Timely vaccination and its associated factors among parents with children aged from 0-23 months in Wolaita Zone Public hospitals, southern Ethiopia, 2024: a facility-based cross-sectional study

Timely vaccination and its associated factors among parents with children aged from 0-23 months in Wolaita Zone Public hospitals, southern Ethiopia, 2024: a facility-based cross-sectional study | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Timely vaccination and its associated factors among parents with children aged from 0-23 months in Wolaita Zone Public hospitals, southern Ethiopia, 2024: a facility-based cross-sectional study Temesgen Geta Hardido, Bizuayehu Atinafu, Eshetu Elifios This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-4269919/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background In Ethiopia, vaccination is mentioned as the vital preventive measure of undue childhood mortality from measles, pneumonia, diarrheal diseases, and other VPDs. Although there are studies conducted on full vaccine coverage, there is relatively no data available about timely vaccination and its related factors in southern Ethiopia. Thus, this study assessed timely vaccination and related factors in children who age from 0 to 23 months in the study area. Methods and material: An institution-based cross-sectional study was undertaken in Wolaita zone Public hospitals, from December 2023, G.C to January 2024, G.C. A total of 376 study subjects were randomly selected through systematic sampling method among parents with children who are 0–23 months old. Data were gathered by questionnaire with a structure which was based on mother’s recalling as well as vaccination cards. A basic questionnaire was completed by respondents and the responses were entered into Epidata Version 4.6, which was later transferred to SPSS Version 23 for analysis. Data were entered into Epidata Version 4.6 and exported to SPSS Version 23 for analysis. An adjusted odds ratio (AOR) along with a 95% confidence interval at a P-value less than 0.05 was used to declare significance level. Results A total of 376 study participants responded to the interview with 100% response rate. This study found that 269 children (71.5%) were timely vaccinated and 107 children (28.5%) had not got their children vaccinated timely. The independent variables, like time to reach the health facility[AOR = 5.7; 95% CI (1.81,17.55), place of delivery[AOR = 4.91; 95% CI (2.85, 10.83)], ANC follow-up[AOR = 8; 95% CI (5.81, 25.01)], attitude[AOR = 2.5; 95% CI (1.23,4.3)] and knowledge [AOR = 3.45; 95% CI (1.61, 10.62)] on the vaccine time, significantly attributed to timely vaccination. Conclusion 71.5% of study participants vaccinated their children on the national recommended vaccination schedule. The research also revealed statistical correlation between time taken from home to health facility, antenatal care follow up, place of delivery, maternal attitude and knowledge of the prompt vaccination and vaccination timeline. For the all stake holders, highly strategic interventions like promoting maternal knowledge about the benefits versus risks of timely vaccination, community-based vaccination programs or campaigns, routine supervision, and counseling during antenatal visits are very effective ways of improving timely vaccination. Ethiopia. Mothers vaccination timelines 0–23 months Children Wolaita Zone Public hospitals Figures Figure 1 Figure 2 Introduction The timeliness of vaccination refers to a child receiving their vaccination at the recommended time and is calculated by subtracting the date of birth from the vaccination date. Vaccines were administered on time if they were received within the first year of life and within the time limits set by the World Health Organization (WHO) [ 1 ]. Vaccination timeliness is defined as administering vaccines at the earliest age possible and adhering to the recommended intervals between doses. The timing of vaccinations is an important mechanism for developing protective antibodies and providing effective disease protection in children. Only when an effective vaccine is administered at the right time will it result in disease protection by strengthening community immunity and preventing the spread of infectious diseases, particularly during illness outbreaks; increased adherence to vaccination timeliness protects children before exposure and lowers morbidity.