e
prese
n
ce o
f
m
i
ssed val
u
es
an
d v
a
riab
les. An
y error iden
tified
was c
o
rrected as
ne
cessary. T
h
e
n
, it was ente
re
d int
o
a
pre
-
designe
d
fo
rm
at
i
n
Epi
-
i
n
f
o
ve
rsi
o
n
3.
5.
1 an
d t
r
a
n
s
f
erre
d t
o
S
PSS
versi
on
2
0
f
o
r anal
y
s
i
s
.
Des
c
ri
pt
i
o
n o
f
t
h
e
m
a
i
n
anal
y
s
i
s
fi
n
d
i
n
gs
was
do
ne
us
i
ng
fre
q
u
enci
e
s
, pe
rce
n
t
a
ges
and
sum
m
ary
st
at
i
s
t
i
c
s. B
i
nary
Logi
st
i
c
re
g
r
essi
on
Mo
d
e
l was fitted
.
First b
i
v
a
ri
ate an
alysis b
e
tween
d
e
p
e
n
d
e
n
t
an
d
ind
e
p
e
nd
en
t v
a
riab
les,
th
en
all in
d
e
p
e
n
d
e
nt
v
a
riab
les th
at sh
owed
statistical sig
n
i
fican
c
e with
a
p-
val
u
e <0.05 in t
h
e
biva
riate analysis were
included in
th
e m
u
ltiv
ariat
e
m
o
d
e
l. Th
ose p
r
ed
ictors wi
th
p-v
a
l
u
e <0.0
5, in
the m
u
lt
iv
ariate an
alysis, were con
s
i
d
ered
as
i
nde
pen
d
e
n
t
and si
gni
fi
ca
nt
fact
ors ass
o
c
i
at
ed wi
t
h
i
n
c
o
m
p
l
e
t
e
imm
u
ni
zat
i
on am
on
g chi
l
d
ren a
g
ed 1
2
-
23m
ont
h
s
.
Ethical Consi
d
eration
Eth
i
cal clearance was ob
tained
fro
m
th
e In
stitu
ti
o
n
a
l Rev
i
ew B
o
ard
s
of
Hawassa
Univ
ersity and
Add
i
s Con
tin
en
tal In
stitu
te
o
f
Pub
lic Health
. Form
al
letter
o
f
coo
p
e
ration
was written
fo
r sid
a
m
a
zo
n
e
Healt
h
Depa
rt
m
e
nt
. Then Pe
rm
i
ssi
on l
e
t
t
e
r was i
n
han
d
fr
om
Sidam
a
Zone he
al
t
h
depa
rt
m
e
n
t
and
Wore
da
heal
t
h
office res
p
ecti
v
ely. During the data
co
llectio
n
p
r
o
cess,
th
e d
a
ta
co
llector
s
were
inform
the m
o
thers/care
t
akers
ab
ou
t th
e purpo
se, an
ticip
ated
b
e
n
e
fits and h
a
rm
s/d
i
sc
o
m
forts of
t
h
e re
search
pr
oject. The
data c
o
llectors
were also
info
rm
th
e
m
th
at th
eir n
a
m
e
were
n
o
t
u
s
ed
and
con
f
i
d
en
tiality o
f
in
fo
rm
atio
n
was k
e
p
t
,
participation in the study is abs
o
lute
ly based on their fre
e
willingness a
nd
as they ha
ve full right to
refuse,
with
draw th
eir p
a
rticip
ation
at an
y ti
m
e
fro
m
th
eir p
a
rti
c
ip
atio
n
.
After d
o
i
ng
so, stud
y p
a
rticip
an
ts were
aske
d i
f
t
h
ey
ha
ve
wel
l
u
nde
rst
o
o
d
t
h
e
w
hol
e
t
h
i
n
g
.
An
y qu
estion
ro
se was mo
re clarified an
d th
ei
r
v
o
l
u
n
t
arin
ess to
p
a
rticip
ate
was ask
e
d
.
Oral
co
nsen
t was obtain
e
d
for
their
willin
gn
ess for p
a
rticip
ation
.
3.
R
E
SU
LTS AN
D ANA
LY
SIS
From
t
h
e t
o
t
a
l
of
31
4 sam
p
l
e
d chi
l
d
re
n ag
ed bet
w
een
1
2
-
2
3
m
ont
hs,
3
08 c
h
i
l
d
r
e
n
(1
03 case
s
an
d
20
5 co
nt
r
o
l
s
)
were i
n
t
e
r
v
i
e
w
e
d wi
t
h
res
p
o
n
se rat
e
of
98
%. The m
ean
age an
d st
and
a
rd de
vi
at
i
o
n (
S
D)
o
f
chi
l
d
re
n
was 1
7
.
25 m
ont
h
s
a
nd
3.
1
2
res
p
ec
t
i
v
el
y
.
Fi
ft
y
on
e perce
n
t
o
f
ch
i
l
d
ren
were
fe
m
a
l
e
and t
h
e r
e
st
are
m
a
le.
Matern
al, c
h
ild and
househ
old s
o
ci
o
-
dem
ogr
ap
hi
c ch
ar
acteri
s
t
i
c
s
Regarding t
o
socio-dem
o
gra
phic
cha
r
acters; as
we
co
mp
a
r
e th
e d
i
ff
er
e
n
t edu
c
a
tiona
l
s
t
a
t
u
s
o
f
respon
d
e
n
t
s 74
(71
.
8
%
) o
f
cases an
d
6
4
(3
1.2%) of contro
ls were illiterates, 21
(20
.
4
%
)
o
f
cases
an
d
9
5
(4
6.
3%
) o
f
co
nt
r
o
l
s
at
t
e
nde
d
pri
m
ary
Scho
ol
& 8
(
7
.
8
%
)
o
f
cases a
n
d
46
(2
2.
