The context of urban immunization services: The case of Sodo town, Wolaita Zone, South Ethiopia

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Urban areas generally have better healthcare resources and higher immunization coverage compared to rural one. However, the challenge of zero doses and under-immunization exist in urban. These variation within urban communities exist due to factors such as population mobility, socio-economic and demographic disparities, and vaccine hesitancy. Therefore, this study tried to assess factors that enhance or affect the delivery of immunization services in Wolaita Sodo town. Methods A community-based cross-sectional study design was conducted among 411 children aged 0–35 months. Participants were selected using simple random sampling method through a multi-stage approach. Data were collected using a structured questionnaire using ODK (Open Data Kit) mobile app. The collected data were analyzed using the Statistical Package for the Social Sciences software version 25 (SPSS). Bivariate and multivariable logistic regression analysis was performed. Results Fully vaccinated and vaccinated for their age as per the national schedule were 56.7% and 29.4%, respectively. And, 7.8% experienced vaccination dropouts and 6.1% of children were never vaccinated. Significant associations were found between the completion of child immunization schedules and factors such as Antenatal Care follow-up AOR = 0.082 with 95% CI (0.009–0.777), facility delivery AOR = 0.18 with 95% CI (0.046–0.703), Community Health Insurance enrollemen OR = 34 with 95% CI (0.125–0.923), and health service access AOR = 0.11 with 95 CI (0.04–0.32). Conclusion Children aged 0–35 months who properly attended their immunization schedule fell below the required optimum level of 95%. Efforts should be made to strengthen vaccination delivery points, promote ANC follow-up and facility deliveries, and enhance the enrollment of the CBHI scheme to improve immunization services in Sodo town. Infectious Diseases Urbanization Immunization service Zero doses Dropout Figures Figure 1 Figure 2 Introduction The global trend of urbanization persists, encompassing approximately 55% of the world's population ( 1 ). Projections suggest a further increase to 68% by 2050, with a substantial 90% surge expected in Asian and African countries ( 2 , 3 ). Urbanization contributes positively to economic growth, poverty reduction, and human development ( 4 , 5 ). Recognizing and addressing obstacles, along with implementing effective strategies to enhance equity in urban settings, are crucial for achieving the targets outlined in the Sustainable Development Goals and Immunization Agenda 2030 ( 6 ). Notably, significant disparities in immunization coverage exist within urban areas, with lower coverage observed among the urban poor in numerous countries ( 7 ). This situation also elevates the risk of vaccine-preventable diseases (VPDs) due to the concentration of people in urban slums and existing disparities in health services between urban populations ( 4 , 5 ). Vaccination plays a crucial role in preventing childhood illnesses and has demonstrated effectiveness in protecting children against vaccine-preventable diseases ( 9 , 10 , 11 ). Initially, vaccination coverage in urban areas seemed higher, but there is now a reversal as urbanization progresses ( 8 ). This shift has resulted in notable disparities in vaccination services between urban and rural populations, with coverage in urban slum areas now comparable to that in remote rural communities ( 4 , 5 ). Globally, around 30% of children who have not received essential vaccines reside in urban areas ( 6 ). A significant number of children in Africa remain unvaccinated or under-vaccinated, often due to limited access to effective interventions ( 12 ). It is essential to comprehend vaccine coverage and the barriers in urban slum areas ( 5 ). Despite the global impact of immunization, saving millions of lives each year, vaccine-preventable diseases still contribute to over 2 million deaths among children under five annually, with sub-Saharan Africa being the most affected region ( 13 ). Inadequate health service delivery, geographical challenges, and conflicts hinder efforts to meet targeted immunization services ( 14 ). Communicable diseases contribute to 60–80% of health problems and a notable portion of under-five mortality in Ethiopia is attributed to vaccine-preventable diseases ( 15 ). Achieving full vaccination against these preventable diseases remains a significant and persistent public health challenge in the country ( 16 ). The expansion of immunization services is one of the child survival strategies aimed at protecting an estimated 2 million children from vaccine-preventable diseases annually. However, a substantial number of children still go unvaccinated. Consequently, many children, particularly those in urban settings, experience the acquisition of vaccine-preventable diseases, and the occurrence of epidemic outbreaks is frequent ( 17 ). Despite urban populations having a greater number of service provision points compared to rural areas, a significant portion of the urban populace encounters restricted access to healthcare due to economic, social, and cultural factors ( 11 ). The increased mobility from rural to urban increases the susceptibility of people contracting vaccine-preventable diseases during the epidemics ( 18 ). Furthermore, elements such as insufficient health infrastructure, socioeconomic disparities, and limited health service accessibility collectively impact immunization services in urban communities. Tailored immunization initiatives targeting urban areas hold promise for improving access, coverage, and equity of immunization services for underserved urban communities ( 19 ). Hence, this study aimed to assess urban immunization services and provide possible recommendations to address factors contributing to the rising number of children with zero doses and under-vaccinated children. Methods and materials Study design and settings A community-based cross-sectional study took place from June 13–23, 2023 in Wolaita Sodo town of Wolaita zone, Ethiopia. Wolaita Sodo town serves as the administrative seat of the South Ethiopia region and is known for its high population density, estimated population over 250,000 people. Administratively, the town is divided into 3 sub-cities and 25 kebeles ( 20 ). Study population The study population was caregivers of children ages 0 to 35 months living in Sodo town. Inclusion criteria Children aged 0–35 months who were living in randomly selected villages of Sodo town were included in the study. Exclusion criteria: Children who had no mother/caretaker in the household during the survey were excluded from the study. Moreover, in households with two or more children aged 0–35 months, the older child was excluded from the study to reduce recall biases, duplication of information and to obtain an accurate representation of the recent status of immunization services in the town. Sample Size determination The sample size was calculated using the single population proportion formula. Based on a previous study conducted in South Ethiopia's Demba Gofa woreda, which reported immunization coverage of 47% ( 21 ), the following single population proportion formula was employed to determine the sample size of 421 children aged 0–35 months. Where: n = sample size Z = value corresponds to a 95% level of significant = 1.96 d = Margin of error = 5% P = proportion = 47% then, = (1.96) 2 × (0.47) (1-0.47)/ (0.05) 2 Non-response rate of (10%) making the total sample size to be 421. Sampling procedure Multi-stage simple random sampling was utilized in Wolaita Sodo town. The town comprised 25 kebeles and 123 villages. From these, 13 kebeles were chosen via simple random sampling (lottery method). Following this selection, a proportional allocation method was employed to randomly select 39 villages from the 13 chosen kebeles for inclusion in the study. Data collectors then generated lists of households within each village and systematically selected 10 to 11 households, resulting in a total of 421 children aged 0–35 months participating in the study. If the targeted households did not have the targeted children, data collection proceeded to subsequent households until the required number of study subjects was reached in each village. Data collection procedures The study engaged a team of 9 data collectors and 5 supervisors who underwent a comprehensive two-day training session to acquire the necessary skills for gathering data from the mothers or caretakers of 421 children. Data collectors were from different disciplines such as midwives, nurses, and health officers with prior experience in data collection. They had Bachelor of Science degrees from health science colleges and Universities. Supervisors, holding bachelor's degrees and above qualifications in public health were used to supervise the overall data collection process. Structured questionnaires were used for data collection. The tool has been developed after reviewing different immunization service-related research and was pretested to ensure it captured the intended information. The questionnaires were collected house to house and administered in a face-to-face manner by trained data collectors. Data regarding immunization services were collected from vaccination card records, which could be standard Expanded Program on Immunization (EPI) cards or any documents indicating the immunization status of children. These vaccination service registration cards were provided by vaccination service providers). Additionally, verbal reports from mothers or caretakers were obtained, including information on the timing of vaccine administration, the number of vaccines received, the site (route) of administration, and the presence of immunization scars, particularly for BCG (Bacillus Calmette-Guérin) specially for those who did not showed their child immunization cards. Variables Dependent variables The dependent variable in this study was children who completed their immunization services as per national schedules. Independent variables Marital status, mothers’ education, mothers’ occupation, husbands’ education, occupation of the husband, age of the child, sex of the child, perceived wealth status, productive safety net program, CBHI, ANC follow-up, TD2+, place of birth, GMP, average distance, health service accessibility and PNC. Operational definitions Dropout : Dropout rate (DOR): The rate difference between the initial vaccines (BCG or Pentavalent I) and the final vaccines (Pentavalent III or Measles) ( 29 ). Fully immunized A child is considered fully vaccinated if he or she took one dose of BCG vaccine, three doses of Diphtheria Pertussis-Tetanus-Hepatitis B and Haemophilus influenza type B (DPT-HepB-Hib), three doses of the polio vaccine and one dose of IPV and measles vaccine ( 13 ). Zero doses A child who has not received any vaccine at all ( 25 ). Data quality control Before the main data collection, researchers conducted a pre-test to evaluate the effectiveness and appropriateness of the measuring instruments. Instruments have demonstrated reliability and validity through rigorous testing. Data collectors received training on the research protocols, data collection procedures, and ethical considerations. Double-entry or verification procedures are implemented during data entry to detect and correct errors. After data entry, data cleaning has been done to identify errors, inconsistencies, and outliers in the dataset. By implementing these data quality control methods, researchers enhanced the trustworthiness and credibility of research findings. Data analysis The collected data were exported to version 25 SPSS statistical software for analysis. The collected data underwent a cleaning process using SPSS. Descriptive statistics, including mean, median, standard deviation, percent, and frequency, were employed for analysis. Bivariate logistic analysis was conducted, considering all explanatory variables with a p-value < 0.25 for inclusion in the multivariable logistic regression analysis ( 22 ). The final multivariable analysis, at a significance level of P-value < 0.05, with Adjusted Odds Ratios (AOR) and 95% Confidence Intervals (CI), was