[ 2 ]–[ 5 ]. It is crucial, especially for diseases like pertussis and Haemophilus influenzae type B (Hib), which cause the majority of deaths within the first six months of life. Additionally, prompt vaccination protects infants who are too young to receive a full vaccination and maximizes herd immunity [ 6 ]. On the other hand, early immunization may not produce an antibody that protects against the diseases [ 7 ]. Because vaccinations given too soon or without a suitable time interval between doses, may not be totally protective (lead to a misleading sensation of protection) [ 8 ]. Ad also, postponing immunizations raises a person's risk of contracting a potentially fatal VPD [ 9 ]. These will lead to lower community-level herd immunity and intervention success rates [ 10 ], full vaccination series completion rates [ 11 ], and elevated risk of infectious illnesses under control [ 12 ]. Globally, immunization is one of the maximum cost-effective techniques in growing infant survival, saving 2–3 million infant deaths every year from vaccine-preventable illnesses (VPDs) [ 13 ]. A vaccine can also additionally have avoided one disorder out of each twenty that claimed an infant’s life in 2019 [ 14 ]. Even with the excessive vaccination rate of 85% global in 2017, a few children nevertheless experience delays in receiving fundamental vaccinations, especially in low-profits countries [ 15 ]. Despite the truth that vaccination timing is an essential public health objective for monitoring vaccine adherence, this information is normally insufficient due to the fact the most extensively utilized metric is vaccination coverage [ 8 ]. Timeliness of vaccination is a measure of the quality of vaccination programs, but it has received less attention than other program performance indicators [ 16 ]. Therefore, inadequate supply chain management, limited access to health care, and suboptimal performance of service providers are contributing to suboptimal vaccination schedule timeliness in low- and middle-income countries (LMICs) around the world [ 17 ]. Additional country-specific studies are also needed to elucidate the impact of schedule completion bottlenecks on dose-specific delays in sub-Saharan African (SSA) countries [ 18 ]. Previous literature shows that 87.5% in Ghana, 94% in Israel, 82% in Philadelphia, 64% in Ethiopia, 71% in New Zealand and 87% in Uganda were vaccinated on time[ 19 ]–[ 24 ]. Previous studies have shown that the timeliness of vaccination is associated with place of delivery, lower education level, antenatal care visits, unplanned pregnancy and male gender of the child, and the oldest age of the mother/caregiver, maternal age, vaccine hesitancy, multipara, residency, and the poorest quintile. However, these variables vary depending on the study setting [ 5 ], [ 17 ], [ 25 ]–[ 29 ]. In Ethiopia, vaccinating children at an adequate time interval is the major method in minimizing avoidable childhood mortality from measles, pneumonia, diarrheal illnesses, and other VPDs [ 30 ]. In general, advanced countries have given cautious concept to the timing of childhood vaccinations; however, comprehensive research in low-earnings nations—specially Ethiopia—has been few[ 31 ]. Untimely vaccinations have significant impact on immune system functioning and are likely to contribute greatly to the preventable disease burden in Ethiopia, allowing for transmission among those in the age group at which they are the most vulnerable to severe disease with tragic consequences [ 32 ]. Previously, most studies conducted in Ethiopia assessed complete vaccination coverage and related factors; however, there is limited information about timely vaccination and its influencing factors, illustrating an essential research gap that must be filled. Because of this, full vaccination is most effective in identifying the number of children vaccinated, however it does not provide adequate information about the countrywide vaccination schedule, which is critical for protecting children from vaccine-preventable illnesses if they receive vaccines within the recommended timeframe. In addition, this study included children aged zero-11 months, which was excluded from previous research performed in Ethiopia. In order to help program implementers and frontline health workers recognize vaccination timelines and its related factors to plan for default tracing mechanisms. So, this study aimed to evaluate