Measles vaccination timeliness and associated factors among infants/children aged 9-24 months in the Bule Hora district, west Guji zone, Oromia, southern Ethiopia

Measles vaccination timeliness and associated factors among infants/children aged 9-24 months in the Bule Hora district, west Guji zone, Oromia, southern Ethiopia | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Measles vaccination timeliness and associated factors among infants/children aged 9-24 months in the Bule Hora district, west Guji zone, Oromia, southern Ethiopia Boko Loka Safayi, Abdisa Haro Guye This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7684029/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background Vaccine timeliness is the administration of vaccines within the specified schedule of immunization. There are more than 1 million deaths from vaccine-preventable diseases each year, accounting for 30% of deaths among those less than 5 years of age. A measles vaccine program achievement has been previously assessed mainly through the measurement of vaccine coverage, with less emphasis on the timing of vaccine administration. Therefore, this study aimed to assess the timeliness and associated factors for measles vaccination among children aged 9–24 months in the Bule Hora district, Oromia, southern Ethiopia. Methods An institution-based cross-sectional study was conducted in Bule Hora district from May 1–June 30, 2024. A systematic random sampling technique was used to select the study participants. Bivariable and multivariable logistic regressions were used to identify the associations between the dependent and independent variables. The associations were measured using odd ratios with 95% CIs, and a p value of ≤ 0.05 was used for final interpretation. Results A total of 361 mother‒child pairs participated in the study, making a response rate of 98.9%. The overall vaccination timeliness for MCV1 and MCV2 were 54% (95% CI: 49.1%, 59.4%) and 58% (95% CI: 48.3%, 67.3%), respectively. Compared with Protestants, Muslim mothers (AOR = 3.25; 95% CI: 1.45, 5.14) vaccinated their children timely. In contrast, mothers with a secondary educational level (AOR = 0.16; 95% CI: 0.62, 0.45), mothers who had no PNC visit (AOR = 0.40, 95% CI: 0.22, 0.86), and mothers who walked 30–60 minutes to vaccinate their child (AOR = 0.46, 95% CI: 0.33, 0.67) had a negative association with timely vaccination. Conclusion This study revealed that there was a significant delay in measles vaccination. Maternal educational status, religion, distance from health facilities, and postnatal visits were factors significantly associated with vaccination timeliness. Therefore, healthcare providers should focus on providing counseling mothers on the role of timely vaccination in disease prevention. Figures Figure 1 Figure 2 Introduction Immunization is a public health intervention that has been shown to reduce childhood illness and death worldwide. A vaccine not only protects immunized children but also protects populations at risk for vaccine preventable diseases (VPDs) through herd immunity ( 1 , 2 ). Measles Vaccine timeliness is the administration of vaccines within the specified schedule of immunizations( 3 ). The World Health Organization (WHO) recommends that measles vaccines be administered at 9 months (for measles containing vaccine 1 [MCV1]) and 15–18 months (for measles containing vaccine 2 [MCV2]) of age in countries with a high risk of measles mortality( 4 , 5 ). Timely administration of vaccines has great implications for a child’s health and helps children to be protected from VPD as early as possible by ensuring an optimal immune response to the vaccines( 5 , 6 ). Every year, there are more than 1 million deaths from VPD, accounting for 30% of deaths in children under 5 years of age( 7 ). Although immunization makes a much more significant contribution to saving the lives of children, nearly 20 million unvaccinated and under vaccinated children still exist in the world today, and 8.5 million live in the African Region ( 7 , 8 ). In many low- and middle-income countries, low-level measles vaccine coverage was observed in a timely manner. For example, in Bangladesh, 88% of children receive measles vaccines, and 36% are delayed in receiving measles vaccines ( 9 ). A study on childhood vaccination timeliness in Addis Ababa, Ethiopia, revealed that of the overall surveyed children, 82.3% received all recommended vaccines, but only 55.9% were vaccinated on time( 10 ). Although immunization programs were initiated long ago to reduce and even eradicate some VPDs, there is still a high burden of VPDs in different developing countries, such as Ethiopia ( 8 ). The Ethiopian government has been investing in immunization programs to ensure that all children receive vaccines to protect them from VPD. However, this program has not reached the expected coverage level recommended by the WHO, which is at least 95% with two doses of MCV. Consequently, the country is facing difficulties in controlling measles outbreaks in different parts of the country( 7 , 11 ). Vaccine program achievement has been previously assessed mainly through estimating vaccine coverage by measuring the proportion of individuals who have received a vaccine at a fixed or benchmark age( 12 ). However, high immunization coverage does not mean that children are immunized at the appropriate age and may not guarantee the effectiveness of immunization( 13 ). Additionally, there is limited research on the timely administration of measles vaccinations and the factors contributing to delays in measles vaccinations in the study area. Therefore, this study aimed to identify the timeliness of measles vaccination and the factors associated with delays among children aged 9–24 months in the Bule Hora district. Methods and Materials Study area and period The study was conducted in eight public health facilities in the Bule Hora district, which includes Bule Hora University Hospital and seven health centers: Bule Hora, Ropi Megada, Kilenso Mokonissa, Kilenso Rasa, Gerba, Chabit and Galessa Nagesso. The Bule Hora district is located in the West Guji Zone of Oromia in southern Ethiopia. The district’s main town, Bule Hora, is 467 km distant from Addis Ababa, the capital city of Ethiopia. The study was conducted from May 1 to June 30, 2024. All the participants’ recruitment, interviews and child immunization card reviews were conducted within the specified days. Study Design An institutional-based cross-sectional study design was employed with a quantitative data collection method. Study population and sample size determination All mothers with children aged 9–24 months who visited the EPI unit of selected governmental health facilities in the Bule Hora district during the data collection period were included in the study. Children with incomplete immunization records or those who were severely ill were excluded from the study. The sample size was calculated using a single population proportion formula on the basis of the following assumption: a 95% confidence level, 5% margin of error, and (P) = 31.5%, which represents the proportion of children who received their measles vaccination on time in Ethiopia ( 14 ). After adding a 10% nonresponse rate, the total sample size was 365. Sampling Procedure All governmental health facilities within the district were included in the study, and the total sample size was allocated proportionally to each health facility. To select the desired sample of mother‒infant pairs among attendees of all health facilities, we identified the average number of mothers who visited the EPI unit for immunization over the three months preceding the study from client registration records. On the basis of these data, we estimated the expected client flow rate during the study period (one month) to be 768. Then, we calculate the sampling interval (k) by dividing the expected number of children visiting the unit during the study period (N) by the determined sample size (n) of respondents (i.e., 768/365), which is approximately 2. Finally, via a systematic random sampling technique, one in every two mother‒child pairs was selected until the required sample was met (Fig. 1 . ) . Data collection tool, procedure and quality control Structured interviewer-administered questionnaires were used to collect data from mother–infant pairs (study subjects) and to review immunization cards. The questionnaire included information on sociodemographic factors, maternal obstetric and health service-related factors, and infant-related factors. Initially, the questionnaire was written in English. To ensure consistency, the questionnaire was translated to Afaan Oromo and then back-translated to English for verification. Eight diploma nurses and four Bachelor of Science (BSc) nurses were recruited as data collectors and supervisors, respectively. We provided orientation and training for two days to the data collectors and supervisors on how to conduct interviews and record the data effectively. To evaluate the clarity of the questions, the suitability of the wording, and the respondents’ reactions, a pretest was conducted with 5% of the participants before the actual study. The tool adjustments were made on the basis of the results of the pretest. During the data collection period, supervisors and investigators closely monitored and supervised the process to ensure the quality and completeness of the data. Operational definitions Timeliness of vaccination any or possible schedule at which the measles vaccines can be administered. It can be on time and delayed/late in this study. Timely vaccination is considered when a particular vaccine is received at a given time or at the recommended age. For MCV1 (270–298 days) and for MCV2 (450–478 days), ( 4 , 15 ) Delayed/late vaccination Vaccines were administered after the recommended age or due time per the above definition for timely vaccination. Data Processing and Analysis After verifying the completeness of the data, it was coded and entered into EPI Data version 4.6 before being exported to Stata version 14.0 for further analysis. Descriptive statistics, including frequencies, percentages, means, standard deviations, and medians, were used to describe sociodemographic characteristics, as well as maternal, infant, and healthcare service attributes. Binary logistic regression was employed to identify factors associated with the timelines of measles vaccination. For the bivariable analysis, crude odds ratios with 95% CIs were calculated to assess the