employed to measure the degree of association between independent variables and the outcome variable ( 23 ). The study results are ultimately presented through tables and figures. Ethical clearance The study was approved by Wolaita zone health department Research Review Committee (Ethics Approval Number: WZH/5955/224 Dated 25/09/2015 EC). All procedures and methods performed adhere to ethical principles. Informed consent was obtained from all caretakers who voluntarily participated in the study. The participant information sheet helped them read and ask questions before consenting in writing (face to face) before the interviews. Results Socio-demographic characteristic A 97.6% response rate was obtained out of 421 eligible children, 411 children between the ages of 0 and 35 months who voluntarily took part in the study. Among the enrolled children, 51.3% (211) were male. The minimum age of children was 1 month while the maximum was 35 months with the mean and standard deviation of 17.2 and 9.4 months respectively. The birth order of the children ranged from 1 to 7, with a mean of 2.3 and a standard deviation of 1.2. The majority of mothers or caretakers 97.1% (399) were married, while a small proportion 2.9% ( 12 ) were single, being either widowed or divorced. In terms of maternal education, 8.8% (36) of mothers or caretakers were unable to read and write and 21.1% (87) completed a diploma or above (Table 1 ). Table 1. Socio-demographic characteristics of participants in Sodo town, Wolaita zone, South Ethiopia, June 2023 (N=411) Variables Frequency Percent Sex of the child Female 200 48.7 Male 211 51.3 Age of the child less than 9 months 114 27.7 9 to 15 months 69 16.8 15-24 months 117 28.5 24-36 months 111 27.0 Mothers marital status Married 399 97.1 Divorced 5 1.2 Widowed 7 1.7 Mothers educational Diploma and above 87 21.2 Secondary education (9-12) 96 23.4 Primary (1-8) education 154 37.5 Read and write 38 9.2 Unable read and write 36 8.8 Fathers education Unable to read and write 12 2.9 Read and write 32 7.8 Primary education (1-8 grade) 131 31.9 Secondary education (9-12 grade) 113 27.5 Diploma and above 114 27.7 No husband 9 2.2 Fathers occupation Farmer 60 14.6 Daily laborer 78 19.0 Governmental employee 110 26.8 Merchant 113 27.5 Other* 50 10.5 Wealth status High 2 .5 Medium 316 76.9 Low 93 22.6 Living in the risk area Yes 141 34.3 No 270 65.7 *Other: drivers, brokers, evangelists, No husband Regarding fathers' educational status, 2.9% ( 12 ) were unable to read and write, and 27.7% (114) completed a diploma and above. One hundred ten (26.8%) fathers were government employees, and 27.5% (113) were engaged in merchant occupations (Table 1 ). Regarding the perceived economic status of the families, the majority 76.9% (316) reported a medium economic status, while 22.3% (93) indicated a low economic status. Nearly two-thirds (65.7%) of the children were residing in areas where immunization services were accessible (Table 1 ). Coverage of key immunization service indicators The immunization status of children in this study revealed that 93.9% (386) received the BCG vaccine, 92.7% (381) received the first dose of the pentavalent vaccine, 92.0% (380) received the first dose of both PCV and Polio vaccines, and 88.8% (378) received the first dose of the Rota vaccine. Regarding the continuity of the immunization schedule, 91.0% (374) received the recommended three doses of the pentavalent vaccine, 91.2% (375) received all three Oral Polio vaccines, 92.5% (380) received the second recommended dose of the Rota vaccine, and 91% (374) received the recommended single dose of IPV (Inactivated Poliovirus Vaccine). Children who received the first and the second dose of measles were 293 (71.3%) and 270 (65.7.6%) respectively (Fig. 1 ). The overall vaccination status of children was 56.7% (233) children were fully vaccinated, 29.4% (121) were vaccinated for their age, 7.8% (32) experienced dropout in their vaccination, and 6.1% ( 25 ) children were zero doses (Fig. 2 ). Reasons cited for not vaccinating their children included a lack of information, lack of motivation, and obstacles related to the place and time of vaccination. Among children who received at least one dose 77.8% (301) were provided with EPI cards, and 141 of them showed the cards to interviewers, resulting in a card retention rate of 46.8%. Factors Affecting Immunization Services Mothers' education, Husband's education, Occupation of the husband, Perceived wealth status, Community-Based Health Insurance (CBHI), Antenatal Care (ANC) follow-up, Tetanus Toxoid 2 + vaccination (TD2+), Place of birth, Growth Monitoring and Promotion (GMP), accessibility of health facility, and Postnatal Care (PNC) were found to have a P-value less than 0.25 in the binary logistic regression and then included in the multiple logistic regression analysis. Women who did not attend ANC were 92% less likely to vaccinate their children according to the schedule, compared to mothers who attended ANC follow-up (Adjusted Odds Ratio [AOR] = 0.082, 95% Confidence Interval [CI]: 0.009–0.777). Similarly, children who were born at home were 82% less likely to receive their immunization services as per schedule compared to those born at a facility level (AOR = 0.18, 95% CI: 0.046–0.703). Families not enrolled in the CBHI scheme were 66% less likely to vaccinate their children according to the vaccination schedules compared to those who paid for CBHI services (AOR = 0.34, 95% CI: 0.125–0.923). Children living in less health service-accessible areas were 89% less likely to vaccinate their children according to the schedule compared to those living within accessible areas (AOR = 0.11, 95% CI: 0.04–0.32) (Table 2 ). Variables such as Mothers' education, Husbands' education, Occupation of the husband, Perceived wealth status, TD2+, Growth Monitoring and Promotion (GMP), and PNC showed no statistically significant association with child vaccination (p > 0.05). Table 2, Table Odds ratios from multinomial logistic regression on immunization service with socioeconomic status, Wolaita, Sodo town, SNNPR, July 2022 (AOR 95% CI) (N=420). Variable Immunization status 95% CI of OR Fully immunized ( n=354) Not Fully immunized (n=57) COR AOR Mothers education Diploma and above 80 (92.0%) 7 (8.0%) 4.39 (1.51 12.71) 2.65 (0.37 19.08) Primary education 128 (83.1%) 26 (16.9%) 1.89 (0.81 4.39) 1.33 (0.29 6.060) Read and write 31 (81.6%) 7 (18.4%) 1.70 (0.57 5.10) 3.72 (0.49 28.07) Secondary education 89 (92.7%) 7 (7.3%) 4.89 (1.69 14.12) 2.47 (0.44 14.07) Unable read and write 26 (72.2%) 10 (27.8%) 1 1 Husband education Diploma and above 104 (91.2%) 10 (8.8%) 10.40(2.82 38.33) 2.92 (0.16 52.31) Not available 2 (22.2%) 7 (77.8%) 3.50(0.50 24.27) 2.05 (0.09 46.54) Primary education 111 (84.7%) 20 (15.3%) 5.550 (1.63 18.94) 5.01 (0.59 42.56) Read and write 23 (71.9%) 9 (28.1%) 2.56(0.65 10.05) 9.60 (0.81 114.22) Secondary education 103 (91.2%) 10 (8.8%) 10.30 (2.79 37.97) 4.20 (0.40 43.67) Unable to read and write 6 (50.0%) 6 (50.0%) 1 1 Occupation of the husband Daily laborers 65 (84.4%) 12 (15.6%) 1 1 Farmer 40 (66.7%) 20 (33.3%) 0.37(0.16 0.84) 3.90 (0.62 24.51) Governmental employee 100 (90.9%) 10 (9.1%) 1.85 (0.75 4.52) 0.74 (0.11 4.99) Merchant 104 (92.0%) 9 (8.0%) 2.13 (0.85 5.34) 0.87 (0.26 2.95) Others 45 (88.2%) 6 (11.8%) 1.38 (0.48 3.96) 0.38 (0.08 1.80) Wealth status Medium 290 (91.2%) 28 (8.8%) 4.69 (2.61 8.43) 2.00 (0.71 5.67) Low 64 (68.8%) 29 (31.2%) 1 1 CBHI Not participated 237 (83.7%) 46 (16.3%) 0.48 (0.24 0.97) 0.34 (0.12 0.92)* Participated 117 (91.4%) 11 (8.6%) 1 1 ANC follow-up Not attended 237 (83.7%) 46 (16.3%) 0.02 (0.01 0.06) 0.082 (0.01 0.78)* Attended 117 (91.4%) 11 (8.6%) 1 1 TD2+ No 19 (47.5%) 21 (52.5%) 0.10 (0.05 0.20) 0.50 (0.14 1.75) Yes 335 (90.3%) 36 (9.7%) 1 1 Place of birth Health facility 338 (91.8%) 30 (8.2%) 1 1 Home 16 (37.2%) 27 (62.8%) 0.05 (0.03 0.11) 0.18 (0.05 0.70)* GMP No 313 (85.1%) 55 (14.9%) 0.28 (0.06 1.18) 1.114 (0.21 5.94) Yes 41 (95.3%) 2 (4.7%) 1 1 Access to health facilities One to five KM 317 (92.4%) 26 (7.6%) 1 1 Six and above KM 37 (54.4%) 31 (45.6%) 0.10 (0.05 0.18) 0.11 (0.04 0.32)* PNC No 226 (83.1%) 46 (16.9%) 0.42 (0.21 0.84) 0.56 (0.20 1.54) Yes 128 (92.1%) 11 (7.9%) 1 1 * Significant at P value less than 0.05 Discussion Among children who enrolled in the study 92.7% (381) and 91.0% (374) received the first and third doses of pentavalent vaccines respectively. Similarly, 293 (71.3%) children received MCV1 and 270 (65.7.6%) received MCV2 vaccines. The overall vaccination status of children was 56.7% were fully vaccinated, 29.4% were vaccinated for age as per national standard, 7.8% dropped their vaccination and 6.% were never vaccinated. Factors such as ANC visits, facility deliveries, enrollment of community health insurance, and access to health service-providing facilities were found to have a statistically significant association with immunization services. The coverage of all key antigens in this study did not reach the optimum level of 95%. However, it was higher than what was reported in the 2019 preliminary Ethiopian Demographic and Health Survey (EDHS) ( 24 ). This difference may be attributed to variations in the timing of the studies and improvements in the urban immunization program in Sodo town. The prevalence of zero doses was consistent in this study and a national-level study conducted by Project HOPE in 2022, which were 6.1% and 6.2% respectively ( 25 ). In the study conducted by Tamirat and Sisay involving further analysis of the 2016 Ethiopian Demographic and Health Survey (EDHS) ( 13 ), ANC follow-ups and skilled delivery assisted by health workers at the facility level had statistically significant associations with child immunization. This finding aligns with the results of the current study, indicating that mothers who did not attend ANC follow-up were 92% less likely to adhere to their child's immunization schedules compared to mothers who attended ANC follow-up. Similarly, mothers who gave birth at home were 82% less likely to vaccinate their children compared to those who gave birth at health facilities assisted by healthcare providers. These findings suggest that attending ANC services and delivering at health facilities might serve as motivating factors for mothers to follow through with vaccinating their children according to immunization schedules. As indicated in the study conducted by Gashaw et.al at the national level, the absence of health facilities in remote kebeles or inaccessibility due to distance or topographic barriers is a major challenge for reaching unvaccinated children ( 25 ). In this study, children who were living in less health service-accessible areas were 89% less likely to vaccinate their children according to the schedule compared to those who were inaccessible areas. This finding is consistent with the study conducted in Nigeria, specifically in Anambra States by Sibeudu, Uzochukwu, and Onwujekwe, which identified distance as one of the factors significantly associated with not vaccinating children ( 26 ). Constructing health facilities that provide comprehensive healthcare within the community might improve the immunization uptake of children. CBHI is believed to increase the health-seeking behavior of the community. In this study, families who were not involved in the CBHI scheme were 66% less likely to vaccinate their children according to the vaccination schedules compared to those who paid for CBHI services, indicating that CBHI services have an impact on the uptake of immunization services. Vaccination cards are crucial tools used to ensure that children receive all recommended vaccinations according to schedule ( 24 ). The 2019 Ethiopian mini-demographic health survey obtained vaccination coverage information from written vaccination cards, mothers' verbal reports, and health facility records ( 27 ). Similarly, the data in this study were obtained from any card providing information on child immunization history and mothers' verbal reports. The card retention rate in this study was 46.8% which is much lower than in the study conducted in the mini-2019 EDHS ( 28 ), where the card retention rate was 62%. The low card availability in this study might be attributed to the inadequate supply of EPI cards from the Regional health bureau and zonal