vaccination timelines and its related factors among children aged zero to 23 months in the study area. Methods and materials Study Area, design, and period A facility-based cross-sectional study was conducted in Wolaita zone public hospitals, Southern region, Ethiopia. Wolaita zone is located from 328 km from capital city of Ethiopia, Addis Ababa. Based on the 2020 Central Statistical Agency (CSA) report, the population of Wolaita zone was projected to be 5,385,782. From these, 2,687,021 populations are accounted by males and 2,698,261 populations were females. Currently, there are 8 public hospitals in this zone including Wolaita Sodo university comprehensive specialized hospital (WSUCSH), Bodit primary hospital PH, Gasuba PH, Tebela PH, Bale PH, Halale PH, Bombe PH, and Bitana PH. These public hospitals have been providing health service for all Wolaita zone population and some other surrounding zones. Source of population The source of population for the study was children aged between 0–23 months in Wolaita zone public hospitals. Study population All children aged between 0–23 months who attended EPI in Wolaita zone public hospitals on the study period. Inclusion and exclusion criteria Inclusion criteria The inclusion criterion was all mothers/care givers with children aged 0–23 months came to each study area for EPI service during data collection period. Exclusion criteria •Children under 24 months old who Immune-compromised children such as a child with clinical AIDS •Those mothers/caregivers who are unable to respond after details of the study purpose were provided during data collection were excluded. Sample size and sampling technique Based on the following assumptions, the sample size was calculated using a population proportion calculation formula. A 95% confidence interval (CI), an error rate of 5%, and a population proportion of 44% were taken from the previous study [ 24 ]. Based on the calculations, 378 participants were needed for the study. A total of four public hospitals in the Wolaita zone were included in the study. During six consecutive months, an average of 3,615 clients used EPI services. In addition, since the population was less than 10,000, we used the correction formula and got a sample size of 342. Taking into account the 10% non-response rate, the total sample for the study was 376. After considering these service centers' monthly customer flows, the final sample size is allocated proportionally. As a final step, a systematic random sampling was used to select the subjects (Fig. 1 ). Data collection tool and procedure Adapted structured questionnaire tool through reviewing numerous preceding research have been used to collect data [ 25 ]–[ 30 ]. It consisted of 4 parts, which include socio-demographic characteristics, obstetric characteristics, knowledge and attitudinal factors about vaccination timeliness. The questionnaires have been first prepared in English after which translated through the specialists into local languages (Wolaita version) after which translated again into English to test for consistency. Data have been gathered through face-to-face interviews and referring immunization card using pretested, structured questionnaires after the women have been briefed about the studies on the time of the EPI visit. Data have been collected through 4 BSC midwives who should hear, speak, and read the local language and M.Sc. nurses who already had data collection and supervising experience respectively. Data quality and analysis Training was held for data collectors and supervisors to ensure data quality.The questionnaire was initially pretested on 5% of women at Boditt Primary Hospital. Throughout the data collection process, the principal investigator and supervisor provided frequent monitoring and observation. After daily data collection, each questionnaire was checked for completeness and accuracy. Completeness and consistency were checked, coded, and entered into Epidata Version 4.6 and exported to SPSS Version 23 for analysis. One variable with a p-value less than 0.25 in the bivariate analysis was recruited for the multivariable logistic regression analysis model. An adjusted odds ratio (AOR) along with a 95% confidence interval at a P-value less than 0.05 in the multivariable logistic regression model was used to declare factors significantly associated with the vaccination timeliness. Study variables Dependent variable