associations between each independent variable and the outcome variable via a binary logistic regression model. Independent variables with a p value of < 0.25 were included in the multivariable analysis to control for all possible confounders. Multicollinearity among the independent variables was assessed via the standard error and variance inflation factor. The Hosmer–Lemeshow goodness-of-fit test with the backward stepwise method was used to test for model fitness. The adjusted odds ratio along with the 95% CI was used to measure the strength of the association between the dependent and independent variables. P values less than 0.05 were considered statistically significant, with a 95% confidence interval. Results Sociodemographic characteristics of the respondents A total of 361 mother‒child pairs participated in the study, resulting in a response rate of 98.9%. More than half of the respondents, 203 (56%), were from urban areas. The mean age of the infants and children was 12.2 months (SD = ± 3.8), with over half, 202 (55.9%), falling within the age group of 9–11 months. Regarding the marital status of the mothers, nearly all, 355 (98%), were married, and almost two-thirds, 272 (65.4%), were housewives. In terms of maternal level of education, about 114(31.6%) reported having no formal education, whereas only 86 (23.82%) had a diploma or above (see Table 1 ). Table 1 Sociodemographic characteristics of the respondents in the Bule Hora district, southern Ethiopia (n = 361). Variables Freq. Percent Residence of mothers Urban 203 56.23 Rural 158 43.77 Age of mother 15–24 119 32.96 25–35 231 63.99 > 35 11 3.05 1 Ethnicity of respondents Oromo 293 81.16 Amhara 41 11.36 Gurage 19 5.26 Others* 8 2.22 Religion of respondents Prothestant 237 65.65 Orthodox 74 20.50 Muslim 38 10.53 Othersª 12 3.32 Marital status of mothers Married 355 98.34 Others γ 6 1.66 Occupation of mothers house wife 236 65.37 gov't employee 53 14.68 self-employee 35 9.70 daily laborer 20 5.54 Others ♣ 17 4.71 Educational status of mothers no formal education 114 31.58 primary education 99 27.42 secondary education 62 17.17 diploma and above 86 23.82 Family size of respondents ≤ 5 236 65.37 < 5 125 34.63 * Gedeo, Tigre, Wolayta and Hadiya. ª Waaqefataa, Hawariyat. γ Single, widowed. ♣ NGO employee and student. Maternal obstetric and health service-related characteristics More than three-fourths of the mothers, 273 (75.6%), were multiparous, and the majority had attended antenatal care (ANC) visits during their last pregnancy. Approximately two-thirds of the mothers, 234 (64.82), delivered their last baby at a health facility. In addition, a majority of the respondents, 232 (64.3%), reported that they walked approximately less than 15 minutes to a healthcare facility to vaccinate their child (see Table 2 ). Table 2 Maternal obstetrics and services-related characteristics of the respondents in Bule Hora district, southern Ethiopia (n = 361). Variables Freq. Percent Parity Primipara 88 24.38 Multipara 273 75.62 ANC follow-up Yes 324 89.75 No 37 10.25 History of abortion Yes 20 5.54 No 341 94.46 No of TT vaccination during last pregnancy ≤ 3 239 81.29 > 3 55 18.71 Place of delivery Health facility 234 64.82 Home 127 35.18 Nearby health facility Health center 116 32.13 Hospital 118 32.69 Health post 127 35.18 Distance from health Facility Less than 15 minute 232 64.27 15–30 minute 64 17.73 31–60 minute 40 11.08 >1 hour 25 6.93 Type of transportation on foot 256 70.91 Taxi 71 19.67 public bus 34 9.42 Presence of PNC visit Yes 28 7.76 No 333 92.24 Number of PNC visit one times 4 14.29 two times 16 57.14 > two times 8 28.57 Child-related characteristics Among the 361 children, 50.2% were male and 49.8% were female, with more than half, 202 (56%), aged between 9 and 11 months. Approximately 50% (24.10%) of the children were first-born, and 50% were second-born (Table 3 ). Table 3 Child-related characteristics of the respondents in the Bule Hora, southern Ethiopia (n = 361). Variables Freq. Percent Sex of the children Male 181 50.2 Female 180 49.8 Age of the infant/child in months 9–11 months 202 55.96 12–15 months 47 13.02 15–17 months 72 19.94 ≥ 18 months 40 11.08 Birth order of your infant/child First 87 24.10 Second 87 24.10. Third 60 16.62 Fourth and above 127 35.18 Measles vaccination timeliness status All 361 children received the MCV1 vaccine; however, only 105 children were vaccinated with MCV2. The overall vaccination timeliness for MCV1 and MCV2 in the study area were 54% (95% CI: 49.1%, 59.4%) and 58% (95% CI: 48.3%, 67.3%), respectively (Fig. 2 ). ). Factors associated with measles vaccination timeliness Maternal educational status, religion, distance from health facilities, and PNC visits were associated with the timeliness of measles vaccination according to both binary and multivariate logistic regression analyses. The odds of timely vaccination for MVC1 were 3.3 times (AOR = 3.3; 95% CI: 1.22, 6.08) greater for Muslims and 3.25 times (AOR = 3.25; 95% CI: 1.45, 5.14) greater for followers of other religions than for protestant followers. Mothers with a secondary education level had an 84% (AOR = 0.16; 95% CI: 0.62, 0.45) lower likelihood of timely measles vaccination than mothers with a diploma or higher educational level. Additionally, the odds of timely MCV1 vaccination were 0.40 times lower (AOR = 0.40, 95% CI: 0.22, 0.86) for mothers who did not attend a PNC visit than for those who did. Moreover, mothers who walked 30–60 minutes to get their child vaccinated were 2.2 times (AOR = 0.46, 95% CI: 0.33, 0.67) less likely to vaccinate their children on time than those who walked less than 15 minutes (see Table 4 ). Table 4 Measles vaccination timeliness among children in the Bule Hora district, southern Ethiopia (n = 361). Variables Timeliness of measles vaccination: COR (95% CI) AOR (95% CI) Timely N (%) Delay N (%) Religion Protestant 114(48.10) 123(51.9) 1.0 1.0 Orthodox 47(63.5) 27(36.5) 1.87(1.09,3.21) 1.56(0.78,3.23) Muslim 24(63.2) 14(36.8) 1.84(0.91,3.74) 3.3(1.22,6.08)* Others 7(63.6) 4(36.4) 2.86(1.15,6.39) 3.25(1.45,5.14)* occupation of mothers house wife 117(49.6) 119(50.4) 0.43(0.23,0.80) 0.78(0.25,2.43) gov't employee 37(69.8) 16(30.2) 1.0 1.0 Self-employee 17(48.6) 18(51.4) 0.40(0.17,0.98)* 0.60(0.17,2.04) daily laborer 13(65.0) 7(35) 0.80(0.27,2.38) 2.23(0.47,10.44) Others 12(70.6) 5(29.4) 1.03(0.31,3.43) 1.56(0.33,7.48) Educational status of mothers no formal education 52(45.6) 62(54.4) 0.28(0.15,0.52)** 0.40(0.13,0.122) Primary education 53(53.5) 46(46.5) 0.39(0.21,0.73)* 0.58(0.21,1.62) Secondary education 27(43.5) 35(56.5) 0.25(0.13,0.53) ** 0.16(0.62,0.45)** diploma & above 64(74.4) 22(25.6) 1.0 1.0 ANC follow-up Yes 184(56.8) 140(43.2) 1.0 1.0 No 12(32.4) 25(67.6) 0.36(0.17,0.75)* 6.1(0.54,6.80) TT vaccination ≤ 3 134(56) 105(44) 0.39(0.24,0.64)* 0.55(0.26,1.13) > 3 41(74.5) 14(25.5) 1.0 1.0 Nearby health facility Hospital 71(60.2) 47(3.8) 1.0 1.0 Health center 71(61.2) 45(38.8) 1.04(0.61,1.76) 1.13(0.58,2.1) Health post 54(42.5) 73(57.5) 0.48(0.29,0.81) * 0.91(0.34,2.44) Distance from health facility 1 hour 9(36) 16(64) 0.44(0.19,1.05) 1.13(0.28,4.5) PNC visit Yes 17(60.7) 11(39.3) 1.0 1.0 No 185(55.6) 148(44.4) 0.80(0.17,0.98) 0.40(0.22,0.86)* * significant variables (p value < 0.05), * * p value < 0.001 Discussion In this study, we aimed to examine the proportion of timely measles vaccinations and the factors associated with timeliness among infants and children visiting public health facilities in the Bule Hora district. Our findings could help mothers vaccinate their child at appropriate times, thereby significantly enhancing the overall health of their children. The findings of this study revealed that the overall timeliness of measles vaccination for MCV1 in the study area was above fifty percent: 54% (95% CI: 49.1%, 59.4%). This finding aligns with a study conducted in India, which reported a rate of 49.9%( 16 ). A possible explanation for this similarity may be the similarity in the study design; a cross-sectional study design was used in both studies. The proportion of timely vaccinations for MCV1 in this study is much lower than the findings of studies conducted in China (76.6%), Senegal (94.5%), western Gambia (80.8%), and Bangladesh (64%)( 17 – 19 ). The differences might be explained by variations in sample sizes; all of the studies mentioned involved large sample sizes. However, these findings are greater than those of studies conducted in Pondicherry, India (19%) and Central Ethiopia (44.1%)( 20 ). These variations might be due to differences in the study methods and sources of data. In the study conducted in Pondicherry, the investigators used retrospective studies and secondary sources of data. Timely administration of the MCV was significantly associated with several factors: the educational status of mothers, their religion, the distance to health facilities, and PNC visits. Our findings revealed an association between religion and measles vaccination timeliness; however, contrary to studies in India, we found that Muslim mothers were more likely to vaccinate their infants on time than were Protestant mothers ( 19 ), ( 21 ). This study revealed that mothers with higher educational levels vaccinate their children in a timely manner. For example, mothers with secondary education levels (AOR = 0.16; 95% CI: 0.62, 0.45) experienced delays in vaccination compared with those with diplomas and above. These findings are also supported by previous studies conducted in Senegal and India ( 18 , 21 ). This may be attributed to the fact that mothers with higher educational levels tend to have a better understanding of the importance of vaccination. In this study, mothers who attended postnatal visits vaccinated their children on time, which aligns with findings from previous studies in Gondar town and the Sidama region, Ethiopia( 22 , 23 ). One possible reason for this trend is that mothers who receive postnatal care often anticipate receiving counseling about vaccination during their visits. Strengths and limitations of the study Although this study utilized primary data sources along with immunization card records, it has certain limitations. Since this was a facility-based study, children who were not registered for immunization at those health facilities were not part of the study. Conclusion This study revealed that overall measles vaccination timeliness remains low. Several factors significantly influence the timeliness of measles vaccination, including the mother’s educational status, religion, distance