health department since 2021. The low provision and retention of EPI cards could impact understanding the status of EPI services and monitoring EPI programs in Sodo town. Conclusions The coverage for all examined antigens in the study fell below the recommended threshold of 95%, indicating a risk of vaccine-preventable disease outbreaks in the community. Factors such as mothers attending ANC services and giving birth at health facilities were identified as strong motivators for proper adherence to their child's vaccination schedule. Additionally, access to health facilities or outreach immunization services played a crucial role in encouraging mothers or caretakers to attend their children's immunization sessions. Enrollment CBHI scheme also proved to be effective in incentivizing mothers or caregivers to seek healthcare services at health facilities or vaccination services. Abbreviations DOR Dropout rate DPT Diaphteria, Petisussia and Tetanus EPI Expanded Program of Immunization IPV Inactivated Polio Vaccine MCV measles-containing vaccine PCV Pneumococcal Conjugated Vaccine Penta Pentavalent vaccine TD Tetanus Toxoid and diphtheria VPD Vaccine-Preventable Diseases Declarations Acknowledgments The completion of this study was made possible with the invaluable support and contributions of all the participants and research assistants involved. The authors extend their heartfelt gratitude to every individual who played a part in the successful completion of this research. Authors’ contributions HB wrote the proposal, study design, methods and drafting of the manuscript; DS contributed to the study design, data collection and conducted the statistical analysis; SG conceived the methodology and provided overall guidance, and collaborated on the manuscript draft; TS contributed to drafting the final versions of the manuscript; MM collaborated on statistical analysis and manuscript draft; AS collaborated on the methodology and manuscript draft and initiated publication of the study; SB contributed in the study design and proofreading. All authors read and approved the final manuscript. Funding This study did not receive funds from any company or institution. Data Availability The authors confirm that the data supporting the findings of this study are available and it can be presented on request from the corresponding author. Ethics approval and consent to participate The study was approved by Wolaita Zone Health Department Research Review Committee (Ethics Approval Number: WZH/5955/224 Dated 25/09/2015 EC). All procedures and methods performed adhere to ethical principles. Informed consent was obtained from all caretakers who voluntarily participated in the study. The participant information sheet helped them read and ask questions before consenting in writing (face to face) before the interviews. Consent for publication Not applicable. Competing interests The authors declare no competing interests. References UN Habitat (2016) World Cities Report 2016. Urbanization and Development: Emerging Futures. Pub. United Nations, New York Desa United Nation (2018) World Urbanization Prospects, the 2018 Revision. Population Division, department of economic and social affairs, United Nations Secretariat United Nations (2014) World Urbanization Prospects: 2014 Revision. Pub. 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Nigeria SAGE open Med 7:2050312118823893. http://DOI:10.1177/2050312118823893 Sako S, Gilano G, Hailegebreal S (2023) Determinants of childhood vaccination among children aged 12–23 months in Ethiopia: a community-based cross-sectional study. BMJ open 13(3). http://doi:10.1136/bmjopen-2022-069278 Ethiopian Public Health Institute (EPHI) Ethiopia Mini Demographic and Health Survey 2019: Rockville, Maryland, USA: EPHI and ICF Kassaw A, Abebe GMA, Kebede A, Kebede F Assessment of Magnitude and Associated Factors of Immunization Drop Out Rate for Children Aged 12–23 Months In Abobo District South West Ethiopia 2021. Additional Declarations The authors declare no competing interests. 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. 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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-4223196","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":287940452,"identity":"b8068bf8-d712-44aa-bdf6-aa230e467f12","order_by":0,"name":"Haile Bekele Adane","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA50lEQVRIiWNgGAWjYBACAwbGxgOMDTY8bOzNBxgYG4jT0gDUkibHz3MsgVgtDAxALYeNJWf4GBCnxZz9cMOBjzuYEzfc4Pkm8XOHjRwD++GjG/BpsexJbDg48wxb4obbvdske8+kGTPwpKXdwOuwA4kNh3nbeBI33Dm7TYK37XBigwSPGX4t5x82HP7bJgF0WM4zyb9EabkBtIWxzQDo/Rw2aeJsufGw4WDvmQRQIBtby7alGbMR9Mv59IcPfu74D4rKhzffttnI8bMfPoZXCzJgkQCRbMQqBwHmD6SoHgWjYBSMgpEDAEPFV+SG75XCAAAAAElFTkSuQmCC","orcid":"","institution":"Wolaita zone health department","correspondingAuthor":true,"prefix":"","firstName":"Haile","middleName":"Bekele","lastName":"Adane","suffix":""}],"badges":[],"createdAt":"2024-04-05 13:06:06","currentVersionCode":1,"declarations":{"humanSubjects":true,"vertebrateSubjects":false,"conflictsOfInterestStatement":false,"humanSubjectEthicalGuidelines":true,"humanSubjectConsent":true,"humanSubjectClinicalTrial":false,"humanSubjectCaseReport":false,"vertebrateSubjectEthicalGuidelines":false},"doi":"10.21203/rs.3.rs-4223196/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-4223196/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":54319903,"identity":"e0d2823f-2a5e-4031-9ae1-a8467066644e","added_by":"auto","created_at":"2024-04-08 19:00:28","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":36463,"visible":true,"origin":"","legend":"\u003cp\u003eKey antigen received by children aged 0-35 months of age, July 2023, Sodo town.\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-4223196/v1/1afcf4c128fa65def85663cd.png"},{"id":54319906,"identity":"fe13c694-948e-4c62-89e8-53d6d4624043","added_by":"auto","created_at":"2024-04-08 19:00:29","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":22701,"visible":true,"origin":"","legend":"\u003cp\u003eVaccination status of children aged 0-36 months in Sodo town, Wolaita, June 2023\u003c/p\u003e","description":"","filename":"2.png","url":"https://assets-eu.researchsquare.com/files/rs-4223196/v1/c0f251c88ae12b878cfa9e4e.png"},{"id":54320282,"identity":"c1e8b59b-e07c-4aa5-bdca-87675f49f265","added_by":"auto","created_at":"2024-04-08 19:08:28","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":402462,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-4223196/v1/f6ae1142-80fa-4855-9ba1-639d711758c6.pdf"}],"financialInterests":"The authors declare no competing interests.","formattedTitle":"\u003cp\u003e\u003cstrong\u003eThe context of urban immunization services: The case of Sodo town, Wolaita Zone, South Ethiopia\u003c/strong\u003e\u003c/p\u003e","fulltext":[{"header":"Introduction","content":"\u003cp\u003eThe global trend of urbanization persists, encompassing approximately 55% of the world's population (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e). Projections suggest a further increase to 68% by 2050, with a substantial 90% surge expected in Asian and African countries (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e). Urbanization contributes positively to economic growth, poverty reduction, and human development (\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e). Recognizing and addressing obstacles, along with implementing effective strategies to enhance equity in urban settings, are crucial for achieving the targets outlined in the Sustainable Development Goals and Immunization Agenda 2030 (\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e). Notably, significant disparities in immunization coverage exist within urban areas, with lower coverage observed among the urban poor in numerous countries (\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e). This situation also elevates the risk of vaccine-preventable diseases (VPDs) due to the concentration of people in urban slums and existing disparities in health services between urban populations (\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eVaccination plays a crucial role in preventing childhood illnesses and has demonstrated effectiveness in protecting children against vaccine-preventable diseases (\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e, \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e, \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e). Initially, vaccination coverage in urban areas seemed higher, but there is now a reversal as urbanization progresses (\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e). This shift has resulted in notable disparities in vaccination services between urban and rural populations, with coverage in urban slum areas now comparable to that in remote rural communities (\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e). Globally, around 30% of children who have not received essential vaccines reside in urban areas (\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eA significant number of children in Africa remain unvaccinated or under-vaccinated, often due to limited access to effective interventions (\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e). It is essential to comprehend vaccine coverage and the barriers in urban slum areas (\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e). Despite the global impact of immunization, saving millions of lives each year, vaccine-preventable diseases still contribute to over 2\u0026nbsp;million deaths among children under five annually, with sub-Saharan Africa being the most affected region (\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e). Inadequate health service delivery, geographical challenges, and conflicts hinder efforts to meet targeted immunization services (\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eCommunicable diseases contribute to 60\u0026ndash;80% of health problems and a notable portion of under-five mortality in Ethiopia is attributed to vaccine-preventable diseases (\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e). Achieving full vaccination against these preventable diseases remains a significant and persistent public health challenge in the country (\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e). The expansion of immunization services is one of the child survival strategies aimed at protecting an estimated 2\u0026nbsp;million children from vaccine-preventable diseases annually. However, a substantial number of children still go unvaccinated. Consequently, many children, particularly those in urban settings, experience the acquisition of vaccine-preventable diseases, and the occurrence of epidemic outbreaks is frequent (\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eDespite urban populations having a greater number of service provision points compared to rural areas, a significant portion of the urban populace encounters restricted access to healthcare due to economic, social, and cultural factors (\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e). The increased mobility from rural to urban increases the susceptibility of people contracting vaccine-preventable diseases during the epidemics (\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e). Furthermore, elements such as insufficient health infrastructure, socioeconomic disparities, and limited health service accessibility collectively impact immunization services in urban communities. Tailored immunization initiatives targeting urban areas hold promise for improving access, coverage, and equity of immunization services for underserved urban communities (\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e). Hence, this study aimed to assess urban immunization services and provide possible recommendations to address factors contributing to the rising number of children with zero doses and under-vaccinated children.\u003c/p\u003e"},{"header":"Methods and materials","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e\n \u003ch2\u003eStudy design and settings\u003c/h2\u003e\n \u003cp\u003eA community-based cross-sectional study took place from June 13\u0026ndash;23, 2023 in Wolaita Sodo town of Wolaita zone, Ethiopia. Wolaita Sodo town serves as the administrative seat of the South Ethiopia region and is known for its high population density, estimated population over 250,000 people. Administratively, the town is divided into 3 sub-cities and 25 kebeles (\u003cspan class=\"CitationRef\"\u003e20\u003c/span\u003e).