Vaccination timelines Independent variable Socio-demographic characteristics, children and obstetric related factors, knowledge about and attitude towards timely vaccination Operational definitions Vaccination timeliness - The program of immunization are recommended as WHO at minimum interval at birth (BCG and Polio0), 6_weeks (Penta1, Polio1, Rota1, PCV1), 10_weeks (Penta2, polio 2, Rota2, PCV2), 14_weeks (penta3, Polio3, IPV, PCV3) and Measles at 9_months, and 15 months [ 1 ], [ 33 ] (Table 1 ) Table 1 National and WHO recommended vaccination timelines Vaccine WHO recommendation Operational definition Minimum age Minimum interval Early Delayed BCG and OPV 0 At birth 4 weeks - > 4weeks DTP-HepB1-Hib1, OPV1, PCV1, Rota1 6 weeks 4 weeks 10 weeks DTP-HepB2-Hib2, OPV2, PCV2, Rota2 10 weeks 4 weeks 14 weeks DTP-HepB3-Hib3, OPV3, PCV3, IPV 14 weeks 4 weeks 18 weeks Measles first dose 9 months 4 weeks 10 months Measles second dose 15–18 months - - - Vaccination timely (Age-appropriate vaccination):- The delivery of vaccines within the World Health Organization (WHO) approved time frames and checked by immunization card. And /or the delivery of vaccines within one month after the minimum age to administer the dose as recommended by WHO [ 1 ], [ 33 ]. Vaccination Untimely (Age-inappropriate vaccination):- The delivery of vaccines earlier and/or delayed than the recommended age by WHO[ 1 ], [ 33 ]. Delay vaccination -was measured as not having received the recommended vaccine doses within one month beyond the minimum age [ 1 ], [ 33 ]. Early vaccination - doses given before the minimum age [ 1 ], [ 33 ]. Maternal knowledge about vaccination timeliness Was measured using six questions related to vaccination timeliness. Each correct answer was given a point of one (1) and zero (0) point was given to the incorrect ones. Those who scored mean and less than the mean value were categorized as having poor knowledge and those who scored above the mean were categorized as having good knowledge [ 33 ]. Maternal attitude towards vaccination timeliness Was assessed using nine [ 9 ] items rated on a five-point Likert scale as [ 1 ] strongly agree, [ 2 ] agree, [ 3 ] not sure, [ 4 ] disagree, and [ 5 ] strongly disagree. For the purpose of ease of analysis, attitude of mothers towards vaccination timeliness items were condensed into three categories as “agree”, “disagree,” and “not sure”. Furthermore, the attitude measurement Likert scale was summarized as “positive attitude” (those who scored the mean and above on attitude measuring items) and “negative attitude” (those who scored below the mean on attitude measuring items) [ 33 ]. Results Socio-demographic Characteristics Of 376 mothers/caregivers, all participants responded to the interviews, making a response rate of 100%. Table 1 shows the social and demographic characteristics of the study participants. Among the sample, 186(49.5%) were Relationship with Mother, 34 (9%) were Relationship with Father, 72 (19.2%) were Relationship with Relative, and 84 (22.3%) were Relationship with Sister or brother And from a total of 376 study participants, 9 (2.4%) were Age of mother below 18,115(30.6%) were the age of 18–28,169(44.9%) were the age of 28–38, and 83 (22.1%) had 38 and above age of mother. The majorities respondent 345 (92%) were married and 12(3%) were widowed. 267 (71%) were protestant religion followers and 16 (4.2%) were Muslim religion followers (Table 2 ). Table 2 Socio demographic characteristics of the respondent in Wolaiata zone public hospitals, (n = 376) Variables Categories Frequency Percentage Is the child 0–24 months of age Yes 376 100 No 0 0 Relationship with the child Mother 186 49.5 Father 34 9 Relative 72 19.2 Sister or brother 84 22.3 Age of caregivers in year Below 18 9 2.4 18–28 115 30.6 28–38 169 44.9 38 and above 83 22.1 Marital status of the mother or care giver Married 345 92.0 Single 0 0 Divorced 18 5.0 Widowed 12 3.0 Religion of mother or care giver Orthodox 87 23.1 Protestant 267 71.0 Muslim 16 4.2 Catholic 4 1.2 Other 2 0.5 Ethnicity of mother or care giver Oromo 9 2.4 Gurage 16 4.3 Amhara 13 3.5 Wolaita 310 82.4 Other 28 7.4 Occupation of mother or care giver Housewife 160 42.6 Merchant 96 25.5 Government employer 106 28.2 Student 14 3.7 Education status of mother or care giver No formal education 34 9.3 Primary school 168 44.7 Secondary school 96 25.7 College or above 76 20.3 Distance from