from the health facility, and maternal obstetrics factors, such as post-natal care follow-up. Therefore, healthcare providers should emphasize these individual and organizational factors when interacting with mothers during pregnancy or after delivery. It is also essential for care providers to offer health education on the negative consequences of untimely vaccination on children’s overall well-being to mothers. Moreover, they should explain the benefits of timely vaccinations for children’s health and their role in disease prevention to mothers. Abbreviations ANC Antenatal Care BCG Bacillus Calmette-Guérin Vaccine DTP Diphtheria Tetanus Pertussis EMDHS Ethiopian Mini Demographic Health Survey GVAP Global Vaccine Action Plan LMIC Low and Middle Income Countries MCV Measles Contain Vaccine OPV0 Oral Polio Vaccine 0 PNC Post-Natal Care TT Tetanus Toxoid UNICEF United Nations International Children's Emergency Fund VPD Vaccine Preventable Diseases WHO World Health Organization Declarations Ethical approval and consent to participate The study was conducted in accordance with the ethical principles outlined in the Declaration of Helsinki. Ethical approval obtained from the Institutional Research Ethics Review Committee of the Institute of Health, on behalf of Bule Hora University, with ethical clearance reference number BHU/IOH/02/35. All methods followed were in accordance with the relevant guidelines and regulations of Bule Hora University’s Institutional Review Board. All Participants were informed about the purpose of the study, and informed consent to participate was obtained from the children’s mothers prior to the interviews. During the data collection, participants were also assured that they had the right to refuse or terminate their involvement at any point during the interview. The information provided by each respondent was kept confidential. Consent for publication Not applicable. Competing interest The authors declare that they have no competing interests in any aspect of the article. Funding No funding was received for this study. Author Contribution B.L : Conception of the research idea, study design, data collection, analysis and interpretation, and manuscript write-up; A.H : Conception of the research idea, follow data collection, analysis and interpretation. All authors have read and approved the final manuscript for submission. Acknowledgment We would like to express our heartfelt gratitude to Bule Hora University, Institute of Health, for providing us with the opportunity to conduct this research and contribute significantly to identifying the problem that hinders the timely vaccination of children. We also extend our appreciation to the Bule Hora zonal health department, the heads of health facilities, and the EPI unit coordinators and workers for their invaluable cooperation throughout this study. Additionally, we are especially thankful to our data collectors for their tireless support and to all the study participants who willingly participated in this research. Data Availability The datasets used and/or analyzed during the current study are available from the corresponding author upon reasonable request. References Andre F, Booy R, Bock H, Clemens J, Datta S, John T, et al. Vaccination greatly reduces disease, disability, death and inequity worldwide. Bull World Health Organ. 2008;86:140–6. 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Timely completion of vaccination and its determinants among children in northwest, Ethiopia: a multilevel analysis. BMC Public Health. 2020;20:1–13. Negash BT, Tediso Y, Yoseph A. Predictors of timeliness of vaccination among children of age 12–23 months in Boricha district, Sidama region Ethiopia, in 2019. BMC Pediatr. 2023;23(1):409. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-7684029","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":530206300,"identity":"e305275f-bfa1-45a3-99cf-07a3b1c2e205","order_by":0,"name":"Boko Loka 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02:19:34","extension":"xml","order_by":7,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":93900,"visible":true,"origin":"","legend":"","description":"","filename":"2fba56d4843c4265b12c074cb161fcc31structuring.xml","url":"https://assets-eu.researchsquare.com/files/rs-7684029/v1/6dd38cda2eed8ef59bd50fdd.xml"},{"id":93730232,"identity":"b8218482-2930-4150-b6f1-042c9ec78bb9","added_by":"auto","created_at":"2025-10-17 02:19:35","extension":"html","order_by":8,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":100273,"visible":true,"origin":"","legend":"","description":"","filename":"earlyproof.html","url":"https://assets-eu.researchsquare.com/files/rs-7684029/v1/d92ac4f4a69912f564ebebd7.html"},{"id":93732101,"identity":"cb90b785-931e-495e-bf09-4ac6c0b2ff56","added_by":"auto","created_at":"2025-10-17 02:27:34","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":569031,"visible":true,"origin":"","legend":"\u003cp\u003eSchematic representation of the sampling procedure for measles vaccination timeliness and associated factors among children aged 9--24 months in public health facilities of Bule Hora District, Oromia, southern Ethiopia, 2024.\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-7684029/v1/e260788402697b5dad251db1.png"},{"id":93732099,"identity":"e8f4d79f-a8c1-4a8e-8594-5c0e9e995f00","added_by":"auto","created_at":"2025-10-17 02:27:34","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":397972,"visible":true,"origin":"","legend":"\u003cp\u003eMeasles vaccination timeliness status for measles vaccination timeliness and associated factors among children aged 9--24 months in the Bule Hora district, West Guji Zone, Oromia, southern Ethiopia, 2024.\u003c/p\u003e","description":"","filename":"2.png","url":"https://assets-eu.researchsquare.com/files/rs-7684029/v1/ef4728c09dcd2c11d6e2811a.png"},{"id":94655599,"identity":"738794a0-d6e6-47e9-8003-ff9adaf07cba","added_by":"auto","created_at":"2025-10-29 10:38:41","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":2036280,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7684029/v1/cfac716f-38d5-48a1-964d-f44b1c6cb162.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Measles vaccination timeliness and associated factors among infants/children aged 9-24 months in the Bule Hora district, west Guji zone, Oromia, southern Ethiopia","fulltext":[{"header":"Introduction","content":"\u003cp\u003eImmunization is a public health intervention that has been shown to reduce childhood illness and death worldwide. A vaccine not only protects immunized children but also protects populations at risk for vaccine preventable diseases (VPDs) through herd immunity (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e). Measles Vaccine timeliness is the administration of vaccines within the specified schedule of immunizations(\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e). The World Health Organization (WHO) recommends that measles vaccines be administered at \u003csup\u003e9\u003c/sup\u003e months (for measles containing vaccine 1 [MCV1]) and 15\u0026ndash;18 months (for measles containing vaccine 2 [MCV2]) of age in countries with a high risk of measles mortality(\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e). Timely administration of vaccines has great implications for a child\u0026rsquo;s health and helps children to be protected from VPD as early as possible by ensuring an optimal immune response to the vaccines(\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eEvery year, there are more than 1\u0026nbsp;million deaths from VPD, accounting for 30% of deaths in children under 5 years of age(\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e). Although immunization makes a much more significant contribution to saving the lives of children, nearly 20\u0026nbsp;million unvaccinated and under vaccinated children still exist in the world today, and 8.5\u0026nbsp;million live in the African Region (\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e). In many low- and middle-income countries, low-level measles vaccine coverage was observed in a timely manner. For example, in Bangladesh, 88% of children receive measles vaccines, and 36% are delayed in receiving measles vaccines (\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e). A study on childhood vaccination timeliness in Addis Ababa, Ethiopia, revealed that of the overall surveyed children, 82.3% received all recommended vaccines, but only 55.9% were vaccinated on time(\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eAlthough immunization programs were initiated long ago to reduce and even eradicate some VPDs, there is still a high burden of VPDs in different developing countries, such as Ethiopia (\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e). The Ethiopian government has been investing in immunization programs to ensure that all children receive vaccines to protect them from VPD. However, this program has not reached the expected coverage level recommended by the WHO, which is at least 95% with two doses of MCV. Consequently, the country is facing difficulties in controlling measles outbreaks in different parts of the country(\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eVaccine program achievement has been previously assessed mainly through estimating vaccine coverage by measuring the proportion of individuals who have received a vaccine at a fixed or benchmark age(\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e). However, high immunization coverage does not mean that children are immunized at the appropriate age and may not guarantee the effectiveness of immunization(\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e). Additionally, there is limited research on the timely administration of measles vaccinations and the factors contributing to delays in measles vaccinations in the study area. Therefore, this study aimed to identify the timeliness of measles vaccination and the factors associated with delays among children aged 9\u0026ndash;24 months in the Bule Hora district.\u003c/p\u003e"},{"header":"Methods and Materials","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e\u003ch2\u003eStudy area and period\u003c/h2\u003e\u003cp\u003eThe study was conducted in eight public health facilities in the Bule Hora district, which includes Bule Hora University Hospital and seven health centers: Bule Hora, Ropi Megada, Kilenso Mokonissa, Kilenso Rasa, Gerba, Chabit and Galessa Nagesso. The Bule Hora district is located in the West Guji Zone of Oromia in southern Ethiopia. The district\u0026rsquo;s main town, Bule Hora, is 467 km distant from Addis Ababa, the capital city of Ethiopia. The study was conducted from May 1 to June 30, 2024. All the participants\u0026rsquo; recruitment, interviews and child immunization card reviews were conducted within the specified days.