4%
) o
f
co
nt
r
o
l
s
at
t
e
nd
e
d
seconda
ry and above level.
If we c
o
m
p
are,
m
a
rital st
a
t
u
s
b
e
tw
een
th
e tw
o-
stud
y gr
oup
s, ab
ou
t 81
(7
8.6%)
cases an
d
18
1
(8
8.
3%
) co
nt
r
o
l
s
were m
a
rri
ed, Pe
rt
ai
ni
n
g
t
o
k
n
o
wl
e
d
ge a
b
o
u
t
i
m
m
uni
zat
i
on
of
res
p
o
n
d
ent
s
,
63
(61.2%
) cas
es and 182 (88.8%) c
o
nt
rols were ha
d satisfa
ctory knowle
d
ge related t
o
vaccination.
When we
com
p
are t
h
e hous
eh
ol
d weal
t
h
st
at
us 32 (
3
1
.
1%
) of cases
and
40 (
1
9.
5%
) of t
h
e C
o
nt
r
o
l
s
were fo
u
nd
i
n
t
h
e
weal
t
h
qui
nt
al
of
p
o
o
r
est
cat
e
g
o
r
y
,
whi
l
e
22
(2
1.
4%
) cases
and
5
8
(2
8.
3%
) co
nt
r
o
l
s
were
fo
u
n
d
i
n
t
h
e
hi
ghe
st
weal
t
h
qui
nt
al
.
R
e
ga
rdi
n
g
t
o
se
x of
t
h
e chi
l
d
, 6
7
(6
5
%
)
cases
an
d
9
0
(4
3.
9%
) cont
rol
s
we
re
fem
a
l
e
s,
Acco
r
d
i
n
g t
o
del
i
v
ery
si
t
e
m
a
jori
t
y
9
3
(
9
0.
3%)
o
f
cases
and
1
25
(
6
1
%
) o
f
c
ont
r
o
l
s
chi
l
d
re
n
were
bo
r
n
at
hom
e. 6
2
(
6
0.
2%)
cases a
n
d
7
3
(
3
5.
6%) c
ont
rol
s
of
t
h
e
part
i
c
i
p
at
i
n
g c
h
i
l
d
re
n
were i
n
t
h
e
bi
rt
h o
r
d
e
r o
f
4
th
an
d abov
e
Knowledge as
determinant of
immuniz
a
ti
on defaulting.
Co
n
c
ern
i
n
g
to Knowledg
e
o
f
resp
ond
en
t
abo
u
t
imm
u
n
i
zatio
n
related
issu
es,
from
th
e to
tal
responde
nt al
m
o
st all 101 (98.1%) case a
nd
205 (100%
)
cont
rols were
heard
a
b
out va
ccination
a
n
d vaccine
pre
v
e
n
t
a
bl
e
di
seases.
Up
t
o
8
6
(
8
3.
5%
)
cases an
d
8
7
(4
2.
4%
) c
o
nt
rol
s
fr
om
t
o
t
a
l
i
n
t
e
rvi
e
wers
wer
e
mentioned less
than four type
s of
vaccine preventa
ble dise
ases, Acc
o
rdin
g to responde
nt’s Knowle
dge
about
the age
at whi
c
h the
child be
gins a
n
d c
o
m
p
lete vaccina
tion. Ma
jority of
cases 55
(53.4%) a
n
d 149 (72.7%)
cont
rol
s
,
w
h
i
l
e
20
(1
9.
4%
) cases an
d 1
25
(
6
1
%
) c
ont
r
o
l
s
were
kne
w t
h
e
age at
whi
c
h
t
h
e chi
l
d
begi
n
s
and
finish imm
unization res
p
ecti
v
ely.
Pertaini
ng
to vaccinati
on session
onl
y 28
(27.2%
)
cases and m
o
st 117
(5
7.
1%
) c
ont
r
o
l
s
of
t
h
e
res
p
o
n
d
ent
s
we
re
kne
w t
h
e
sessi
on
n
eeded
t
o
be
f
u
l
l
y
pr
ot
ect
ed.
Predictor
s
of
i
mmuniz
a
tion defaulter
Bivariable logistic regressi
on anal
ysis res
ults
Biv
a
riab
le log
i
stic reg
r
essi
o
n
an
alysis sh
owed
th
at Mo
th
ers liv
in
g
withou
t a p
a
rtn
e
r [(OR: 2
.
1
,
95%
CI: (1
.1-3.9)], rural resid
e
n
t
[(OR: 2
.
9
,
9
5
% CI:(1.5-5.
9
)], Illiterate
m
o
th
er[(OR:6
.
6
,
9
5
% CI: (2
.9
-1
5.3)],
Evaluation Warning : The document was created with Spire.PDF for Python.
I
J
PH
S I
S
SN
:
225
2-8
8
0
6
Pred
icto
rs o
f
Immun
i
za
tion
Defa
u
ltin
g Among
C
h
ild
ren Ag
e 12
-23
mon
t
h
s
in
Ha
w
a
ssa .... (Fikru
Tesf
a
y
a
)
18
9
Tim
e
take
≥
3
0
Min
u
t
es’
walk
away to h
eal
th
facility[(OR
:
1
.
7
5
,
95
% CI: (1.03
-
2
.
97
)],
≥
5
fam
ily
size[(
OR:
2
.
6
,
95
% CI:
[(1.6-4
.3
)], child
ren
liv
ing
i
n
po
orest
qu
intile[(OR: 2
.
1
,
9
5
% CI: (1.1-4
.1
)], Ho
m
e
d
e
liv
ery
[(
OR
:
5.
9, 9
5
%
C
I
:
(2.
9
-
1
2.
1)
), Se
x of c
h
i
l
d
bei
n
g fem
a
l
e
[(
OR
:
2.