\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec4\" class=\"Section2\"\u003e\n \u003ch2\u003eStudy population\u003c/h2\u003e\n \u003cp\u003eThe study population was caregivers of children ages 0 to 35 months living in Sodo town.\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec5\" class=\"Section2\"\u003e\n \u003ch2\u003eInclusion criteria\u003c/h2\u003e\n \u003cp\u003eChildren aged 0\u0026ndash;35 months who were living in randomly selected villages of Sodo town were included in the study.\u003c/p\u003e\n \u003cdiv id=\"Sec6\" class=\"Section3\"\u003e\n \u003ch2\u003eExclusion criteria:\u003c/h2\u003e\n \u003cp\u003eChildren who had no mother/caretaker in the household during the survey were excluded from the study. Moreover, in households with two or more children aged 0\u0026ndash;35 months, the older child was excluded from the study to reduce recall biases, duplication of information and to obtain an accurate representation of the recent status of immunization services in the town.\u003c/p\u003e\n \u003c/div\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec7\" class=\"Section2\"\u003e\n \u003ch2\u003eSample Size determination\u003c/h2\u003e\n \u003cp\u003eThe sample size was calculated using the single population proportion formula. Based on a previous study conducted in South Ethiopia\u0026apos;s Demba Gofa woreda, which reported immunization coverage of 47% (\u003cspan class=\"CitationRef\"\u003e21\u003c/span\u003e), the following single population proportion formula was employed to determine the sample size of 421 children aged 0\u0026ndash;35 months.\u003c/p\u003e\n \u003cp\u003e\u003cimg src=\"data:image/png;base64,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\" width=\"164\" height=\"63\"\u003e\u003c/p\u003e\n \u003cp\u003eWhere:\u003c/p\u003e\n \u003cp\u003en\u0026thinsp;=\u0026thinsp;sample size\u003c/p\u003e\n \u003cp\u003eZ\u0026thinsp;=\u0026thinsp;value corresponds to a 95% level of significant\u0026thinsp;=\u0026thinsp;1.96\u003c/p\u003e\n \u003cp\u003ed\u0026thinsp;=\u0026thinsp;Margin of error\u0026thinsp;=\u0026thinsp;5%\u003c/p\u003e\n \u003cp\u003eP\u0026thinsp;=\u0026thinsp;proportion\u0026thinsp;=\u0026thinsp;47% then, = (1.96)\u003csup\u003e2\u003c/sup\u003e\u0026times; (0.47) (1-0.47)/ (0.05)\u003csup\u003e2\u003c/sup\u003e\u003c/p\u003e\n \u003cp\u003eNon-response rate of (10%) making the total sample size to be 421.\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec8\" class=\"Section2\"\u003e\n \u003ch2\u003eSampling procedure\u003c/h2\u003e\n \u003cp\u003eMulti-stage simple random sampling was utilized in Wolaita Sodo town. The town comprised 25 kebeles and 123 villages. From these, 13 kebeles were chosen via simple random sampling (lottery method). Following this selection, a proportional allocation method was employed to randomly select 39 villages from the 13 chosen kebeles for inclusion in the study. Data collectors then generated lists of households within each village and systematically selected 10 to 11 households, resulting in a total of 421 children aged 0\u0026ndash;35 months participating in the study. If the targeted households did not have the targeted children, data collection proceeded to subsequent households until the required number of study subjects was reached in each village.\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec9\" class=\"Section2\"\u003e\n \u003ch2\u003eData collection procedures\u003c/h2\u003e\n \u003cp\u003eThe study engaged a team of 9 data collectors and 5 supervisors who underwent a comprehensive two-day training session to acquire the necessary skills for gathering data from the mothers or caretakers of 421 children. Data collectors were from different disciplines such as midwives, nurses, and health officers with prior experience in data collection. They had Bachelor of Science degrees from health science colleges and Universities. Supervisors, holding bachelor\u0026apos;s degrees and above qualifications in public health were used to supervise the overall data collection process.\u003c/p\u003e\n \u003cp\u003eStructured questionnaires were used for data collection. The tool has been developed after reviewing different immunization service-related research and was pretested to ensure it captured the intended information. The questionnaires were collected house to house and administered in a face-to-face manner by trained data collectors.\u003c/p\u003e\n \u003cp\u003eData regarding immunization services were collected from vaccination card records, which could be standard Expanded Program on Immunization (EPI) cards or any documents indicating the immunization status of children. These vaccination service registration cards were provided by vaccination service providers). Additionally, verbal reports from mothers or caretakers were obtained, including information on the timing of vaccine administration, the number of vaccines received, the site (route) of administration, and the presence of immunization scars, particularly for BCG (Bacillus Calmette-Gu\u0026eacute;rin) specially for those who did not showed their child immunization cards.\u003c/p\u003e\n \u003cdiv id=\"Sec10\" class=\"Section3\"\u003e\n \u003ch2\u003eVariables\u003c/h2\u003e\n \u003cdiv id=\"Sec11\" class=\"Section4\"\u003e\n \u003ch2\u003eDependent variables\u003c/h2\u003e\n \u003cp\u003eThe dependent variable in this study was children who completed their immunization services as per national schedules.\u003c/p\u003e\n \u003c/div\u003e\n \u003c/div\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec12\" class=\"Section2\"\u003e\n \u003ch2\u003eIndependent variables\u003c/h2\u003e\n \u003cp\u003eMarital status, mothers\u0026rsquo; education, mothers\u0026rsquo; occupation, husbands\u0026rsquo; education, occupation of the husband, age of the child, sex of the child, perceived wealth status, productive safety net program, CBHI, ANC follow-up, TD2+, place of birth, GMP, average distance, health service accessibility and PNC.\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec13\" class=\"Section2\"\u003e\n \u003ch2\u003eOperational definitions\u003c/h2\u003e\n \u003cp\u003e\u003cstrong\u003eDropout\u003c/strong\u003e: Dropout rate (DOR): The rate difference between the initial vaccines (BCG or Pentavalent I) and the final vaccines (Pentavalent III or Measles) (\u003cspan class=\"CitationRef\"\u003e29\u003c/span\u003e).\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eFully immunized\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003eA child is considered fully vaccinated if he or she took one dose of BCG vaccine, three doses of Diphtheria Pertussis-Tetanus-Hepatitis B and Haemophilus influenza type B (DPT-HepB-Hib), three doses of the polio vaccine and one dose of IPV and measles vaccine (\u003cspan class=\"CitationRef\"\u003e13\u003c/span\u003e).\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eZero doses\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003eA child who has not received any vaccine at all (\u003cspan class=\"CitationRef\"\u003e25\u003c/span\u003e).\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec14\" class=\"Section2\"\u003e\n \u003ch2\u003eData quality control\u003c/h2\u003e\n \u003cp\u003eBefore the main data collection, researchers conducted a pre-test to evaluate the effectiveness and appropriateness of the measuring instruments. Instruments have demonstrated reliability and validity through rigorous testing. Data collectors received training on the research protocols, data collection procedures, and ethical considerations. Double-entry or verification procedures are implemented during data entry to detect and correct errors. After data entry, data cleaning has been done to identify errors, inconsistencies, and outliers in the dataset. By implementing these data quality control methods, researchers enhanced the trustworthiness and credibility of research findings.\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec15\" class=\"Section2\"\u003e\n \u003ch2\u003eData analysis\u003c/h2\u003e\n \u003cp\u003eThe collected data were exported to version 25 SPSS statistical software for analysis. The collected data underwent a cleaning process using SPSS. Descriptive statistics, including mean, median, standard deviation, percent, and frequency, were employed for analysis. Bivariate logistic analysis was conducted, considering all explanatory variables with a p-value\u0026thinsp;\u0026lt;\u0026thinsp;0.25 for inclusion in the multivariable logistic regression analysis (\u003cspan class=\"CitationRef\"\u003e22\u003c/span\u003e). The final multivariable analysis, at a significance level of P-value\u0026thinsp;\u0026lt;\u0026thinsp;0.05, with Adjusted Odds Ratios (AOR) and 95% Confidence Intervals (CI), was employed to measure the degree of association between independent variables and the outcome variable (\u003cspan class=\"CitationRef\"\u003e23\u003c/span\u003e). The study results are ultimately presented through tables and figures.\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec16\" class=\"Section2\"\u003e\n \u003ch2\u003eEthical clearance\u003c/h2\u003e\n \u003cp\u003eThe study was approved by Wolaita zone health department Research Review Committee (Ethics Approval Number: WZH/5955/224 Dated 25/09/2015 EC). All procedures and methods performed adhere to ethical principles. Informed consent was obtained from all caretakers who voluntarily participated in the study. The participant information sheet helped them read and ask questions before consenting in writing (face to face) before the interviews.\u003c/p\u003e\n\u003c/div\u003e"},{"header":"Results","content":"\u003cdiv id=\"Sec18\" class=\"Section2\"\u003e\n \u003ch2\u003eSocio-demographic characteristic\u003c/h2\u003e\n \u003cp\u003eA 97.6% response rate was obtained out of 421 eligible children, 411 children between the ages of 0 and 35 months who voluntarily took part in the study. Among the enrolled children, 51.3% (211) were male. The minimum age of children was 1 month while the maximum was 35 months with the mean and standard deviation of 17.2 and 9.4 months respectively. The birth order of the children ranged from 1 to 7, with a mean of 2.3 and a standard deviation of 1.2. The majority of mothers or caretakers 97.1% (399) were married, while a small proportion 2.9% (\u003cspan class=\"CitationRef\"\u003e12\u003c/span\u003e) were single, being either widowed or divorced. In terms of maternal education, 8.8% (36) of mothers or caretakers were unable to read and write and 21.1% (87) completed a diploma or above (Table \u003cspan class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e\n \u003cdiv class=\"gridtable\"\u003e\n \u003cp\u003e\u003cstrong\u003eTable 1.