\u003c/p\u003e\u003c/div\u003e\n\u003ch3\u003eStudy Design\u003c/h3\u003e\n\u003cp\u003eAn institutional-based cross-sectional study design was employed with a quantitative data collection method.\u003c/p\u003e\n\u003ch3\u003eStudy population and sample size determination\u003c/h3\u003e\n\u003cp\u003eAll mothers with children aged 9\u0026ndash;24 months who visited the EPI unit of selected governmental health facilities in the Bule Hora district during the data collection period were included in the study. Children with incomplete immunization records or those who were severely ill were excluded from the study. The sample size was calculated using a single population proportion formula on the basis of the following assumption: a 95% confidence level, 5% margin of error, and (P)\u0026thinsp;=\u0026thinsp;31.5%, which represents the proportion of children who received their measles vaccination on time in Ethiopia (\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e). After adding a 10% nonresponse rate, the total sample size was 365.\u003c/p\u003e\n\u003ch3\u003eSampling Procedure\u003c/h3\u003e\n\u003cp\u003eAll governmental health facilities within the district were included in the study, and the total sample size was allocated proportionally to each health facility. To select the desired sample of mother‒infant pairs among attendees of all health facilities, we identified the average number of mothers who visited the EPI unit for immunization over the three months preceding the study from client registration records. On the basis of these data, we estimated the expected client flow rate during the study period (one month) to be 768. Then, we calculate the sampling interval (k) by dividing the expected number of children visiting the unit during the study period (N) by the determined sample size (n) of respondents (i.e., 768/365), which is approximately 2. Finally, via a systematic random sampling technique, one in every two mother‒child pairs was selected until the required sample was met (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e.\u003cb\u003e)\u003c/b\u003e.\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\n\u003ch3\u003eData collection tool, procedure and quality control\u003c/h3\u003e\n\u003cp\u003eStructured interviewer-administered questionnaires were used to collect data from mother\u0026ndash;infant pairs (study subjects) and to review immunization cards. The questionnaire included information on sociodemographic factors, maternal obstetric and health service-related factors, and infant-related factors. Initially, the questionnaire was written in English. To ensure consistency, the questionnaire was translated to Afaan Oromo and then back-translated to English for verification.\u003c/p\u003e\u003cp\u003eEight diploma nurses and four Bachelor of Science (BSc) nurses were recruited as data collectors and supervisors, respectively. We provided orientation and training for two days to the data collectors and supervisors on how to conduct interviews and record the data effectively. To evaluate the clarity of the questions, the suitability of the wording, and the respondents\u0026rsquo; reactions, a pretest was conducted with 5% of the participants before the actual study. The tool adjustments were made on the basis of the results of the pretest. During the data collection period, supervisors and investigators closely monitored and supervised the process to ensure the quality and completeness of the data.\u003c/p\u003e\u003cdiv id=\"Sec8\" class=\"Section2\"\u003e\u003ch2\u003eOperational definitions\u003c/h2\u003e\u003cp\u003e\u003cstrong\u003eTimeliness of vaccination\u003c/strong\u003e\u003cp\u003eany or possible schedule at which the measles vaccines can be administered. It can be on time and delayed/late in this study.\u003c/p\u003e\u003c/p\u003e\u003cp\u003e\u003cb\u003eTimely vaccination\u003c/b\u003e is considered when a particular vaccine is received at a given time or at the recommended age. For MCV1 (270\u0026ndash;298 days) and for MCV2 (450\u0026ndash;478 days), (\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e)\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eDelayed/late vaccination\u003c/strong\u003e\u003cp\u003eVaccines were administered after the recommended age or due time per the above definition for timely vaccination.\u003c/p\u003e\u003c/p\u003e\u003c/div\u003e\n\u003ch3\u003eData Processing and Analysis\u003c/h3\u003e\n\u003cp\u003eAfter verifying the completeness of the data, it was coded and entered into EPI Data version 4.6 before being exported to Stata version 14.0 for further analysis. Descriptive statistics, including frequencies, percentages, means, standard deviations, and medians, were used to describe sociodemographic characteristics, as well as maternal, infant, and healthcare service attributes. Binary logistic regression was employed to identify factors associated with the timelines of measles vaccination. For the bivariable analysis, crude odds ratios with 95% CIs were calculated to assess the associations between each independent variable and the outcome variable via a binary logistic regression model. Independent variables with a p value of \u0026lt;\u0026thinsp;0.25 were included in the multivariable analysis to control for all possible confounders. Multicollinearity among the independent variables was assessed via the standard error and variance inflation factor. The Hosmer\u0026ndash;Lemeshow goodness-of-fit test with the backward stepwise method was used to test for model fitness. The adjusted odds ratio along with the 95% CI was used to measure the strength of the association between the dependent and independent variables. P values less than 0.05 were considered statistically significant, with a 95% confidence interval.\u003c/p\u003e"},{"header":"Results","content":"\u003cdiv id=\"Sec11\" class=\"Section2\"\u003e\u003ch2\u003eSociodemographic characteristics of the respondents\u003c/h2\u003e\u003cp\u003eA total of 361 mother‒child pairs participated in the study, resulting in a response rate of 98.9%. More than half of the respondents, 203 (56%), were from urban areas. The mean age of the infants and children was 12.2 months (SD\u0026thinsp;=\u0026thinsp;\u0026plusmn;\u0026thinsp;3.8), with over half, 202 (55.9%), falling within the age group of 9\u0026ndash;11 months. Regarding the marital status of the mothers, nearly all, 355 (98%), were married, and almost two-thirds, 272 (65.4%), were housewives. In terms of maternal level of education, about 114(31.6%) reported having no formal education, whereas only 86 (23.82%) had a diploma or above (see Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eSociodemographic characteristics of the respondents in the Bule Hora district, southern Ethiopia (n\u0026thinsp;=\u0026thinsp;361).\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"3\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eVariables\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eFreq.\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003ePercent\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003ctr\u003e\u003cth align=\"left\" colspan=\"3\" nameend=\"c3\" namest=\"c1\"\u003e\u003cp\u003eResidence of mothers\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eUrban\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e203\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e56.23\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eRural\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e158\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e43.77\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"3\" nameend=\"c3\" namest=\"c1\"\u003e\u003cp\u003e\u003cb\u003eAge of mother\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e15\u0026ndash;24\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e119\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e32.96\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e25\u0026ndash;35\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e231\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e63.99\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u0026gt;\u0026thinsp;35\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e11\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e3.05 1\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"3\" nameend=\"c3\" namest=\"c1\"\u003e\u003cp\u003e\u003cb\u003eEthnicity of respondents\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eOromo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e293\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e81.16\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAmhara\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e41\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e11.36\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eGurage\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e19\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e5.26\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eOthers*\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e8\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e2.22\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"3\" nameend=\"c3\" namest=\"c1\"\u003e\u003cp\u003e\u003cb\u003eReligion of respondents\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eProthestant\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e237\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e65.65\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eOrthodox\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e74\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e20.50\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMuslim\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e38\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e10.53\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eOthers\u0026ordf;\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e12\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e3.32\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"3\" nameend=\"c3\" namest=\"c1\"\u003e\u003cp\u003e\u003cb\u003eMarital status of