4, 9
5
%
C
I
:
(1.
5
-
3
.
9
)]
, Or
der
of c
h
i
l
d
bei
n
g
3
rd
an
d l
e
ss
i
n
t
h
e
fam
i
l
y
[(O
R
:
2.
7,
9
5
% C
I
:
(
1
.
7
-
4
.
5
)]
,
C
h
i
l
d
re
n
of
m
o
thers
w
h
o
had
no
A
N
C
fol
l
o
w
u
p
attendance during their last pregna
nc
y [(OR: 4.3,
95% CI: (2.6-7.1)], an
d Mothe
r
s who did
not recei
ve at
least two do
se of TT
v
accin
atio
n[
(OR:
3
.
5
,
95
% CI: (2.1-
5
.
7)]
were sign
ifican
tly asso
ciated
with
i
m
m
u
n
i
zatio
n
d
e
fau
ltin
g.
See
Tab
l
e 2
.
Tab
l
e
2
.
Bi
v
a
ri
ab
le log
i
stic reg
r
essi
on
an
alysis o
f
Matern
al,
ch
ild
an
d facility related
ch
aracteristics o
n
i
m
m
u
n
i
zatio
n
d
e
fau
ltin
g, in so
u
t
h
e
rn
Et
h
i
opia 2
014
Variables
I
m
m
uni
z
a
tion De
faulting
COR
,
95
%
CI
Case,
n (
%
)
Contr
o
l,
n (
%
)
Maternal Age
(yrs.)
<20 13(
12.
6)
23(
11.
2)
1
20–2
4
10(
9.
7)
87(
42.
4)
0.
09(
.
033-
.
263)
25–2
9
17(
16.
5)
45(
22.
0)
0.
51(
.
221-
1.
18
3)
30–3
4
31(
30.
1)
24(
11.
7)
1.
29(
.
555-
3.
02
9)
35–3
9
24(
23.
3)
22(
10.
7)
1.
97(
.
859-
4.
51
0)
≥
40 8(
7.
8)
4(
2.
0)
2.
71(
.
699-
10.
4
80)
Marit
a
l st
at
us
M
a
rr
ied 81(
78.
6)
181(
88.
3)
2.
05(
1.
085-
3.
8
66)
*
Un
m
a
rr
ied
22(
21.
4)
24(
11.
7)
1
Educational statu
s
Illiterat
e
74(71.8)
64(
31.2)
6.65(
2.92-15.13)
***
Pr
im
ary 21(
20.
4)
95(
46.
3)
1.
27(
0.
52-
3.
09)
Secondar
y
and above
8(
7.
8)
46(
22.
4)
1
Residential area o
f
fa
m
ily
Rur
a
l 92(
89.
3)
152(
74.
1)
2.
92(
1.
449-
5.
8
67)
**
Ur
ban 11(
10.
7)
53(
25.
9)
1
Dista
n
ce
fa
r fro
m
Hea
l
th
Insti
t
utio
n
<31 M
i
nutes
69(
67)
160(
78)
1
≥
31 M
i
nutes
34(
33)
45(
22)
4.
60(
2.
478-
8.
5
37)
*
Fa
m
ily si
ze
<5 43(
24.
3)
134(
75.
7)
1
≥
5 60(
45.
8)
71(
54.
2)
2.
63(
1.
620-
4.
2
81)
Wealth Index
Poor
est 32(
31.
1)
40(
19.
5)
2.
11(
1.
073-
4.
1
46)
*
Poor
er
11(
10.
7)
21(
10.
2)
1.
38(
.
573-
3.
32
7)
M
i
ddle 16(
15.
5)
34(
16.
6)
1.
24(
.
574-
2.
68
1)
Richer
22(
21.
4)
52(
25.
4)
1.
12(
.
554-
2.
24
5)
Richest 22(
21.
4)
58(
28.
3)
1
ANC
follow
-
up of last pregnancy
Yes 34(
33)
148(
72.
2)
1
No 69(
67)
57(
27.
8)
4.
28(
2.
587-
7.
0
82)
***
Tok
i
ng t
w
o or
m
o
re dose of
TT
Yes 32(
31.
1)
125(
61)
1
No 71(
68.
9)
80(
39)
3.
47(
2.
097-
5.
7
32)
***
Postponing sched
u
le of chi
l
d i
m
m
u
niz
a
tion
Yes 42(
37.
5)
70(
62.
5)
0.
75(
.
462-
1.
22
6)
No 61(
)
31.
1
135(
68.
9)
1
Sex of
child
Fem
a
le 67(
65)
90(
43.
9)
2.
38
(
1
.
457-
3.
882)
**
M
a
le 36(
35)
115(
56.
1)
1
Place of bi
rth
Ho
m
e
93(
90.
3)
125(
61)
1
Health Institution
10(9.7)
80(39)
5.95(
2.926-1
2
.107
)
***
Order
(
ran
k
) of th
e Child
in the fa
mily
1
s
t
,2
nd
and 3
ed
41(
39.
8)
132(
61)
2.
73(
1.
680 -
4.
451
)
***
4
th
and above
62(
60.
2)
73(
39)
1
I
m
m
uniz
a
t
i
on relat
ed
k
n
ow
ledge
Poor
knowledge
40(
38.
8)
23(
11.
2)
5.
03(
2.
792-
9.
0
41)
***
Satisfactor
y
knowledge
63(
61.
2)
182(
88.
8)
1
P-
value: * 0.
01<p<0.
05 **0.
001<p
<
0.
01 ***p<0.
00
1
Multiple logistic re
gression analysis
Fro
m
th
e Mu
ltip
le lo
g
i
stics reg
r
ession
an
al
ysis
; ch
ild
ren
who
born
e
from Illi
terate
m
o
th
er [(
AOR:
3
.