\u0026nbsp;\u003c/strong\u003e Socio-demographic characteristics of participants in Sodo town, Wolaita zone, South Ethiopia, June 2023 (N=411)\u003c/p\u003e\n \u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"60.27164685908319%\" colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eVariables\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.770797962648556%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003eFrequency\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.95755517826825%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cstrong\u003ePercent\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"26.10169491525424%\" rowspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003eSex of the child\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"34.23728813559322%\"\u003e\n \u003cp\u003eFemale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.745762711864407%\"\u003e\n \u003cp\u003e200\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.915254237288135%\"\u003e\n \u003cp\u003e48.7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"46.330275229357795%\"\u003e\n \u003cp\u003eMale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.954128440366972%\"\u003e\n \u003cp\u003e211\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"33.71559633027523%\"\u003e\n \u003cp\u003e51.3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"26.10169491525424%\" rowspan=\"4\" valign=\"top\"\u003e\n \u003cp\u003eAge of the child\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"34.23728813559322%\" valign=\"top\"\u003e\n \u003cp\u003eless than 9 months\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.745762711864407%\"\u003e\n \u003cp\u003e114\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.915254237288135%\"\u003e\n \u003cp\u003e27.7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"46.330275229357795%\" valign=\"top\"\u003e\n \u003cp\u003e9 to 15 months\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.954128440366972%\"\u003e\n \u003cp\u003e69\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"33.71559633027523%\"\u003e\n \u003cp\u003e16.8\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"46.330275229357795%\" valign=\"top\"\u003e\n \u003cp\u003e15-24 months\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.954128440366972%\"\u003e\n \u003cp\u003e117\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"33.71559633027523%\"\u003e\n \u003cp\u003e28.5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"46.330275229357795%\" valign=\"top\"\u003e\n \u003cp\u003e24-36 months\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.954128440366972%\"\u003e\n \u003cp\u003e111\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"33.71559633027523%\"\u003e\n \u003cp\u003e27.0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"26.10169491525424%\" rowspan=\"3\" valign=\"top\"\u003e\n \u003cp\u003eMothers marital status\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"34.23728813559322%\" valign=\"top\"\u003e\n \u003cp\u003eMarried\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.745762711864407%\"\u003e\n \u003cp\u003e399\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.915254237288135%\"\u003e\n \u003cp\u003e97.1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"46.330275229357795%\" valign=\"top\"\u003e\n \u003cp\u003eDivorced\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.954128440366972%\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"33.71559633027523%\"\u003e\n \u003cp\u003e1.2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"46.330275229357795%\" valign=\"top\"\u003e\n \u003cp\u003eWidowed\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.954128440366972%\"\u003e\n \u003cp\u003e7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"33.71559633027523%\"\u003e\n \u003cp\u003e1.7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"26.10169491525424%\" rowspan=\"5\" valign=\"top\"\u003e\n \u003cp\u003eMothers educational\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"34.23728813559322%\" valign=\"top\"\u003e\n \u003cp\u003eDiploma and above\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.745762711864407%\"\u003e\n \u003cp\u003e87\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.915254237288135%\"\u003e\n \u003cp\u003e21.2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"46.330275229357795%\" valign=\"top\"\u003e\n \u003cp\u003eSecondary education (9-12)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.954128440366972%\"\u003e\n \u003cp\u003e96\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"33.71559633027523%\"\u003e\n \u003cp\u003e23.4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"46.330275229357795%\" valign=\"top\"\u003e\n \u003cp\u003ePrimary (1-8) education\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.954128440366972%\"\u003e\n \u003cp\u003e154\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"33.71559633027523%\"\u003e\n \u003cp\u003e37.5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"46.330275229357795%\" valign=\"top\"\u003e\n \u003cp\u003eRead and write\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.954128440366972%\"\u003e\n \u003cp\u003e38\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"33.71559633027523%\"\u003e\n \u003cp\u003e9.2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"46.330275229357795%\" valign=\"top\"\u003e\n \u003cp\u003eUnable read and write\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.954128440366972%\"\u003e\n \u003cp\u003e36\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"33.71559633027523%\"\u003e\n \u003cp\u003e8.8\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"26.10169491525424%\" rowspan=\"6\" valign=\"top\"\u003e\n \u003cp\u003eFathers education\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"34.23728813559322%\" valign=\"top\"\u003e\n \u003cp\u003eUnable to read and write\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.745762711864407%\"\u003e\n \u003cp\u003e12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.915254237288135%\"\u003e\n \u003cp\u003e2.9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"46.330275229357795%\" valign=\"top\"\u003e\n \u003cp\u003eRead and write\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.954128440366972%\"\u003e\n \u003cp\u003e32\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"33.71559633027523%\"\u003e\n \u003cp\u003e7.8\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"46.330275229357795%\" valign=\"top\"\u003e\n \u003cp\u003ePrimary education (1-8 grade)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.954128440366972%\"\u003e\n \u003cp\u003e131\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"33.71559633027523%\"\u003e\n \u003cp\u003e31.9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"46.330275229357795%\" valign=\"top\"\u003e\n \u003cp\u003eSecondary education (9-12 grade)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.954128440366972%\"\u003e\n \u003cp\u003e113\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"33.71559633027523%\"\u003e\n \u003cp\u003e27.5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"46.330275229357795%\" valign=\"top\"\u003e\n \u003cp\u003eDiploma and above\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.954128440366972%\"\u003e\n \u003cp\u003e114\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"33.71559633027523%\"\u003e\n \u003cp\u003e27.7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"46.330275229357795%\" valign=\"top\"\u003e\n \u003cp\u003eNo husband\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.954128440366972%\"\u003e\n \u003cp\u003e9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"33.71559633027523%\"\u003e\n \u003cp\u003e2.2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"26.10169491525424%\" rowspan=\"5\" valign=\"top\"\u003e\n \u003cp\u003eFathers occupation\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"34.23728813559322%\" valign=\"top\"\u003e\n \u003cp\u003eFarmer\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.745762711864407%\"\u003e\n \u003cp\u003e60\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.915254237288135%\"\u003e\n \u003cp\u003e14.6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"46.330275229357795%\" valign=\"top\"\u003e\n \u003cp\u003eDaily laborer\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.954128440366972%\"\u003e\n \u003cp\u003e78\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"33.71559633027523%\"\u003e\n \u003cp\u003e19.0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"46.330275229357795%\" valign=\"top\"\u003e\n \u003cp\u003eGovernmental employee\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.954128440366972%\"\u003e\n \u003cp\u003e110\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"33.71559633027523%\"\u003e\n \u003cp\u003e26.8\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"46.330275229357795%\" valign=\"top\"\u003e\n \u003cp\u003eMerchant\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.954128440366972%\"\u003e\n \u003cp\u003e113\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"33.71559633027523%\"\u003e\n \u003cp\u003e27.5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"46.330275229357795%\" valign=\"top\"\u003e\n \u003cp\u003eOther*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.954128440366972%\"\u003e\n \u003cp\u003e50\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"33.71559633027523%\"\u003e\n \u003cp\u003e10.5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"26.10169491525424%\" rowspan=\"3\" valign=\"top\"\u003e\n \u003cp\u003eWealth status\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"34.23728813559322%\" valign=\"top\"\u003e\n \u003cp\u003eHigh\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.745762711864407%\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.915254237288135%\"\u003e\n \u003cp\u003e.5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"46.330275229357795%\" valign=\"top\"\u003e\n \u003cp\u003eMedium\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.954128440366972%\"\u003e\n \u003cp\u003e316\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"33.71559633027523%\"\u003e\n \u003cp\u003e76.9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"46.330275229357795%\" valign=\"top\"\u003e\n \u003cp\u003eLow\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.954128440366972%\"\u003e\n \u003cp\u003e93\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"33.71559633027523%\"\u003e\n \u003cp\u003e22.6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"26.10169491525424%\" rowspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003eLiving in the risk area\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"34.23728813559322%\" valign=\"top\"\u003e\n \u003cp\u003eYes\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.745762711864407%\"\u003e\n \u003cp\u003e141\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"24.915254237288135%\"\u003e\n \u003cp\u003e34.3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"46.330275229357795%\" valign=\"top\"\u003e\n \u003cp\u003eNo\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.954128440366972%\"\u003e\n \u003cp\u003e270\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"33.71559633027523%\"\u003e\n \u003cp\u003e65.7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n \u003cp\u003e*Other: drivers, brokers, evangelists, No husband \u0026nbsp;\u003c/p\u003e\n \u003c/div\u003e\n \u003cp\u003eRegarding fathers\u0026apos; educational status, 2.9% (\u003cspan class=\"CitationRef\"\u003e12\u003c/span\u003e) were unable to read and write, and 27.7% (114) completed a diploma and above. One hundred ten (26.8%) fathers were government employees, and 27.5% (113) were engaged in merchant occupations (Table \u003cspan class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e\n \u003cp\u003eRegarding the perceived economic status of the families, the majority 76.9% (316) reported a medium economic status, while 22.3% (93) indicated a low economic status. Nearly two-thirds (65.7%) of the children were residing in areas where immunization services were accessible (Table \u003cspan class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec19\" class=\"Section2\"\u003e\n \u003ch2\u003eCoverage of key immunization service indicators\u003c/h2\u003e\n \u003cp\u003eThe immunization status of children in this study revealed that 93.9% (386) received the BCG vaccine, 92.7% (381) received the first dose of the pentavalent vaccine, 92.0% (380) received the first dose of both PCV and Polio vaccines, and 88.8% (378) received the first dose of the Rota vaccine. Regarding the continuity of the immunization schedule, 91.0% (374) received the recommended three doses of the pentavalent vaccine, 91.2% (375) received all three Oral Polio vaccines, 92.5% (380) received the second recommended dose of the Rota vaccine, and 91% (374) received the recommended single dose of IPV (Inactivated Poliovirus Vaccine). Children who received the first and the second dose of measles were 293 (71.3%) and 270 (65.7.6%) respectively (Fig. \u003cspan class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e\n \u003cp\u003eThe overall vaccination status of children was 56.7% (233) children were fully vaccinated, 29.4% (121) were vaccinated for their age, 7.8% (32) experienced dropout in their vaccination, and 6.1% (\u003cspan class=\"CitationRef\"\u003e25\u003c/span\u003e) children were zero doses (Fig. \u003cspan class=\"InternalRef\"\u003e2\u003c/span\u003e). Reasons cited for not vaccinating their children included a lack of information, lack of motivation, and obstacles related to the place and time of vaccination. Among children who received at least one dose 77.8% (301) were provided with EPI cards, and 141 of them showed the cards to interviewers, resulting in a card retention rate of 46.8%.