mothers\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMarried\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e355\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e98.34\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eOthers \u003csup\u003e\u003csub\u003eγ\u003c/sub\u003e\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e6\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1.66\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"3\" nameend=\"c3\" namest=\"c1\"\u003e\u003cp\u003e\u003cb\u003eOccupation of mothers\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ehouse wife\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e236\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e65.37\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003egov't employee\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e53\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e14.68\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eself-employee\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e35\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e9.70\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003edaily laborer\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e20\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e5.54\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eOthers\u003csup\u003e\u0026clubs;\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e17\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e4.71\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"3\" nameend=\"c3\" namest=\"c1\"\u003e\u003cp\u003e\u003cb\u003eEducational status of mothers\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eno formal education\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e114\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e31.58\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eprimary education\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e99\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e27.42\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003esecondary education\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e62\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e17.17\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ediploma and above\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e86\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e23.82\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"3\" nameend=\"c3\" namest=\"c1\"\u003e\u003cp\u003e\u003cb\u003eFamily size of respondents\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u0026le;\u0026thinsp;5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e236\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e65.37\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e125\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e34.63\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003e\u003csup\u003e\u003cem\u003e*\u003c/em\u003e\u003c/sup\u003e\u003cem\u003eGedeo, Tigre, Wolayta and Hadiya. \u0026ordf; Waaqefataa, Hawariyat.\u003c/em\u003e \u003csup\u003e\u003cb\u003e\u003csub\u003eγ\u003c/sub\u003e\u003c/b\u003e\u003c/sup\u003e \u003cem\u003eSingle, widowed.\u003c/em\u003e \u003csup\u003e\u003cem\u003e\u0026clubs;\u003c/em\u003e\u003c/sup\u003e\u003cem\u003eNGO employee and student.\u003c/em\u003e\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec12\" class=\"Section2\"\u003e\u003ch2\u003eMaternal obstetric and health service-related characteristics\u003c/h2\u003e\u003cp\u003eMore than three-fourths of the mothers, 273 (75.6%), were multiparous, and the majority had attended antenatal care (ANC) visits during their last pregnancy. Approximately two-thirds of the mothers, 234 (64.82), delivered their last baby at a health facility. In addition, a majority of the respondents, 232 (64.3%), reported that they walked approximately less than 15 minutes to a healthcare facility to vaccinate their child (see Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eMaternal obstetrics and services-related characteristics of the respondents in Bule Hora district, southern Ethiopia (n\u0026thinsp;=\u0026thinsp;361).\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"3\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eVariables\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eFreq.\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003ePercent\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003ctr\u003e\u003cth align=\"left\" colspan=\"3\" nameend=\"c3\" namest=\"c1\"\u003e\u003cp\u003eParity\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003ePrimipara\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e88\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e24.38\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMultipara\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e273\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e75.62\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"3\" nameend=\"c3\" namest=\"c1\"\u003e\u003cp\u003e\u003cb\u003eANC follow-up\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e324\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e89.75\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e37\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e10.25\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"3\" nameend=\"c3\" namest=\"c1\"\u003e\u003cp\u003e\u003cb\u003eHistory of abortion\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e20\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e5.54\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e341\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e94.46\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"3\" nameend=\"c3\" namest=\"c1\"\u003e\u003cp\u003e\u003cb\u003eNo of TT vaccination during last pregnancy\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u0026le;\u0026thinsp;3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e239\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e81.29\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u0026gt;\u0026thinsp;3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e55\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e18.71\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"3\" nameend=\"c3\" namest=\"c1\"\u003e\u003cp\u003e\u003cb\u003ePlace of delivery\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eHealth facility\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e234\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e64.82\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eHome\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e127\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e35.18\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"3\" nameend=\"c3\" namest=\"c1\"\u003e\u003cp\u003e\u003cb\u003eNearby health facility\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eHealth center\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e116\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e32.13\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eHospital\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e118\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e32.69\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eHealth post\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e127\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e35.18\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"3\" nameend=\"c3\" namest=\"c1\"\u003e\u003cp\u003e\u003cb\u003eDistance from health Facility\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eLess than 15 minute\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e232\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e64.27\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e15\u0026ndash;30 minute\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e64\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e17.73\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e31\u0026ndash;60 minute\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e40\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e11.08\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u0026gt;1 hour\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e25\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e6.93\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"3\" nameend=\"c3\" namest=\"c1\"\u003e\u003cp\u003e\u003cb\u003eType of transportation\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eon foot\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e256\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e70.91\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eTaxi\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e71\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e19.67\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003epublic bus\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e34\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e9.42\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"3\" nameend=\"c3\" namest=\"c1\"\u003e\u003cp\u003e\u003cb\u003ePresence of PNC visit\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e28\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e7.76\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e333\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e92.24\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"3\" nameend=\"c3\" namest=\"c1\"\u003e\u003cp\u003e\u003cb\u003eNumber of PNC visit\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eone times\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e14.29\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003etwo times\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e16\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e57.14\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u0026gt; two times\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e8\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e28.57\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec13\" class=\"Section2\"\u003e\u003ch2\u003eChild-related characteristics\u003c/h2\u003e\u003cp\u003eAmong the 361 children, 50.2% were male and 49.8% were female, with more than half, 202 (56%), aged between 9 and 11 months. Approximately 50% (24.10%) of the children were first-born, and 50% were second-born (Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e).\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eChild-related characteristics of the respondents in the Bule Hora, southern Ethiopia (n\u0026thinsp;=\u0026thinsp;361).