home < 30 minute 300 79.8 ≥ 30 minute 76 20.2 Obstetric characteristics of the study Majority children 98.7% were born at health institution, while 1% of them at home. In addition, majority of the children were ever took more doses of vaccine, out of these only 2% of them had no vaccination card during the study. Out of 376 (100%) respondents 367 (97.6%) said their child has received at least one vaccine and, 9 (2.4%) of them not vaccinated. Out of 376 (100%) respondent 368 (98%) were able to provide the vaccinated card and 8 (2%) were no vaccinated card. This study revealed that from 376 participants, 259(69%) had good knowledge about vaccination timeliness whereas 117(31%) of them had a poor knowledge. It also revealed that 241(64%) participants had positive attitude about vaccination timeliness whereas 135(36%) of them had negative attitude. The majority of the children were in the age of 0–8 months group 228(60.6%) followed by the age group of 9–16 months group 91(24.2%) (Table 3 ). Table 3 Obstetric characteristics of the study in Wolaita zone public hospitals, 2024 (n = 376) Variable Category Frequency Percent Number of < 2year children 0–12 month 363 96.5 13–24 month 13 3.5 Sex of children Male 162 43.1 Female 264 56.9 Age of children in month 0–8 228 60.6 9–16 91 24.2 Place of delivery Home 5 1.3 Health institution 371 98.7 Ever vaccinated Yes 360 95.7 No 16 4.3 Had vaccination card Yes 368 98 No 8 2 Knowledge about VT Good 259 69 Poor 117 31 Attitude towards VT Positive 241 64 Negative 135 36 ANC follow up Yes 336 89.4 No 40 10.6 VT-Vaccine timeliness Vaccination timelines by card plus maternal recall By combining the evidence of cards and parents recall vaccination timelines, 128(83.1%) took vaccination timely and 26(16.9%) took it untimely at birth respectively. Regarding six week schedule, 57(72.2%) took vaccination timely on the recommended period whereas 22(27.8%) vaccinated untimely. 45(72.5%) took vaccination timely at ten week whereas 17(27.5%) took vaccination untimely at ten week. 26(49.1%) took vaccination timely fourteen week whereas 27(50.9%) took vaccination untimely at fourteen week. 9(52.9%) Vaccinated timely at nine month whereas 8(47.1%) unvaccinated timely at nine month. 4(36.4%) took fifteen month whereas 3.6% took vaccination untimely at fifteen month. Overall 269(71.5%) took vaccination timely and 107(28.5%) took untimely. Of the total 107 of children who did not received vaccination at the recommended interval, 32% and 68% received their vaccination earlier and later than the recommended schedule respectively(Table 4 ). Table 4 Vaccination timelines by card plus maternal recall in Wolaita zone public hospitals, 2024 (n = 376) Vaccination schedule Vaccination timely N (%) Vaccination untimely (%) Early N (%) Delayed N (%) Totally N (%) At birth 128(83.1) 0(0) 26(16.6) 26(16.9) At six week 57( 72.2) 5(6.3) 17(24.5) 22(27.8) At ten week 45(72.5) 7(11.3) 10(16.2) 17(27.5) At fourteen week 26(49.1)) 8(15.1) 19(35.8) 27(50.9) At nine month 9(52.9) 2(11.8) 6(35.3) 8(47.1) At fifteen month 4(36.4) 2(18.2) 5(45.4) 7(63.6) Total 269(71.5) 34(9.1`) 73(19.4) 107(28.5) Reasons for vaccination untimely Among the reasons given for untimely vaccination, majority of the respondents 43(40.2%) indicated that they have forgotten their vaccination schedules, 35(32.7%) lack of awareness on the importance of vaccination, 19 (17.8%) of them reported that they lost their children’s vaccination card and afraid of poor welcoming of the health professionals, 10(9.3%) reported that they were afraid that their children may get sick (Fig. 2 ). Factors associated with vaccination timeliness Distance from home to health facility, ANC follow up, place of delivery, knowledge about vaccination timeliness, and attitude toward vaccination timeliness remained significantly associated with vaccination timeliness in multivariable logistic regression. When compared to those who never attended formal education, the odds of timely vaccination were nearly six times [AOR = 5.7; 95% CI (1.81,17.55)] higher among women who went more than 30 minute to reach health facility. Moreover, the odds of vaccinating child on the recommended schedule were 3.45 times [AOR = 3.45; 95% CI (1.61, 10.62)] higher among women who had good knowledge about timely vaccination compared to opposite group. The odds of timely vaccination were 8 times higher [AOR = 8; 95% CI (5.81, 25.01)] among women