Abstract
Objectives
Childhood vaccines and biannual vitamin A delivery by health systems are key to child health; suboptimal administration may be a result of inadequate coverage or access to health systems. There have been national programs set in Ethiopia, such as the health sector development program, to improve child health. Therefore, we sought to describe trends in infant vaccines and vitamin A in urban and rural settings in Ethiopia. We hypothesized there would be an increase over time in infants (1) receiving all basic vaccines and (2) vitamin A in the past 6 months. We also hypothesized (3) coverage would be higher in urban settings.
Methods
We used four nationally representative Demographic and Health Surveys (DHS) from Ethiopia between 2000 and 2016. The analysis comprised 11,621 infants 6–23 months old. Logistic regression models using a forward-stepwise approach were created to test these 3 hypotheses, controlling for wealth, age, sex of infant, and mother's highest education level. Interaction terms were fitted between survey year and education level, setting and education level, and setting and wealth index quintile, and tested using the Wald test.
Results
(1) The percentage of infants having received all basic vaccines increased from 11.1% in 2000 to 31.0% in 2016; the odds of having received these vaccines increased over time also. (2) This is not true for vitamin A, where there was no pattern in the odds of having received vitamin A between survey years. (3) Rural infants were 40% less likely to have received all basic vaccines, compared to urban infants (adjusted odds ratio (AOR): 0.60; 95% CI: 0.43, 0.83), and there was no evidence of an association between setting and receiving vitamin A (AOR: 0.81; 95% CI: 0.61, 1.09). There was strong evidence for interaction between setting and mother's highest education level, setting and wealth index quintile, and survey year and education level (all P < 0.01).
Conclusions
These results suggest that (1) while there has been improvement in infants receiving basic vaccines, (2) progress may be slowing slightly in vitamin A coverage and (3)there is a need to improve coverage of basic vaccines for infants in rural areas. Strengthening of and improved access to health services should remain a priority to ensure proper distribution of vaccines and vitamin A in Ethiopia.
Funding Sources
N/A.
Supporting Tables, Images and/or Graphs
Lot quality survey: an appealing method for rapid evaluation of vaccine coverage in developing countries – experience in Turkey