\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"3\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eVariables\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eFreq.\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003ePercent\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003ctr\u003e\u003cth align=\"left\" colspan=\"3\" nameend=\"c3\" namest=\"c1\"\u003e\u003cp\u003eSex of the children\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e181\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e50.2\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eFemale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e180\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e49.8\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"3\" nameend=\"c3\" namest=\"c1\"\u003e\u003cp\u003e\u003cb\u003eAge of the infant/child in months\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e9\u0026ndash;11 months\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e202\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e55.96\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e12\u0026ndash;15 months\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e47\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e13.02\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e15\u0026ndash;17 months\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e72\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e19.94\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u0026ge;\u0026thinsp;18 months\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e40\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e11.08\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"3\" nameend=\"c3\" namest=\"c1\"\u003e\u003cp\u003e\u003cb\u003eBirth order of your infant/child\u003c/b\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eFirst\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e87\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e24.10\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eSecond\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e87\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e24.10.\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eThird\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e60\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e16.62\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eFourth and above\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e127\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e35.18\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec14\" class=\"Section2\"\u003e\u003ch2\u003eMeasles vaccination timeliness status\u003c/h2\u003e\u003cp\u003eAll 361 children received the MCV1 vaccine; however, only 105 children were vaccinated with MCV2. The overall vaccination timeliness for MCV1 and MCV2 in the study area were 54% (95% CI: 49.1%, 59.4%) and 58% (95% CI: 48.3%, 67.3%), respectively (Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e). ).\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec15\" class=\"Section2\"\u003e\u003ch2\u003eFactors associated with measles vaccination timeliness\u003c/h2\u003e\u003cp\u003eMaternal educational status, religion, distance from health facilities, and PNC visits were associated with the timeliness of measles vaccination according to both binary and multivariate logistic regression analyses.\u003c/p\u003e\u003cp\u003eThe odds of timely vaccination for MVC1 were 3.3 times (AOR\u0026thinsp;=\u0026thinsp;3.3; 95% CI: 1.22, 6.08) greater for Muslims and 3.25 times (AOR\u0026thinsp;=\u0026thinsp;3.25; 95% CI: 1.45, 5.14) greater for followers of other religions than for protestant followers. Mothers with a secondary education level had an 84% (AOR\u0026thinsp;=\u0026thinsp;0.16; 95% CI: 0.62, 0.45) lower likelihood of timely measles vaccination than mothers with a diploma or higher educational level. Additionally, the odds of timely MCV1 vaccination were 0.40 times lower (AOR\u0026thinsp;=\u0026thinsp;0.40, 95% CI: 0.22, 0.86) for mothers who did not attend a PNC visit than for those who did. Moreover, mothers who walked 30\u0026ndash;60 minutes to get their child vaccinated were 2.2 times (AOR\u0026thinsp;=\u0026thinsp;0.46, 95% CI: 0.33, 0.67) less likely to vaccinate their children on time than those who walked less than 15 minutes (see Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e).\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eMeasles vaccination timeliness among children in the Bule Hora district, southern Ethiopia (n\u0026thinsp;=\u0026thinsp;361).\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"6\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colspan=\"2\" morerows=\"1\" nameend=\"c2\" namest=\"c1\" rowspan=\"2\"\u003e\u003cp\u003eVariables\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colspan=\"2\" nameend=\"c4\" namest=\"c3\"\u003e\u003cp\u003eTimeliness of measles vaccination:\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eCOR (95% CI)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c6\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eAOR (95% CI)\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eTimely N (%)\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eDelay N (%)\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"3\" rowspan=\"4\"\u003e\u003cp\u003eReligion\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eProtestant\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e114(48.10)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e123(51.9)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e1.0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e1.0\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eOrthodox\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e47(63.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e27(36.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e1.87(1.09,3.21)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e1.56(0.78,3.23)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eMuslim\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e24(63.2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e14(36.8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e1.84(0.91,3.74)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e3.3(1.22,6.08)*\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eOthers\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e7(63.6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e4(36.4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e2.86(1.15,6.39)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e3.25(1.45,5.14)*\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"4\" rowspan=\"5\"\u003e\u003cp\u003eoccupation of mothers\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003ehouse wife\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e117(49.6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e119(50.4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.43(0.23,0.80)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e0.78(0.25,2.43)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003egov't employee\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e37(69.8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e16(30.2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e1.0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e1.0\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eSelf-employee\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e17(48.6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e18(51.4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.40(0.17,0.98)*\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e0.60(0.17,2.04)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003edaily laborer\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e13(65.0)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e7(35)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.80(0.27,2.38)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e2.23(0.47,10.44)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eOthers\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e12(70.6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e5(29.4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e1.03(0.31,3.43)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e1.56(0.33,7.48)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"3\" rowspan=\"4\"\u003e\u003cp\u003eEducational status of mothers\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eno formal education\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e52(45.6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e62(54.4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.28(0.15,0.52)**\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e0.40(0.13,0.122)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003ePrimary education\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e53(53.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e46(46.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.39(0.21,0.73)*\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e0.58(0.21,1.62)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eSecondary education\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e27(43.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e35(56.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.25(0.13,0.53)\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e0.16(0.62,0.45)**\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003ediploma \u0026amp; above\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e64(74.4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e22(25.6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e1.0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e1.0\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eANC follow-up\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e184(56.8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e140(43.2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e1.0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e1.0\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e12(32.4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e25(67.6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.36(0.17,0.75)*\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e6.1(0.54,6.80)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003eTT vaccination\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u0026le;\u0026thinsp;3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e134(56)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e105(44)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.39(0.24,0.64)*\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e0.55(0.26,1.13)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u0026gt;\u0026thinsp;3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e41(74.