who had ANC visit versus those who did not have it. Moreover, the odds of receiving vaccine on the recommended time were nearly 5 times [AOR = 4.91; 95% CI (2.85, 10.83)] higher among women who gave birth at health facility compared to their contrast. Furthermore, women who had a positive attitude toward timely vaccination were four times [AOR = 2.5; 95% CI (1.23,4.3)] more likely to vaccine their children on the recommended period compared to those who had a negative attitude (Table 5 ). Table 5 Factors associated with vaccination timeliness in Wolaita public hospitals, 2024 (n = 376) Variables Category COR AOR P-values Time taken to reach health facility < 30 minute 1 1 ≥ 30minute 7.2(2.34,20.21) 5.7(1.81,17.55) 0.002 Knowledge about VT Poor 1 1 Good 4.35(1.51, 12.49) 3.45(1.61,10.62) 0.034 ANC follow up No 1 1 Yes 6.8(3.35,10.3) 8(5.81,25.01) 0.021 Place of birth Home 1 1 Hospital 3.96(2.47, 6.35) 4.91(2.85,10.83) 0.004 Attitude towards VT Negative 1 1 Positive 4.5(2.5, 7.7) 2.5(1.23,4.3) 0.026 Discussion Vaccination is one of the most cost-effective interventions in promoting child survival, preventing 2–3 million child deaths annually from vaccine-preventable diseases [ 1 ]. This study assessed vaccination timelines among the children aged 0–24 months. Accordingly 71.5% of children received their recommended vaccination timely. This study is supported by previous study [ 23 ]. However, this finding is higher than previous study carried out in North Shewa Zon (33.7%) [ 29 ], Gondar city (31.9% ) [ 34 ], West Shewa Zone (23.9%) [ 35 ]. The possible reason for the discrepancy might be due to difference in study period, geographical location, methodological, quality of EPI service, and care giver’s attitude and knowledge toward timely vaccination. Current study is lower than study done in Ghana 87.5% [ 19 ], 94% in Israrel [ 20 ], 82% in Philadelphia [ 21 ], and 87% in Uganda [ 24 ]. Study participants, geographical location, methodological differences, participant’s socio-demographic characteristics, policy and strategy, women perception, infrastructure, and quality of EPI service could be possible cause for the difference. Time taken from home to health facility, previous ANC follow up, place of delivery, knowledge about and attitude toward vaccination timeliness were identified as associated factors that affected timely vaccination. Women who reach health facility less 30 minutes were 5.7 times more likely to vaccinate their children with in recommended period compared to the opposite group. This indicate that the time spent to spent to reach the vaccination time expenses a high opportunity cost to caregivers by creating the need for multiple visits. To enhance timely vaccination accessibility, it is better to expanded immunization program through health extension program in community-based service. This is consistent with other studies [ 35 ], [ 36 ]. Having good knowledge about timely vaccination increases the odds of vaccinating child at recommended schedule. This study consistent with previous studies [ 26 ], [ 37 ]. The possible explanation is that knowledge lessens likelihood of negative feelings about timely child vaccination, which the usage and timeliness. Also knowing appropriate vaccination time, vaccine preventable diseases, and reasons for vaccination will increase the chance for timely [ 35 ]. This implies that adequate maternal knowledge is critical to vaccinate their child on time and needs special attention. According to this study women who had ANC follow history were more likely to vaccinate their child on-time. During ANC follow up the caregivers would informed adequately about child vaccination, which could enhance their knowledge about timely vaccination and its utilization among them. Study done in Ethiopia supported and found that ANC utilization have increased timely vaccination (34). In this study, giving a birth at health facility was statistically associated with vaccination timeliness. Outcome of this study in line with other studies [ 35 ], [ 38 ], which indicated if the mother deliver child at a health facility this increases the timely initiation of vaccination at the recommended interval. This is why mothers who give a birth in health facility had a greater opportunity of being advised about the benefit and risk of timely vaccination and getting health education. Furthermore, women who gave birth at home might be exposed