6
2
;
95
%
C
I
:
(
1
.33-
9.86
)
] w
a
s
4
tim
es
more likely to defaulting v
acci
nation sc
he
dul
es than childre
n who
Evaluation Warning : The document was created with Spire.PDF for Python.
I
S
SN
:
2
252
-88
06
I
J
PH
S Vo
l. 3
,
N
o
. 3
,
Sep
t
emb
e
r
201
4
:
1
85
–
19
3
19
0
bo
r
n
e fr
om
m
o
t
h
ers w
h
o had
com
p
l
e
t
e
d secon
d
a
r
y
and ab
o
v
e
ed
u
cation
a
l lev
e
l, reg
a
rd
in
g
to
wealth
; ch
ild
ren
liv
in
g
with
i
n
ho
u
s
eho
l
d
s
with p
o
o
r
est qu
in
ti
le [(
AO
R:
2.
9
0
, 9
5
%
CI: (1
.1
7-
7.
1
7
)
]
,
wa
s 3 tim
e
s at risk fo
r
i
m
m
u
n
i
zatio
n
d
e
fau
ltin
g
th
an
h
i
gh
est wealth
q
u
i
n
tile.
From
h
ealth
facili
ty facto
r
s;
Home d
e
liv
ery
[(
AO
R:
4.
10
, 9
5
%
CI: (1.
7
1
-
9.
83
)
],
w
a
s
4
t
i
m
es at
hi
g
h
er ri
s
k
f
o
r
im
m
uni
zat
i
on defa
ul
t
i
ng t
h
a
n
chi
l
d
re
n w
ho
bo
r
n
e
in
th
e h
ealt
h
facility. Ano
t
her
h
ealth
facility rela
ted
ch
aracteristics wh
i
c
h
h
a
d
asso
ciatio
n
was ANC
fo
llo
w
up
. Th
us m
o
t
h
ers w
ho h
a
d n
o
t
fol
l
o
we
d A
N
C
du
ri
n
g
t
h
e
i
r l
a
st
pregna
n
c
y
[(
AO
R:
2.
39
, 9
5
%
CI:
(1
.2
8-
4.
49
)
] w
a
s
2
times h
i
g
h
l
y d
e
fau
lt fro
m
i
m
mu
n
i
zation
sch
e
d
u
l
es th
an
m
o
t
h
ers
who
tried to
u
tilize ANC care
fo
r
l
a
st
pre
g
na
ncy
.
C
h
i
l
d
re
n wh
o b
o
r
n
e fr
o
m
m
o
t
h
ers
w
h
o had
po
or
i
m
m
uni
zat
i
on
rel
a
t
e
d kn
owl
e
d
g
e
was
(
AOR
:
4
.
05
4, 95
%
C
I
:
(
1
.9
6-8
.
3
9
)
]
4
times
m
o
re likely to de
faulti
ng
from
full
vaccination t
h
an the
counterpart
(se
e
Table 3
).
Tab
l
e
3
.
M
u
ltip
le log
i
stic regression
an
alysis of eff
ect
o
f
matern
al, ch
ild
,
h
o
u
s
eho
l
d
and
h
ealth
institu
tio
n
a
l
r
e
lated
ch
ar
act
er
istics on
imm
u
n
i
zatio
n
d
e
fau
ltin
g
,
in
sou
t
h
e
rn
Et
h
i
op
ia,
2
014
P-
value: * 0.
01<p<0.
05 **0.
001<p
<
0.
01 ***p<0.
00
1
Childhood m
o
rtality can be signi
fican
tly lowered if routine vaccinatio
n is com
p
leted, but
significant
n
u
m
b
e
r
o
f
eligib
le ch
ildren in
Et
h
i
op
ia was d
e
fau
lted from
i
m
m
u
n
i
zati
o
n sch
e
du
le
wh
ich
i
n
crease t
h
em
to
die from
vacci
ne pre
v
e
n
table
disease
[9]. This study was assessed pre
d
ic
tors for imm
uniz
a
tion de
faulting and
reveale
d
educa
tional status, place of
delivery, ANC follow up and house
hol
d wealth status as the significant
p
r
ed
icto
rs
o
f
defau
lting
fro
m
co
m
p
letio
n
of
i
m
m
u
n
i
za
tio
n
sch
e
d
u
l
es in
ch
ild
ren
ag
ed
between 12
-23
m
o
n
t
h
s
after
ad
ju
sting
all
co
nfoun
d
i
ng
v
a
riab
les.
Acco
r
d
i
n
gl
y
M
a
t
e
rnal
educ
at
i
on st
at
us w
a
s si
gni
fi
cant
l
y
associ
at
ed wi
t
h
im
m
uni
zation
defa
ul
t
i
n
g
.
Ch
ild
ren
who bo
rn
e
fro
m
i
lliterate
m
o
th
ers
were
3
.