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e14(25.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e1.0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e1.0\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003eNearby health facility\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eHospital\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e71(60.2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e47(3.8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e1.0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e1.0\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eHealth center\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e71(61.2)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e45(38.8)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e1.04(0.61,1.76)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e1.13(0.58,2.1)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eHealth post\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e54(42.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e73(57.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.48(0.29,0.81)\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e0.91(0.34,2.44)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e\u003cp\u003eDistance from health facility\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;15 minute\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e129(55.6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e103(44.4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e1.0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e1.0\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e15\u0026ndash;30 minute\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e35(54.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e29(45.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.96(0.55,1.68)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e0.94(0.48,1.85)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e31\u0026ndash;60 minute\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e17(57.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e23(42.5)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e.032(0.54,0.78)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e0.46(0.33,0.67)\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003e\u0026gt;\u0026thinsp;1 hour\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e9(36)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e16(64)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.44(0.19,1.05)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e1.13(0.28,4.5)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u003cp\u003ePNC visit\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eYes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e17(60.7)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e11(39.3)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e1.0\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e1.0\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNo\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e185(55.6)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e148(44.4)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.80(0.17,0.98)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e0.40(0.22,0.86)*\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003ctfoot\u003e\u003ctr\u003e\u003ctd colspan=\"6\"\u003e\u003csup\u003e\u003cb\u003e*\u003c/b\u003e\u003c/sup\u003esignificant variables (p value\u0026thinsp;\u0026lt;\u0026thinsp;0.05), *\u003csup\u003e*\u003c/sup\u003e p value\u0026thinsp;\u0026lt;\u0026thinsp;0.001\u003c/td\u003e\u003c/tr\u003e\u003c/tfoot\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eIn this study, we aimed to examine the proportion of timely measles vaccinations and the factors associated with timeliness among infants and children visiting public health facilities in the Bule Hora district. Our findings could help mothers vaccinate their child at appropriate times, thereby significantly enhancing the overall health of their children.\u003c/p\u003e\u003cp\u003eThe findings of this study revealed that the overall timeliness of measles vaccination for MCV1 in the study area was above fifty percent: 54% (95% CI: 49.1%, 59.4%). This finding aligns with a study conducted in India, which reported a rate of 49.9%(\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e). A possible explanation for this similarity may be the similarity in the study design; a cross-sectional study design was used in both studies.\u003c/p\u003e\u003cp\u003eThe proportion of timely vaccinations for MCV1 in this study is much lower than the findings of studies conducted in China (76.6%), Senegal (94.5%), western Gambia (80.8%), and Bangladesh (64%)(\u003cspan additionalcitationids=\"CR18\" citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e). The differences might be explained by variations in sample sizes; all of the studies mentioned involved large sample sizes. However, these findings are greater than those of studies conducted in Pondicherry, India (19%) and Central Ethiopia (44.1%)(\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e). These variations might be due to differences in the study methods and sources of data. In the study conducted in Pondicherry, the investigators used retrospective studies and secondary sources of data.\u003c/p\u003e\u003cp\u003eTimely administration of the MCV was significantly associated with several factors: the educational status of mothers, their religion, the distance to health facilities, and PNC visits. Our findings revealed an association between religion and measles vaccination timeliness; however, contrary to studies in India, we found that Muslim mothers were more likely to vaccinate their infants on time than were Protestant mothers (\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e), (\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e). This study revealed that mothers with higher educational levels vaccinate their children in a timely manner. For example, mothers with secondary education levels (AOR\u0026thinsp;=\u0026thinsp;0.16; 95% CI: 0.62, 0.45) experienced delays in vaccination compared with those with diplomas and above. These findings are also supported by previous studies conducted in Senegal and India (\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e, \u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e). This may be attributed to the fact that mothers with higher educational levels tend to have a better understanding of the importance of vaccination.\u003c/p\u003e\u003cp\u003eIn this study, mothers who attended postnatal visits vaccinated their children on time, which aligns with findings from previous studies in Gondar town and the Sidama region, Ethiopia(\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e, \u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e). One possible reason for this trend is that mothers who receive postnatal care often anticipate receiving counseling about vaccination during their visits.\u003c/p\u003e\u003cdiv id=\"Sec17\" class=\"Section2\"\u003e\u003ch2\u003eStrengths and limitations of the study\u003c/h2\u003e\u003cp\u003eAlthough this study utilized primary data sources along with immunization card records, it has certain limitations. Since this was a facility-based study, children who were not registered for immunization at those health facilities were not part of the study.\u003c/p\u003e\u003c/div\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThis study revealed that overall measles vaccination timeliness remains low. Several factors significantly influence the timeliness of measles vaccination, including the mother\u0026rsquo;s educational status, religion, distance from the health facility, and maternal obstetrics factors, such as post-natal care follow-up. Therefore, healthcare providers should emphasize these individual and organizational factors when interacting with mothers during pregnancy or after delivery. It is also essential for care providers to offer health education on the negative consequences of untimely vaccination on children\u0026rsquo;s overall well-being to mothers. Moreover, they should explain the benefits of timely vaccinations for children\u0026rsquo;s health and their role in disease prevention to mothers.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cdiv class=\"DefinitionList\"\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eANC\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eAntenatal Care\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eBCG\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eBacillus Calmette-Gu\u0026eacute;rin Vaccine\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eDTP\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eDiphtheria\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eTetanus\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003ePertussis\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eEMDHS\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eEthiopian Mini Demographic Health Survey\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eGVAP\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eGlobal Vaccine Action Plan\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eLMIC\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eLow and Middle Income Countries\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eMCV\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eMeasles Contain Vaccine\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eOPV0\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eOral Polio Vaccine 0\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003ePNC\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003ePost-Natal Care\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eTT\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eTetanus Toxoid\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eUNICEF\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eUnited Nations International Children's Emergency Fund\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eVPD\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eVaccine Preventable Diseases\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003eWHO\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eWorld Health Organization\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003c/div\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthical approval and consent to participate\u003c/strong\u003e\u003cp\u003e The study was conducted in accordance with the ethical principles outlined in the Declaration of Helsinki. Ethical approval obtained from the Institutional Research Ethics Review Committee of the Institute of Health, on behalf of Bule Hora University, with ethical clearance reference number BHU/IOH/02/35. All methods followed were in accordance with the relevant guidelines and regulations of Bule Hora University\u0026rsquo;s Institutional Review Board. All Participants were informed about the purpose of the study, and informed consent to participate was obtained from the children\u0026rsquo;s mothers prior to the interviews. During the data collection, participants were also assured that they had the right to refuse or terminate their involvement at any point during the interview. The information provided by each respondent was kept confidential.