\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec20\" class=\"Section2\"\u003e\n \u003ch2\u003eFactors Affecting Immunization Services\u003c/h2\u003e\n \u003cp\u003eMothers\u0026apos; education, Husband\u0026apos;s education, Occupation of the husband, Perceived wealth status, Community-Based Health Insurance (CBHI), Antenatal Care (ANC) follow-up, Tetanus Toxoid 2\u0026thinsp;+\u0026thinsp;vaccination (TD2+), Place of birth, Growth Monitoring and Promotion (GMP), accessibility of health facility, and Postnatal Care (PNC) were found to have a P-value less than 0.25 in the binary logistic regression and then included in the multiple logistic regression analysis.\u003c/p\u003e\n \u003cp\u003eWomen who did not attend ANC were 92% less likely to vaccinate their children according to the schedule, compared to mothers who attended ANC follow-up (Adjusted Odds Ratio [AOR]\u0026thinsp;=\u0026thinsp;0.082, 95% Confidence Interval [CI]: 0.009\u0026ndash;0.777). Similarly, children who were born at home were 82% less likely to receive their immunization services as per schedule compared to those born at a facility level (AOR\u0026thinsp;=\u0026thinsp;0.18, 95% CI: 0.046\u0026ndash;0.703). Families not enrolled in the CBHI scheme were 66% less likely to vaccinate their children according to the vaccination schedules compared to those who paid for CBHI services (AOR\u0026thinsp;=\u0026thinsp;0.34, 95% CI: 0.125\u0026ndash;0.923). Children living in less health service-accessible areas were 89% less likely to vaccinate their children according to the schedule compared to those living within accessible areas (AOR\u0026thinsp;=\u0026thinsp;0.11, 95% CI: 0.04\u0026ndash;0.32) (Table \u003cspan class=\"InternalRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e\n \u003cp\u003eVariables such as Mothers\u0026apos; education, Husbands\u0026apos; education, Occupation of the husband, Perceived wealth status, TD2+, Growth Monitoring and Promotion (GMP), and PNC showed no statistically significant association with child vaccination (p\u0026thinsp;\u0026gt;\u0026thinsp;0.05).\u003c/p\u003e\n \u003cdiv class=\"gridtable\"\u003e\n \u003cp\u003e\u003cstrong\u003eTable 2,\u003c/strong\u003e Table Odds ratios from multinomial logistic regression on immunization service with socioeconomic status, Wolaita, Sodo town, SNNPR, July 2022 (AOR \u0026nbsp;95% CI) (N=420).\u003c/p\u003e\n \u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"642\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"34.57943925233645%\" colspan=\"2\" rowspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003eVariable\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"28.97196261682243%\" colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003eImmunization status\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"36.44859813084112%\" colspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e95% CI of OR\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"24.285714285714285%\" valign=\"top\"\u003e\n \u003cp\u003eFully immunized \u0026nbsp;\u003c/p\u003e\n \u003cp\u003e( n=354)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"20%\" valign=\"top\"\u003e\n \u003cp\u003eNot Fully immunized \u0026nbsp;(n=57)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"25.714285714285715%\" valign=\"top\"\u003e\n \u003cp\u003eCOR\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"30%\" valign=\"top\"\u003e\n \u003cp\u003eAOR\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"12.149532710280374%\" rowspan=\"5\" valign=\"top\"\u003e\n \u003cp\u003eMothers education\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.429906542056074%\" valign=\"top\"\u003e\n \u003cp\u003eDiploma and above\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.88785046728972%\" valign=\"top\"\u003e\n \u003cp\u003e80 (92.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.08411214953271%\" valign=\"top\"\u003e\n \u003cp\u003e7 (8.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.822429906542055%\" valign=\"top\"\u003e\n \u003cp\u003e4.39 (1.51 \u0026nbsp;12.71)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.626168224299064%\" valign=\"top\"\u003e\n \u003cp\u003e2.65 (0.37 \u0026nbsp;19.08)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"25.53191489361702%\" valign=\"top\"\u003e\n \u003cp\u003ePrimary education\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.085106382978722%\" valign=\"top\"\u003e\n \u003cp\u003e128 (83.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.893617021276595%\" valign=\"top\"\u003e\n \u003cp\u003e26 (16.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.148936170212767%\" valign=\"top\"\u003e\n \u003cp\u003e1.89 (0.81 \u0026nbsp;4.39)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.340425531914892%\" valign=\"top\"\u003e\n \u003cp\u003e1.33 (0.29 \u0026nbsp;6.060)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"25.53191489361702%\" valign=\"top\"\u003e\n \u003cp\u003eRead and write\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.085106382978722%\" valign=\"top\"\u003e\n \u003cp\u003e31 (81.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.893617021276595%\" valign=\"top\"\u003e\n \u003cp\u003e7 (18.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.148936170212767%\" valign=\"top\"\u003e\n \u003cp\u003e1.70 (0.57 5.10)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.340425531914892%\" valign=\"top\"\u003e\n \u003cp\u003e3.72 (0.49 \u0026nbsp;28.07)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"25.53191489361702%\" valign=\"top\"\u003e\n \u003cp\u003eSecondary education\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.085106382978722%\" valign=\"top\"\u003e\n \u003cp\u003e89 (92.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.893617021276595%\" valign=\"top\"\u003e\n \u003cp\u003e7 (7.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.148936170212767%\" valign=\"top\"\u003e\n \u003cp\u003e4.89 (1.69 \u0026nbsp;14.12)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.340425531914892%\" valign=\"top\"\u003e\n \u003cp\u003e2.47 (0.44 \u0026nbsp;14.07)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"25.53191489361702%\" valign=\"top\"\u003e\n \u003cp\u003eUnable read and write\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.085106382978722%\" valign=\"top\"\u003e\n \u003cp\u003e26 (72.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.893617021276595%\" valign=\"top\"\u003e\n \u003cp\u003e10 (27.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.148936170212767%\" valign=\"top\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.340425531914892%\" valign=\"top\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"12.149532710280374%\" rowspan=\"6\" valign=\"top\"\u003e\n \u003cp\u003eHusband education\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.429906542056074%\" valign=\"top\"\u003e\n \u003cp\u003eDiploma and above\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.88785046728972%\" valign=\"top\"\u003e\n \u003cp\u003e104 (91.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.08411214953271%\" valign=\"top\"\u003e\n \u003cp\u003e10 (8.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.822429906542055%\" valign=\"top\"\u003e\n \u003cp\u003e10.40(2.82 \u0026nbsp;38.33)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.626168224299064%\" valign=\"top\"\u003e\n \u003cp\u003e2.92 (0.16 \u0026nbsp;52.31)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"25.53191489361702%\" valign=\"top\"\u003e\n \u003cp\u003eNot available\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.085106382978722%\" valign=\"top\"\u003e\n \u003cp\u003e2 (22.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.893617021276595%\" valign=\"top\"\u003e\n \u003cp\u003e7 (77.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.148936170212767%\" valign=\"top\"\u003e\n \u003cp\u003e3.50(0.50 \u0026nbsp;24.27)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.340425531914892%\" valign=\"top\"\u003e\n \u003cp\u003e2.05 (0.09 \u0026nbsp;46.54)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"25.53191489361702%\" valign=\"top\"\u003e\n \u003cp\u003ePrimary education\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.085106382978722%\" valign=\"top\"\u003e\n \u003cp\u003e111 (84.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.893617021276595%\" valign=\"top\"\u003e\n \u003cp\u003e20 (15.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.148936170212767%\" valign=\"top\"\u003e\n \u003cp\u003e5.550 (1.63 18.94)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.340425531914892%\" valign=\"top\"\u003e\n \u003cp\u003e5.01 (0.59 \u0026nbsp;42.56)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"25.53191489361702%\" valign=\"top\"\u003e\n \u003cp\u003eRead and write\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.085106382978722%\" valign=\"top\"\u003e\n \u003cp\u003e23 (71.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.893617021276595%\" valign=\"top\"\u003e\n \u003cp\u003e9 (28.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.148936170212767%\" valign=\"top\"\u003e\n \u003cp\u003e2.56(0.65 \u0026nbsp;10.05)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.340425531914892%\" valign=\"top\"\u003e\n \u003cp\u003e9.60 (0.81 114.22)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"25.53191489361702%\" valign=\"top\"\u003e\n \u003cp\u003eSecondary education\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.085106382978722%\" valign=\"top\"\u003e\n \u003cp\u003e103 (91.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.893617021276595%\" valign=\"top\"\u003e\n \u003cp\u003e10 (8.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.148936170212767%\" valign=\"top\"\u003e\n \u003cp\u003e10.30 (2.79 37.97)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.340425531914892%\" valign=\"top\"\u003e\n \u003cp\u003e4.20 (0.40 \u0026nbsp;43.67)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"25.53191489361702%\" valign=\"top\"\u003e\n \u003cp\u003eUnable to read and write\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.085106382978722%\" valign=\"top\"\u003e\n \u003cp\u003e6 (50.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.893617021276595%\" valign=\"top\"\u003e\n \u003cp\u003e6 (50.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.148936170212767%\" valign=\"top\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.340425531914892%\" valign=\"top\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"12.149532710280374%\" rowspan=\"5\" valign=\"top\"\u003e\n \u003cp\u003eOccupation of the husband\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.429906542056074%\" valign=\"top\"\u003e\n \u003cp\u003eDaily laborers\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.88785046728972%\" valign=\"top\"\u003e\n \u003cp\u003e65 (84.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.08411214953271%\" valign=\"top\"\u003e\n \u003cp\u003e12 (15.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.822429906542055%\" valign=\"top\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.626168224299064%\" valign=\"top\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"25.53191489361702%\" valign=\"top\"\u003e\n \u003cp\u003eFarmer\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.085106382978722%\" valign=\"top\"\u003e\n \u003cp\u003e40 (66.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.893617021276595%\" valign=\"top\"\u003e\n \u003cp\u003e20 (33.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.148936170212767%\" valign=\"top\"\u003e\n \u003cp\u003e0.37(0.16 \u0026nbsp;0.84)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.340425531914892%\" valign=\"top\"\u003e\n \u003cp\u003e3.90 (0.62 24.51)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"25.53191489361702%\" valign=\"top\"\u003e\n \u003cp\u003eGovernmental employee\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.085106382978722%\" valign=\"top\"\u003e\n \u003cp\u003e100 (90.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.893617021276595%\" valign=\"top\"\u003e\n \u003cp\u003e10 (9.