6
ti
mes
m
o
re likely to
d
e
fau
l
t
fro
m
i
m
m
u
n
i
zatio
n
sche
dul
e t
h
a
n
chi
l
d
re
n
wh
o
bo
r
n
e fr
om
m
o
t
h
e
r
s w
h
o ha
d at
t
e
nde
d sec
o
n
d
a
r
y
or
hi
g
h
er e
d
ucat
i
on:
Thi
s
i
s
co
nsisten
t
w
ith th
e st
ud
y done b
y
Edw
a
rd Bb
aale,
wh
ich
sh
ow
ed
t
h
at m
a
ter
n
al ed
u
c
ation
con
t
r
i
bu
te to br
ing
i
m
p
o
r
tan
t
ch
ang
e
s
on
attitu
d
e
s, trad
itio
n
s
and
b
e
liefs
, wh
ich
i
n
crease au
t
o
n
o
m
y an
d con
t
ro
l
ov
er hou
seh
o
l
d
resources,
wh
i
c
h
enh
a
n
ce h
e
alth
care seek
ing
,
wh
ereas
illiteracy h
a
d
h
i
gh
risk
of d
e
fau
ltin
g
[10
]
. An
o
t
h
e
r
fi
n
d
i
n
g f
r
om
Nepal
a
nd
Phi
l
i
ppi
nes
wer
e
i
n
l
i
n
e wi
t
h
t
h
is stud
y th
at
m
a
tern
al ed
ucatio
n
was imp
o
rtan
t
p
r
ed
icto
rs fo
r i
mmu
n
i
zatio
n
defau
lting
[11
]
,[1
2
]
. Th
is m
i
g
h
t
b
e
du
e to
t
h
e lo
w lev
e
l of un
d
e
rstand
ing
ab
out
the be
nefits of vaccination, l
o
w c
h
a
n
ce of expos
u
re a
n
d diffic
u
lt to listen a m
e
ssage
in Am
haric from radio
Variable
I
m
m
uni
z
a
tion de
f
a
ulting
Odds
Ratio (95
%
Cl)
Case Control
Crude
Adjuste
d
M
a
r
ital status
M
a
rr
ied
81(
78.
6)
181(
88.
3)
2.
048(
1.
08
5-
3.
866
)
1.
640(
0.
73-
3.
6
9
)
Un
m
a
rr
ied
22(
21.
4)
24(
11.
7)
1
1
Educational status
Illiterat
e
74(
53.6)
64(46.4)
6.
648(2.92-1
5
.13)
3.
618(
1.
33-
9.
8
6
)
*
Pr
im
ary
21(
18.
1)
95(
81.
9)
1.
271(
0.
52-
3.
0
9
)
1.
078(
0.
38-
3.
0
3
)
Secondar
y
and above
8(
14.
8)
46(
85.
2)
1
1
Sex of child
Fem
a
le
67(
65)
90(
43.
9)
2.
378
(
1
.
457-
3.
882)
1.
44(
0.
78-
2.
66)
M
a
le 36(
35)
115(
56.
1)
1
1
Place of delivery
Ho
m
e
93(90.3)
125(61)
5.952(2.
92
6-12.10
7)
4.
102(
1.
71-
9.
8
3
)
*
*
Health facility
10(
9.7) 80(39)
1
1
Bir
t
h or
der
1
s
t
-3
ed
41(
39.
8)
132(
64.
4)
2.
734(
1.
68
0 -
4.
451)
1
4
th
and above
62(
60.
2)
73(
35.
6)
1
1.
318(
0.
66-
2.
6
4
)
Residential ar
ea
Rur
a
l
92(
89.
3)
152(
74.
1)
2.
916(
1.
44
9-
5.
867
)
1.
076(
0.
43-
2.
7
3
)
Ur
ban 11(
10.
7)
53(
25.
9)
1
1
Average ti
m
e
w
a
l
k
to
facility
<31 M
i
nutes
69(
67)
160(
78)
1
1
≥
31 M
i
nutes
34(
33)
45(
22)
4.
600(
2.
47
8-
8.
537
)
1.
251(
0.
62-
2.
5
1
)
Fam
i
ly
size
<5
43(
41.
7)
134(
65.
4)
1
1
≥
5 60(
58.
3)
71(
34.
6)
2.
633(
1.
62
0-
4.
281
)
1.
463(
0.
73-
2.
9
2
)
W
ealth I
ndex
Poor
est
32(
44.
4)
40(
55.
6)
2.
109(
1.
07
3-
4.
146
)
2.
897(
1.
17-
7.
1
7
)
*
Poor
er
11(
34.
4)
21(
65.
6)
1.
381(
.
573-
3.
3
27)
0.
941(
0.
29-
3.
0
0
)
M
i
ddle
16(
32.
0)
34(
68.
0)
1.
241(
.
574-
2.
6
81)
0.
959(
0.
34-
2.
6
4
)
Richer
22(
29.
7)
52(
70.
3)
1.
115(
.
554-
2.
2
45)
1.
247(
0.
53-
2.
9
5
)
Richest 22(
27.
5)
58(
72.
5)
1
1
ANC follow-
up
Yes
34(
33)
148(
72.
2)
1
1
No 69(
67)
57(
27.
8)
4.
280(
2.
58
7-
7.
082
)
2.
39(
1.
28-
4.
49)
*
*
Receiving two or
m
o
re TT
d
o
s
e
Yes
32(
31.
1)
125(
61)
1
1
No
71(
68.
9)
80(
39)
3.
467(
2.
09
7-
5.
732
)
1364(
0.
7
0
-
2
.
64)
knowledge
of
Mo
th
er’s
Poor
40(
38.
8)
23(
11.
2)
5.
025(
2.
79
2-
9.
041
)
4.
054(
1.
96-
8.
3
9
)
*
**
E
nough
63(
61.
2)
182(
88.
8)
1
1
Evaluation Warning : The document was created with Spire.PDF for Python.
I
J
PH
S I
S
SN
:
225
2-8
8
0
6
Pred
icto
rs o
f
Immun
i
za
tion
Defa
u
ltin
g Among
C
h
ild
ren Ag
e 12
-23
mon
t
h
s
in
Ha
w
a
ssa .... (Fikru
Tesf
a
y
a
)
19
1
an
d
TV, am
o
n
g
illiterates. Bu
t, in
con
s
istent with
ano
t
h
e
r stu
d
i
es
do
n
e
in
Nigeria an
d in
sou
t
h
e
rn
part of
Eth
i
op
ia,
wh
ich
sh
owed
edu
c
atio
n
a
l statu
s
were no
t sign
ifican
t pred
ictors to
imm
u
n
i
zat
io
n
d
e
fau
lting
[13
]
.