\u003c/p\u003e\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003cp\u003eNot applicable.\u003c/p\u003e\u003c/p\u003e\u003cp\u003e\u003ch2\u003eCompeting interest\u003c/h2\u003e\u003cp\u003eThe authors declare that they have no competing interests in any aspect of the article.\u003c/p\u003e\u003c/p\u003e\u003ch2\u003eFunding\u003c/h2\u003e\u003cp\u003eNo funding was received for this study.\u003c/p\u003e\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003eB.L : Conception of the research idea, study design, data collection, analysis and interpretation, and manuscript write-up; A.H : Conception of the research idea, follow data collection, analysis and interpretation. All authors have read and approved the final manuscript for submission.\u003c/p\u003e\u003ch2\u003eAcknowledgment\u003c/h2\u003e\u003cp\u003eWe would like to express our heartfelt gratitude to Bule Hora University, Institute of Health, for providing us with the opportunity to conduct this research and contribute significantly to identifying the problem that hinders the timely vaccination of children.\u003c/p\u003e\u003cp\u003eWe also extend our appreciation to the Bule Hora zonal health department, the heads of health facilities, and the EPI unit coordinators and workers for their invaluable cooperation throughout this study.\u003c/p\u003e\u003cp\u003eAdditionally, we are especially thankful to our data collectors for their tireless support and to all the study participants who willingly participated in this research.\u003c/p\u003e\u003ch2\u003eData Availability\u003c/h2\u003e\u003cp\u003eThe datasets used and/or analyzed during the current study are available from the corresponding author upon reasonable request.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eAndre F, Booy R, Bock H, Clemens J, Datta S, John T, et al. Vaccination greatly reduces disease, disability, death and inequity worldwide. Bull World Health Organ. 2008;86:140\u0026ndash;6.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eCanou\u0026iuml; E, Launay O. History and principles of vaccination. Rev Mal Respir. 2019;36(1):74\u0026ndash;81.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eRocha HAL, Correia LL, Campos JS, Silva AC, Andrade FO, Silveira DI, et al. Factors associated with non-vaccination against measles in northeastern Brazil: Clues about causes of the 2015 outbreak. Vaccine. 2015;33(38):4969\u0026ndash;74.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eWHO recommendations for routine immunization - summary tables. 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Available at \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.who.int/immunization/monitoring_surveillance/burden/vpd/JRF_Supplementary_Questionnaire_Surveillance_18Mar.pdf?ua=1\u003c/span\u003e\u003cspan address=\"https://www.who.int/immunization/monitoring_surveillance/burden/vpd/JRF_Supplementary_Questionnaire_Surveillance_18Mar.pdf?ua=1\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e [LAST UPDATED MARCH 19, 2018].\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eMasters NB, Wagner AL, Boulton ML. Vaccination timeliness and delay in low- and middle-income countries: a systematic review of the literature, 2007\u0026ndash;2017. Hum Vaccines Immunotherapeutics. 2019;15(12):2790\u0026ndash;805.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eMcCarthy NL, Irving S, Donahue JG, Weintraub E, Gee J, Belongia E, et al. Vaccination coverage levels among children enrolled in the Vaccine Safety Datalink. Vaccine. 2013;31(49):5822\u0026ndash;6.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eBoulton ML, Carlson BF, Wagner AL, Porth JM, Gebremeskel B, Abeje Y. Vaccination timeliness among newborns and infants in Ethiopia. PLoS ONE. 2019;14(2):e0212408.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eWorld Health O. Measles vaccines: WHO position paper, April 2017 - Recommendations. Vaccine. 2019;37(2):219\u0026ndash;22.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eWagner AL, Shenton LM, Gillespie BW, Mathew JL, Boulton ML. Assessing the timeliness of vaccine administration in children under five years in India, 2013. Vaccine. 2019;37(4):558\u0026ndash;64.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eHu Y, Chen Y, Liang H, Wang Y. Routine vaccination coverage of children aged 1\u0026ndash;7 years in Zhejiang province, China. Hum Vaccines Immunotherapeutics. 2018;14(12):2876\u0026ndash;83.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eMbengue MAS, Mboup A, Ly ID, Faye A, Camara FBN, Thiam M et al. Vaccination coverage and immunization timeliness among children aged 12\u0026ndash;23 months in Senegal: a Kaplan-Meier and Cox regression analysis approach. Pan Afr Med J. 2017;27(Suppl 3).\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eMiyahara R, Jasseh M, Gomez P, Shimakawa Y, Greenwood B, Keita K, et al. Barriers to timely administration of birth dose vaccines in The Gambia, West Africa. Vaccine. 2016;34(29):3335\u0026ndash;41.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eDirirsa K, Makuria M, Mulu E, Deriba BS. Assessment of vaccination timeliness and associated factors among children in Toke Kutaye district, central Ethiopia: A Mixed study. PLoS ONE. 2022;17(1):e0262320.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eChoudhary TS, Reddy NS, Apte A, Sinha B, Roy S, Nair NP, et al. Delayed vaccination and its predictors among children under 2 years in India: insights from the national family health survey\u0026ndash;4. Vaccine. 2019;37(17):2331\u0026ndash;9.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eMekonnen ZA, Gelaye KA, Were MC, Tilahun B. Timely completion of vaccination and its determinants among children in northwest, Ethiopia: a multilevel analysis. BMC Public Health. 2020;20:1\u0026ndash;13.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eNegash BT, Tediso Y, Yoseph A. Predictors of timeliness of vaccination among children of age 12\u0026ndash;23 months in Boricha district, Sidama region Ethiopia, in 2019. BMC Pediatr. 2023;23(1):409.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"","lastPublishedDoi":"10.21203/rs.3.rs-7684029/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7684029/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e\u003cp\u003eVaccine timeliness is the administration of vaccines within the specified schedule of immunization. There are more than 1\u0026nbsp;million deaths from vaccine-preventable diseases each year, accounting for 30% of deaths among those less than 5 years of age. A measles vaccine program achievement has been previously assessed mainly through the measurement of vaccine coverage, with less emphasis on the timing of vaccine administration. Therefore, this study aimed to assess the timeliness and associated factors for measles vaccination among children aged 9\u0026ndash;24 months in the Bule Hora district, Oromia, southern Ethiopia.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e\u003cp\u003eAn institution-based cross-sectional study was conducted in Bule Hora district from May 1\u0026ndash;June 30, 2024. A systematic random sampling technique was used to select the study participants. Bivariable and multivariable logistic regressions were used to identify the associations between the dependent and independent variables. The associations were measured using odd ratios with 95% CIs, and a p value of \u0026le;\u0026thinsp;0.05 was used for final interpretation.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e\u003cp\u003eA total of 361 mother‒child pairs participated in the study, making a response rate of 98.9%. The overall vaccination timeliness for MCV1 and MCV2 were 54% (95% CI: 49.1%, 59.4%) and 58% (95% CI: 48.3%, 67.3%), respectively. Compared with Protestants, Muslim mothers (AOR\u0026thinsp;=\u0026thinsp;3.25; 95% CI: 1.45, 5.14) vaccinated their children timely. In contrast, mothers with a secondary educational level (AOR\u0026thinsp;=\u0026thinsp;0.16; 95% CI: 0.62, 0.45), mothers who had no PNC visit (AOR\u0026thinsp;=\u0026thinsp;0.40, 95% CI: 0.22, 0.86), and mothers who walked 30\u0026ndash;60 minutes to vaccinate their child (AOR\u0026thinsp;=\u0026thinsp;0.46, 95% CI: 0.33, 0.67) had a negative association with timely vaccination.\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e\u003cp\u003eThis study revealed that there was a significant delay in measles vaccination. Maternal educational status, religion, distance from health facilities, and postnatal visits were factors significantly associated with vaccination timeliness. Therefore, healthcare providers should focus on providing counseling mothers on the role of timely vaccination in disease prevention.\u003c/p\u003e","manuscriptTitle":"Measles vaccination timeliness and associated factors among infants/children aged 9-24 months in the Bule Hora district, west Guji zone, Oromia, southern Ethiopia","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-10-17 02:19:30","doi":"10.21203/rs.3.rs-7684029/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"2c2a98a2-caba-41b9-ae43-e46c5a56e52a","owner":[],"postedDate":"October 17th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2025-10-29T10:38:17+00:00","versionOfRecord":[],"versionCreatedAt":"2025-10-17 02:19:30","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-7684029","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7684029","identity":"rs-7684029","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}