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.148936170212767%\" valign=\"top\"\u003e\n \u003cp\u003e1.85 (0.75 \u0026nbsp;4.52)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.340425531914892%\" valign=\"top\"\u003e\n \u003cp\u003e0.74 (0.11 \u0026nbsp;4.99)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"25.53191489361702%\" valign=\"top\"\u003e\n \u003cp\u003eMerchant\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.085106382978722%\" valign=\"top\"\u003e\n \u003cp\u003e104 (92.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.893617021276595%\" valign=\"top\"\u003e\n \u003cp\u003e9 (8.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.148936170212767%\" valign=\"top\"\u003e\n \u003cp\u003e2.13 (0.85 \u0026nbsp;5.34)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.340425531914892%\" valign=\"top\"\u003e\n \u003cp\u003e0.87 (0.26 \u0026nbsp;2.95)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"25.53191489361702%\" valign=\"top\"\u003e\n \u003cp\u003eOthers\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.085106382978722%\" valign=\"top\"\u003e\n \u003cp\u003e45 (88.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.893617021276595%\" valign=\"top\"\u003e\n \u003cp\u003e6 (11.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.148936170212767%\" valign=\"top\"\u003e\n \u003cp\u003e1.38 (0.48 \u0026nbsp;3.96)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.340425531914892%\" valign=\"top\"\u003e\n \u003cp\u003e0.38 (0.08 \u0026nbsp;1.80)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"12.149532710280374%\" rowspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003eWealth status\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.429906542056074%\" valign=\"top\"\u003e\n \u003cp\u003eMedium\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.88785046728972%\" valign=\"top\"\u003e\n \u003cp\u003e290 (91.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.08411214953271%\" valign=\"top\"\u003e\n \u003cp\u003e28 (8.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.822429906542055%\" valign=\"top\"\u003e\n \u003cp\u003e4.69 (2.61 \u0026nbsp;8.43)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.626168224299064%\" valign=\"top\"\u003e\n \u003cp\u003e2.00 (0.71 \u0026nbsp;5.67)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"25.53191489361702%\" valign=\"top\"\u003e\n \u003cp\u003eLow\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.085106382978722%\" valign=\"top\"\u003e\n \u003cp\u003e64 (68.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.893617021276595%\" valign=\"top\"\u003e\n \u003cp\u003e29 (31.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.148936170212767%\" valign=\"top\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.340425531914892%\" valign=\"top\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"12.149532710280374%\" rowspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003eCBHI\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.429906542056074%\" valign=\"top\"\u003e\n \u003cp\u003eNot participated\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.88785046728972%\" valign=\"top\"\u003e\n \u003cp\u003e237 (83.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.08411214953271%\" valign=\"top\"\u003e\n \u003cp\u003e46 (16.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.822429906542055%\" valign=\"top\"\u003e\n \u003cp\u003e0.48 (0.24 \u0026nbsp;0.97)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.626168224299064%\" valign=\"top\"\u003e\n \u003cp\u003e0.34 (0.12 \u0026nbsp;0.92)*\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"25.53191489361702%\" valign=\"top\"\u003e\n \u003cp\u003eParticipated\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.085106382978722%\" valign=\"top\"\u003e\n \u003cp\u003e117 (91.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.893617021276595%\" valign=\"top\"\u003e\n \u003cp\u003e11 (8.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.148936170212767%\" valign=\"top\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.340425531914892%\" valign=\"top\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"12.149532710280374%\" rowspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003eANC follow-up\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.429906542056074%\" valign=\"top\"\u003e\n \u003cp\u003eNot attended\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.88785046728972%\" valign=\"top\"\u003e\n \u003cp\u003e237 (83.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.08411214953271%\" valign=\"top\"\u003e\n \u003cp\u003e46 (16.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.822429906542055%\" valign=\"top\"\u003e\n \u003cp\u003e0.02 (0.01 \u0026nbsp;0.06)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.626168224299064%\" valign=\"top\"\u003e\n \u003cp\u003e0.082 (0.01 \u0026nbsp;0.78)*\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"25.53191489361702%\" valign=\"top\"\u003e\n \u003cp\u003eAttended\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.085106382978722%\" valign=\"top\"\u003e\n \u003cp\u003e117 (91.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.893617021276595%\" valign=\"top\"\u003e\n \u003cp\u003e11 (8.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.148936170212767%\" valign=\"top\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.340425531914892%\" valign=\"top\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"12.149532710280374%\" rowspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003eTD2+\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.429906542056074%\" valign=\"top\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.88785046728972%\" valign=\"top\"\u003e\n \u003cp\u003e19 (47.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.08411214953271%\" valign=\"top\"\u003e\n \u003cp\u003e21 (52.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.822429906542055%\" valign=\"top\"\u003e\n \u003cp\u003e0.10 (0.05 \u0026nbsp;0.20)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.626168224299064%\" valign=\"top\"\u003e\n \u003cp\u003e0.50 (0.14 \u0026nbsp;1.75)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"25.53191489361702%\" valign=\"top\"\u003e\n \u003cp\u003eYes\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.085106382978722%\" valign=\"top\"\u003e\n \u003cp\u003e335 (90.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.893617021276595%\" valign=\"top\"\u003e\n \u003cp\u003e36 (9.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.148936170212767%\" valign=\"top\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.340425531914892%\" valign=\"top\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"12.149532710280374%\" rowspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003ePlace of birth\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.429906542056074%\" valign=\"top\"\u003e\n \u003cp\u003eHealth facility\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.88785046728972%\" valign=\"top\"\u003e\n \u003cp\u003e338 (91.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.08411214953271%\" valign=\"top\"\u003e\n \u003cp\u003e30 (8.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.822429906542055%\" valign=\"top\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.626168224299064%\" valign=\"top\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"25.53191489361702%\" valign=\"top\"\u003e\n \u003cp\u003eHome\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.085106382978722%\" valign=\"top\"\u003e\n \u003cp\u003e16 (37.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.893617021276595%\" valign=\"top\"\u003e\n \u003cp\u003e27 (62.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.148936170212767%\" valign=\"top\"\u003e\n \u003cp\u003e0.05 (0.03 \u0026nbsp;0.11)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.340425531914892%\" valign=\"top\"\u003e\n \u003cp\u003e0.18 (0.05 \u0026nbsp;0.70)*\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"12.149532710280374%\" rowspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003eGMP\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.429906542056074%\" valign=\"top\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.88785046728972%\" valign=\"top\"\u003e\n \u003cp\u003e313 (85.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.08411214953271%\" valign=\"top\"\u003e\n \u003cp\u003e55 (14.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.822429906542055%\" valign=\"top\"\u003e\n \u003cp\u003e0.28 \u0026nbsp;(0.06 \u0026nbsp;1.18)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.626168224299064%\" valign=\"top\"\u003e\n \u003cp\u003e1.114 (0.21 \u0026nbsp;5.94)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"25.53191489361702%\" valign=\"top\"\u003e\n \u003cp\u003eYes\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.085106382978722%\" valign=\"top\"\u003e\n \u003cp\u003e41 (95.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.893617021276595%\" valign=\"top\"\u003e\n \u003cp\u003e2 (4.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.148936170212767%\" valign=\"top\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.340425531914892%\" valign=\"top\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"12.149532710280374%\" rowspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003eAccess to health facilities\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.429906542056074%\" valign=\"top\"\u003e\n \u003cp\u003eOne to five KM\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.88785046728972%\" valign=\"top\"\u003e\n \u003cp\u003e317 (92.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.08411214953271%\" valign=\"top\"\u003e\n \u003cp\u003e26 (7.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.822429906542055%\" valign=\"top\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.626168224299064%\" valign=\"top\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"25.53191489361702%\" valign=\"top\"\u003e\n \u003cp\u003eSix and above KM\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.085106382978722%\" valign=\"top\"\u003e\n \u003cp\u003e37 (54.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.893617021276595%\" valign=\"top\"\u003e\n \u003cp\u003e31 (45.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.148936170212767%\" valign=\"top\"\u003e\n \u003cp\u003e0.10 (0.05 \u0026nbsp;0.18)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.340425531914892%\" valign=\"top\"\u003e\n \u003cp\u003e0.11 (0.04 \u0026nbsp;0.32)*\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"12.149532710280374%\" rowspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003ePNC\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.429906542056074%\" valign=\"top\"\u003e\n \u003cp\u003eNo\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"15.88785046728972%\" valign=\"top\"\u003e\n \u003cp\u003e226 (83.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.08411214953271%\" valign=\"top\"\u003e\n \u003cp\u003e46 (16.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.822429906542055%\" valign=\"top\"\u003e\n \u003cp\u003e0.42 (0.21 \u0026nbsp; 0.84)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.626168224299064%\" valign=\"top\"\u003e\n \u003cp\u003e0.56 (0.20 \u0026nbsp;1.54)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"25.53191489361702%\" valign=\"top\"\u003e\n \u003cp\u003eYes\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.085106382978722%\" valign=\"top\"\u003e\n \u003cp\u003e128 (92.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.893617021276595%\" valign=\"top\"\u003e\n \u003cp\u003e11 (7.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"19.148936170212767%\" valign=\"top\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.340425531914892%\" valign=\"top\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n \u003cp\u003e\u003cstrong\u003e* Significant at P value less than 0.05\u003c/strong\u003e\u003c/p\u003e\n \u003c/div\u003e\n\u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eAmong children who enrolled in the study 92.7% (381) and 91.0% (374) received the first and third doses of pentavalent vaccines respectively. Similarly, 293 (71.3%) children received MCV1 and 270 (65.7.6%) received MCV2 vaccines. The overall vaccination status of children was 56.7% were fully vaccinated, 29.4% were vaccinated for age as per national standard, 7.8% dropped their vaccination and 6.% were never vaccinated. Factors such as ANC visits, facility deliveries, enrollment of community health insurance, and access to health service-providing facilities were found to have a statistically significant association with immunization services.