Othe
r soci
o-ec
onom
ic characteristic of the
respo
n
d
e
n
t
s
wh
ich
was si
gn
ifican
tly associated
with
defa
ul
t
i
ng f
r
o
m
co
m
p
l
e
t
i
on of chi
l
d im
m
u
ni
zat
i
on wa
s h
ous
eh
ol
d we
al
t
h
st
at
us. I
n
t
h
u
s
chi
l
d
re
n l
i
v
i
n
g i
n
t
h
e
fam
i
ly with
in
p
oorest qu
artil
e were 3
tim
e
s
m
o
re lik
ely to
d
e
fau
lting
fro
m
i
m
m
u
n
i
za
tio
n
sch
e
du
le
th
an
ch
ild
ren
wh
o liv
e in th
e h
i
g
h
e
st wealth
qu
in
t
a
l. Th
ese fi
n
d
i
n
g
is co
n
s
istence with th
e st
ud
y don
e
b
y
Ren
s
tein
,
wh
ich
sh
owed
fam
i
ly wealth
statu
s
as sign
ifican
t p
r
ed
ictors o
f
imm
u
n
i
zat
io
n
d
e
fau
ltin
g
[14
]
. Ano
t
h
e
r rep
o
rt
do
ne i
n
W
e
st
-
C
ape ha
d i
ndi
c
a
t
e
d t
h
at
t
h
e hous
eh
ol
d wi
t
h
hi
g
h
er we
al
t
h
st
at
us were m
o
re l
i
k
el
y
t
o
com
p
l
e
t
e
th
e i
m
m
u
n
i
zat
io
n
schedu
le.
Si
m
ilarly
li
teratu
re ob
tain
ed fro
m
Eth
i
o
p
i
a also
assu
res t
h
at wealth
level h
a
d
si
gni
fi
ca
nt
ass
o
ci
at
i
on
f
o
r i
m
m
uni
zat
i
on de
f
a
ul
t
i
ng
[
7
]
.
Thi
s
m
i
ght
be
at
t
r
i
but
a
b
l
e
t
o
ho
use
hol
d
wi
t
h
go
o
d
ec
o
nom
i
c
st
at
us were a
b
l
e
t
o
c
ove
r t
h
e
co
st
in
vo
lv
ed
du
ri
ng
rep
eated
v
i
sits lik
e tran
sportatio
n
and
o
t
her related
co
st [15
]
. Th
is m
a
y b
e
also
du
e
to
th
e
abse
nce
of t
r
ansportation, acc
ess t
o
m
e
di
a l
i
k
e
radi
o a
n
d
T
V
a
n
d
ot
her
rel
a
t
e
d co
st
.
Am
ong health facility related fact
ors; ANC follow
up
of m
o
thers
was significa
nt pre
d
ictor
of
im
m
uni
zat
i
on defa
ul
t
i
ng a
f
t
e
r ad
j
u
st
m
e
nt
of
al
l
ot
her
vari
a
b
l
e
s, C
h
i
l
dre
n
of m
o
t
h
er
w
h
o
had
n
o
ANC
f
o
l
l
o
w
up
d
u
ri
n
g
t
h
ei
r
l
a
st
pre
g
nanc
y
were
2.
4 t
i
m
es m
o
re l
i
k
el
y
t
o
de
fa
ul
t
fr
om
im
m
uni
zat
i
o
n
sche
d
u
l
e
t
h
a
n
t
hos
e
at
t
e
nd
A
N
C
f
o
l
l
o
w
up
.
St
u
d
y
d
one
i
n
P
h
i
l
i
ppi
nes
an
d
su
b-
Saha
ran
A
fri
ca
n a
g
ree
d
wi
t
h
t
h
i
s
fi
ndi
n
g
[
1
2
]
,[1
6
]
.
Ano
t
h
e
r stud
y
d
o
n
e
in
Eth
i
o
p
i
a also
ind
i
cate ANC
u
tilizatio
n
as sign
ifican
t
p
r
ed
icto
rs
o
f
imm
u
n
i
zatio
n
defa
ul
t
i
ng
[8]
.
R
eason
behi
n
d
t
h
i
s
m
i
ght
b
e
whe
n
m
o
t
h
ers ha
d n
o
A
N
C
fol
l
o
w
u
p
;
t
h
ey
m
i
ss i
n
for
m
at
i
on
abo
u
t
i
m
m
uni
zat
i
on rel
a
t
e
d k
n
o
w
l
e
d
g
e w
h
i
c
h was obt
ai
ned
fr
om
repeat
ed
educat
i
o
n d
u
ri
ng
A
N
C
fol
l
o
w up
.
Place of delive
r
y was a
n
othe
r facility relate
d c
h
aract
eristi
c whic
h showe
d
a
significa
n
t association
with
th
e immu
n
i
zation
d
e
fau
ltin
g
.
Ch
ildren
o
f
m
o
th
er
d
e
liv
ered
at
ho
m
e
were
4
t
i
m
e
s
m
o
re lik
ely to
d
e
fau
ltin
g
v
a
ccin
atio
n
th
an
t
h
o
s
e ch
ildren
d
e
liv
ered
in
a
h
ealth
facility. Th
is is si
m
ila
r with
stud
y do
n
e
at
M
o
zam
bi
que
whi
c
h i
n
di
cat
e
t
h
at
h
o
m
e
del
i
v
ere
d
m
o
t
h
ers
chi
l
d
re
n
ha
d
hi
gh
ri
s
k
of
de
fa
ul
t
i
ng i
m
m
uni
zat
i
on
[17]. Anothe
r
studies
done i
n
Ke
nya and i
n
East Africa
showe
d
place of
delive
r
y as significa
nt pre
d
ictors
.
[18
]
,[19
]. Eth
i
o
p
i
an
stud
y also
rev
ealed
that ch
ild
ren
b
o
rn
in
Health
facilit
y were 2
.
6 ti
mes
m
o
re li
k
e
ly to
co
m
p
lete i
m
mu
n
i
zation
[8
].
Th
is m
i
g
h
t
due to
t
h
e
f
act t
h
at m
o
thers
delivering at
home would not
ha
ve
cont
act
wi
t
h
h
eal
t
h
pr
ofes
si
o
n
al
s an
d ex
po
s
u
re t
o
kn
o
w
a
b
o
u
t
i
m
m
uni
zat
i
on w
h
i
c
h i
s
pr
o
v
i
d
e
d
i
n
p
r
enat
al
an
d po
st
n
a
tal per
i
od
.
An
ot
he
r rea
s
o
n
t
h
at
c
ont
ri
b
u
t
e
f
o
r i
m
m
u
ni
zat
i
on
defa
u
l
t
i
ng was m
a
ternal
i
m
m
uni
zat
i
on rel
a
t
e
d
kk
n
o
wl
e
dge
. C
h
i
l
d
re
n o
f
m
o
ther
wh
o ha
d p
o
o
r
k
n
o
wl
e
dge
rel
a
t
e
d t
o
im
m
uni
zat
i
on we
re 4 t
i
m
e
s
m
o
re l
i
k
el
y
to inc
o
m
p
lete
vaccination than those
who
had satisfact
ory knowledge.
This is
c
onsist
e
nce
with a c
r
oss
-
sectio
n
a
l study in
W
e
st Ben
g
a
l
o
f
I
n
d
i
a, th
at id
en
tif
ied
low
kno
w
l
ed
g
e
abo
u
t
imm
u
n
i
zatio
n
was th
e
si
gni
fi
ca
nt
pre
d
i
c
t
o
rs i
m
m
uni
zat
i
on de
faul
t
i
ng
[2
0]
. The
fi
ndi
ng
obt
ai
ned
from
Ni
geri
a r
e
po
rt
ed t
h
at
Pa
rent
al
i
m
m
u
n
i
zatio
n
related
kn
owled
g
e
h
a
d
stron
g
in
flu
e
n
ce
on
immu
n
i
zatio
n
defau
lting
[13
]
. Ano
t
h
e
r stud
y d
o
n
e
i
n
East
ern Et
hi
opi
a ap
p
r
o
v
e
d
t
h
at
Una
w
are
of m
o
t
h
ers l
e
t
t
h
em
not
t
o
ret
u
r
n
f
o
r 2
n
d
an
d 3r
d d
o
se b
e
c
a
use o
f
inform
ation on place a
nd/
or
tim
e
of
imm
u
nization a
n
d
wrong pe
rcept
i
on
c
o
ntraindi
cation were statistical
si
gni
fi
ca
nt
fact
ors
f
o
r
t
h
e
i
m
m
uni
zat
i
on de
f
a
ul
t
o
f
c
h
i
l
d
re
n
[2
1]
. Si
m
i
l
a
r
l
y
t
h
e re
po
rt
d
one
i
n
so
ut
h
E
t
hi
opi
a
reveale
d
that
knowledge
of the m
o
th
ers/caretakers
about the
be
n
e
fit of imm
u
n
i
zatio
n
h
a
d
sign
ifican
t effect on
vaccine
defa
ulters [7]. T
h
is might be
due to
inform
ation de
pth; with l
o
w
analysis of
be
nefit and
harm
about
vaccination
of the child a
nd low
unde
rsta
ndi
ng
of m
o
rbidities and m
o
rtalities due to vaccine
preve
n
table
diseases a
n
d likes.
Limita
tio
n
Attitu
d
e
o
f
t
h
e m
o
th
ers/caretak
ers was no
t
stu
d
i
ed
,
wh
ich
may h
a
v
e
an im
p
act o
n
i
mmu
n
i
zation
and
not c
o
m
p
lim
e
n
t
ed by
qualitative m
e
thod
which ca
n a
n
sw
e
r
why question. Recall
bias
wa
s
introduce
d
due
t
o
m
o
th
er mig
h
t
fo
rg
et th
e v
a
ccin
a
tio
n an
d related
issu
e
o
f
t
h
eir ch
ildren
.
Desp
ite th
ese limita
tio
n
s
, t
o
t
h
e
b
e
st
of
o
u
r
kn
o
w
l
e
dge
, t
h
i
s
st
u
d
y
prese
n
t
e
d
pri
m
ary
res
u
l
t
s
of
t
h
e st
udy
a
n
d
h
a
d
use
d
a
d
e
q
u
a
t
e
cases a
n
d
c
ont
rol
s
and R
e
gul
ar a
n
d i
n
t
e
nsi
v
e co
n
t
i
nuo
us s
upe
r
v
i
s
i
on m
a
de by
t
h
e su
per
v
i
s
o
r
s
and t
h
e p
r
i
n
ci
pal
i
nvest
i
g
at
o
r
t
h
at
en
su
red
th
e issu
e
o
f
d
a
ta
qu
ality
m
a
n
a
g
e
m
e
n
t
.
4.