\u003c/p\u003e \u003cp\u003eThe coverage of all key antigens in this study did not reach the optimum level of 95%. However, it was higher than what was reported in the 2019 preliminary Ethiopian Demographic and Health Survey (EDHS) (\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e). This difference may be attributed to variations in the timing of the studies and improvements in the urban immunization program in Sodo town. The prevalence of zero doses was consistent in this study and a national-level study conducted by Project HOPE in 2022, which were 6.1% and 6.2% respectively (\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eIn the study conducted by Tamirat and Sisay involving further analysis of the 2016 Ethiopian Demographic and Health Survey (EDHS) (\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e), ANC follow-ups and skilled delivery assisted by health workers at the facility level had statistically significant associations with child immunization. This finding aligns with the results of the current study, indicating that mothers who did not attend ANC follow-up were 92% less likely to adhere to their child's immunization schedules compared to mothers who attended ANC follow-up. Similarly, mothers who gave birth at home were 82% less likely to vaccinate their children compared to those who gave birth at health facilities assisted by healthcare providers. These findings suggest that attending ANC services and delivering at health facilities might serve as motivating factors for mothers to follow through with vaccinating their children according to immunization schedules.\u003c/p\u003e \u003cp\u003eAs indicated in the study conducted by Gashaw et.al at the national level, the absence of health facilities in remote kebeles or inaccessibility due to distance or topographic barriers is a major challenge for reaching unvaccinated children (\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e). In this study, children who were living in less health service-accessible areas were 89% less likely to vaccinate their children according to the schedule compared to those who were inaccessible areas. This finding is consistent with the study conducted in Nigeria, specifically in Anambra States by Sibeudu, Uzochukwu, and Onwujekwe, which identified distance as one of the factors significantly associated with not vaccinating children (\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e). Constructing health facilities that provide comprehensive healthcare within the community might improve the immunization uptake of children. CBHI is believed to increase the health-seeking behavior of the community. In this study, families who were not involved in the CBHI scheme were 66% less likely to vaccinate their children according to the vaccination schedules compared to those who paid for CBHI services, indicating that CBHI services have an impact on the uptake of immunization services.\u003c/p\u003e \u003cp\u003eVaccination cards are crucial tools used to ensure that children receive all recommended vaccinations according to schedule (\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e). The 2019 Ethiopian mini-demographic health survey obtained vaccination coverage information from written vaccination cards, mothers' verbal reports, and health facility records (\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e). Similarly, the data in this study were obtained from any card providing information on child immunization history and mothers' verbal reports. The card retention rate in this study was 46.8% which is much lower than in the study conducted in the mini-2019 EDHS (\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e), where the card retention rate was 62%. The low card availability in this study might be attributed to the inadequate supply of EPI cards from the Regional health bureau and zonal health department since 2021. The low provision and retention of EPI cards could impact understanding the status of EPI services and monitoring EPI programs in Sodo town.\u003c/p\u003e"},{"header":"Conclusions","content":"\u003cp\u003eThe coverage for all examined antigens in the study fell below the recommended threshold of 95%, indicating a risk of vaccine-preventable disease outbreaks in the community. Factors such as mothers attending ANC services and giving birth at health facilities were identified as strong motivators for proper adherence to their child's vaccination schedule. Additionally, access to health facilities or outreach immunization services played a crucial role in encouraging mothers or caretakers to attend their children's immunization sessions. Enrollment CBHI scheme also proved to be effective in incentivizing mothers or caregivers to seek healthcare services at health facilities or vaccination services.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003eDOR Dropout rate\u003c/p\u003e \u003cp\u003eDPT Diaphteria, Petisussia and Tetanus\u003c/p\u003e \u003cp\u003eEPI Expanded Program of Immunization\u003c/p\u003e \u003cp\u003eIPV Inactivated Polio Vaccine\u003c/p\u003e \u003cp\u003eMCV measles-containing vaccine\u003c/p\u003e \u003cp\u003ePCV Pneumococcal Conjugated Vaccine\u003c/p\u003e \u003cp\u003ePenta Pentavalent vaccine\u003c/p\u003e \u003cp\u003eTD Tetanus Toxoid and diphtheria\u003c/p\u003e \u003cp\u003eVPD Vaccine-Preventable Diseases\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eAcknowledgments\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe completion of this study was made possible with the invaluable support and contributions of all the participants and research assistants involved. The authors extend their heartfelt gratitude to every individual who played a part in the successful completion of this research.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026rsquo; contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eHB wrote the proposal, study design, methods and drafting of the manuscript; \u0026nbsp;DS contributed to the study design, data collection and conducted the statistical analysis; SG conceived the methodology and provided overall guidance, and collaborated on the manuscript draft; TS contributed to drafting the final versions of the manuscript; MM collaborated on statistical analysis and manuscript draft; AS collaborated on the methodology and manuscript draft and initiated publication of the study; SB contributed in the study design and proofreading. All authors read and approved the final manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study did not receive funds from any company or institution.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData Availability\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors confirm that the data supporting the findings of this study are available and it can be presented on request from the corresponding author.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe study was approved by Wolaita Zone Health Department Research Review Committee (Ethics Approval Number:\u0026nbsp;WZH/5955/224\u0026nbsp;Dated\u0026nbsp;25/09/2015 EC). All procedures and methods performed adhere to ethical principles. Informed consent was obtained from all caretakers who voluntarily participated in the study. The participant information sheet helped them read and ask questions before consenting in writing (face to face) before the interviews.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare no competing interests.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eUN Habitat (2016) World Cities Report 2016. Urbanization and Development: Emerging Futures. Pub. United Nations, New York\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eDesa United Nation (2018) World Urbanization Prospects, the 2018 Revision. Population Division, department of economic and social affairs, United Nations Secretariat\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eUnited Nations (2014) World Urbanization Prospects: 2014 Revision. 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BMJ open 13(3). \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttp://doi:10.1136/bmjopen-2022-069278\u003c/span\u003e\u003cspan address=\"http://doi:10.1136/bmjopen-2022-069278\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eEthiopian Public Health Institute (EPHI) Ethiopia Mini Demographic and Health Survey 2019: Rockville, Maryland, USA: EPHI and ICF\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKassaw A, Abebe GMA, Kebede A, Kebede F Assessment of Magnitude and Associated Factors of Immunization Drop Out Rate for Children Aged 12\u0026ndash;23 Months In Abobo District South West Ethiopia 2021.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":true,"hideJournal":true,"highlight":"","institution":"Wolaita Sodo University","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":"Urbanization, Immunization service, Zero doses, Dropout","lastPublishedDoi":"10.21203/rs.3.rs-4223196/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-4223196/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eIntroduction:\u003c/h2\u003e \u003cp\u003eThe world continued to be urbanized with approximately 55% of the world's population and it is expected to increase to 68 per cent by 2050. Urban areas generally have better healthcare resources and higher immunization coverage compared to rural one. However, the challenge of zero doses and under-immunization exist in urban. These variation within urban communities exist due to factors such as population mobility, socio-economic and demographic disparities, and vaccine hesitancy. Therefore, this study tried to assess factors that enhance or affect the delivery of immunization services in Wolaita Sodo town.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eA community-based cross-sectional study design was conducted among 411 children aged 0\u0026ndash;35 months. Participants were selected using simple random sampling method through a multi-stage approach. Data were collected using a structured questionnaire using ODK (Open Data Kit) mobile app. The collected data were analyzed using the Statistical Package for the Social Sciences software version 25 (SPSS). Bivariate and multivariable logistic regression analysis was performed.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eFully vaccinated and vaccinated for their age as per the national schedule were 56.7% and 29.4%, respectively. And, 7.8% experienced vaccination dropouts and 6.1% of children were never vaccinated. Significant associations were found between the completion of child immunization schedules and factors such as Antenatal Care follow-up AOR\u0026thinsp;=\u0026thinsp;0.082 with 95% CI (0.009\u0026ndash;0.777), facility delivery AOR\u0026thinsp;=\u0026thinsp;0.18 with 95% CI (0.046\u0026ndash;0.703), Community Health Insurance enrollemen OR\u0026thinsp;=\u0026thinsp;34 with 95% CI (0.125\u0026ndash;0.923), and health service access AOR\u0026thinsp;=\u0026thinsp;0.11 with 95 CI (0.04\u0026ndash;0.32).\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e \u003cp\u003eChildren aged 0\u0026ndash;35 months who properly attended their immunization schedule fell below the required optimum level of 95%. Efforts should be made to strengthen vaccination delivery points, promote ANC follow-up and facility deliveries, and enhance the enrollment of the CBHI scheme to improve immunization services in Sodo town.\u003c/p\u003e","manuscriptTitle":"The context of urban immunization services: The case of Sodo town, Wolaita Zone, South Ethiopia","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-04-08 19:00:20","doi":"10.21203/rs.3.rs-4223196/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":"33f965ad-9d6d-40f0-ac3e-d48b79fbe95a","owner":[],"postedDate":"April 8th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[{"id":30318516,"name":"Infectious Diseases"}],"tags":[],"updatedAt":"2024-04-08T19:00:20+00:00","versionOfRecord":[],"versionCreatedAt":"2024-04-08 19:00:20","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-4223196","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-4223196","identity":"rs-4223196","version":["v1"]},"buildId":"qtupq5eGEP_6zYnWcrvyt","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}