CO
NCL
USI
O
N
Th
is stud
y id
en
tified
th
e
pred
icto
rs
fo
r imm
u
n
i
zatio
n
d
e
fau
lter thro
ugh
Biv
a
riab
le an
d
m
u
ltip
le
lo
g
i
stics lo
g
i
stic reg
r
ession
. In
th
e Biv
a
riab
le an
alysis
m
a
n
y
p
r
ed
ictors were id
en
tified
as p
r
ed
icto
rs. Mo
thers
liv
e witho
u
t
a
p
a
rt
n
e
r, Rural resid
e
n
t
, Illiterate
m
o
th
er, Reg
a
rd
ing
to
d
i
st
an
ce m
o
th
ers
walk
≥
30
Minu
tes to
h
ealth
facility,
Un
-p
rop
o
rtion
a
l fam
ily size
(
≥
5
)
, Fam
ily
liv
in
g
with
in po
or
est
q
u
a
rtile, Ch
illed
of m
o
th
ers
wh
o del
i
v
e
r
y
at
hom
e, Sex of chi
l
d bei
n
g fem
a
l
e
,
R
a
nk of chi
l
d bei
n
g 4
th
and a
b
o
v
e,
C
h
i
l
d
ren
of
m
o
t
h
ers
Evaluation Warning : The document was created with Spire.PDF for Python.
I
S
SN
:
2
252
-88
06
I
J
PH
S Vo
l. 3
,
N
o
. 3
,
Sep
t
emb
e
r
201
4
:
1
85
–
19
3
19
2
who
had no
ANC follow up
last pre
gna
ncy,
and
m
o
thers who not receive
TT vacci
nation
we
re pre
d
ictors
of
i
m
m
unization defa
ulting. But in
m
u
ltiv
ariate analysis only factors
such
as educational status, pl
ace of
del
i
v
ery
,
ANC
fol
l
o
w u
p
,
H
ous
eh
ol
d
weal
t
h
st
at
us an
d I
m
m
uni
zat
i
on r
e
l
a
t
e
d kn
o
w
l
e
dge
of m
o
t
h
er
s wer
e
sh
owed
t
h
e si
g
n
i
fican
t associatio
n
with
t
h
e
d
e
fau
ltin
g
fro
m
co
m
p
let
i
o
n of imm
u
n
i
zatio
n
sch
e
d
u
l
es in
chi
l
d
re
n a
g
ed
bet
w
ee
n
12
-
23 m
ont
hs aft
e
r ad
j
u
st
m
e
nt fo
r
ot
her
va
r
i
abl
e
s. Heal
t
h
pr
ofe
ssi
o
n
al
s
sh
oul
d
m
o
t
i
v
a
te an
d
co
n
tinuo
usly te
ach
m
o
th
ers to
p
r
o
m
o
t
e atten
d
a
n
ce
o
f
ANC
fo
llow up
and in
stitu
tio
n
a
l deliv
ery
as well as to
red
u
ce l
o
ng
waitin
g
tim
e
in
h
e
alth
fac
ility an
d
p
o
s
t
p
on
em
en
ts. Pro
p
e
r informatio
n
o
n
t
h
e
d
o
s
es
and tim
i
ng of
the vacci
nation s
h
ould be
gi
ven for t
h
e
mothe
r
com
i
ng
for imm
unizing
their c
h
ild
by health
pr
ofe
ssi
o
n
. B
e
si
des t
h
e
go
ver
n
m
e
nt
s and
st
a
c
k
hol
der
s
s
h
o
u
l
d
gi
ve m
u
ch
em
phasi
s
o
n
i
m
provi
n
g
e
d
uc
at
i
onal
status m
o
thers
and econom
i
c
status of
house
hol
ds.
ACKNOWLE
DGE
M
ENTS
The a
u
thors a
r
e very
grateful to
Ha
wass
a Zu
riy
a
distr
i
ct for
its administrative and technical
assistan
ce. The
schoo
l o
f
pu
b
lic h
ealth
,
co
lleg
e
o
f
m
e
di
ci
ne and heal
t
h
sci
e
nce, of
Hawassa U
n
i
v
ersi
t
y
deser
v
es ac
kn
owl
e
dgem
e
nt
for
gi
vi
n
g
a ch
ance an
d Ha
w
a
ssa t
o
w
n
hea
l
t
h
depa
rt
m
e
nts al
so t
h
esau
r
u
s
f
o
r
fin
a
n
c
ial supp
ort.
Author
s' contributions: FT
was t
h
e
prim
ary researc
h
e
r
, c
oncei
ved the
st
udy
,
de
si
g
n
ed
,
pa
rt
i
c
i
p
at
ed i
n
dat
a
col
l
ect
i
on, c
o
n
duct
e
d dat
a
a
n
al
y
s
i
s
, draft
e
d
an
d
fin
a
lized
t
h
e m
a
n
u
s
crip
t
for pub
licatio
n;
AT
was assis
t
ed in
d
a
ta co
llectio
n an
d
rev
i
ewed
th
e in
itial
an
d
fin
a
l drafts
o
f
t
h
e m
a
n
u
s
crip
t;
YB
was as
sisted in
data coll
ection
an
d
rev
i
ewed
th
e in
itial an
d
fin
a
l d
r
afts o
f
the
m
a
n
u
s
crip
t;
TT
in
terp
reted th
e resu
lts, and
rev
i
ewed
th
e in
itial
an
d fi
n
a
l drafts of th
e m
a
n
u
s
crip
t
.
Al
l
aut
h
o
r
s rea
d
a
n
d
ap
p
r
ove
d t
h
e
fi
nal
m
a
nuscri
p
t
.
L
i
st of
abbre
v
i
a
ti
on
: HE
P
:
h
ealth
ex
tensio
n
p
r
og
ram
,
MD
G
: millen
n
i
u
m
d
e
v
e
lo
p
m
en
ts Go
al,
OP
V
(o
r
a
l
polio vaccine
),
RED
: reac
hing eve
r
y distric
t;
SNNP
R
: Sou
t
h
e
rn
n
a
tio
n
n
a
tio
n
a
lity an
d p
e
op
le reg
i
on,
TT
:
Tet
a
nus
T
oxi
c,
WHO
:
Wo
rl
d Heal
t
h
or
ga
ni
zat
i
on.
Com
p
eting interests:
T
h
e a
u
thors
declare
that ther
e is
no
co
m
p
etin
g
in
terest.
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