to wrong cultural perception and practice about disease prevention for children than vaccine. Finally, attitude toward timely vaccination was significantly associated with vaccination timeliness. This is could be related to women or caregiver feeling towards it. Having positive attitude helps increase mother health care seeking behavior from the facility. Conclusion This study revealed that 71.5% of caregivers vaccinated their child on the national recommended vaccination time. It also identified time taken from home to health facility, previous ANC follow up, place of delivery, Knowledge about and attitude toward vaccination timeliness as significant factors that affect the timely vaccination. Thus, in collaboration with non-governmental organization, all stake holders such as top hospital management, zonal health departments, and southern regional office should place emphasis on regular supervision and periodic in-service training of health workers to practice timely vaccine commencement, and maintain proper intervals between doses. Strong interpersonal communication or counseling between mothers and health care providers should be in place to improve timely vaccine doses. To enhance good knowledge and bring positive attitude toward timely vaccination, all caregivers need health education about vaccine-preventable disease, creating caregiver awareness about the benefit and risk of timely vaccination, an adequate counseling women during ANC follow up about advantaged of delivery at health facility which has more chance take vaccine at birth and adequate advice for the future vaccine schedule. Finally, home-to-home visit to address those who were far from health facility and vaccinating their children through campaign is also strongly recommended. Declarations Ethical Approval and participant consent: An ethical clearance was obtained from the institutional review board of Wolaita Sodo University with the reference number of 9/877/2023 and then submitted to the Wolaita Zone Health Office. Then a permission and cooperation letter was obtained from the zonal health office and distributed to each selected Hospital prior to data collection. Written informed consent was obtained from the study participant and data was collected after assuring the confidentiality nature of responses. All methods throughout the study were carried out in accordance with relevant guidelines and regulations. Consent for publication : not applicable Availability of Data and Materials The datasets generated and/or analysed during the current study are not publicly available to prevent any kinds of misuse by the public before publication but are available from the corresponding author upon reasonable request. Competing interest The author declared no competing interests. Funding No funding was received Author's Contributions TG: Conceived data and designed the study, supervised the data collection, performed the analysis and interpretation of data, drafted the manuscript, and finally approved the revision for publication. TG had full access to all the data in the study and takes responsibility for the integrity of data and the accuracy of data analysis. EE, BA, and TG assisted in designing the study and data interpretation, and critically reviewed the manuscript. All authors read and approved the final manuscript. 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Timeliness of childhood vaccine uptake among children attending immunoprophylaxis clinic in central India. J Evol Med Dent Sci. (2017). Marefiaw TA, Yenesew MA, Mihirete KM. Age-appropriate vaccination coverage and its associated factors for pentavalent 1-3 and measles vaccine doses, in northeast Ethiopia: a community-based cross-sectional study. PLoS One. (2019). Kidanne L, Solomon M, Bisrat F, Asres M, Tadesse T, Asress A, et al. Child vaccination timing, intervals and missed opportunities in pastoral and semi-pastoral areas in Ethiopia. Ethiop J Health Dev. Moore HC, Fathima P, Gidding HF, de Klerk N, Liu B, Sheppeard V, et al. Assessment of on-time vaccination coverage in population subgroups: a record linkage cohort study. Vaccine. (2018). Boulton ML, Carlson BF, Wagner AL, Porth JM, Gebremeskel B, Abeje Y. Vaccination timeliness among newborns and infants in Ethiopia. PLoS One. (2019). Curran D, Terlinden A, Poirrier JE, Masseria C, Krishnarajah G. Vaccine timeliness: a cost analysis of the potential implications of delayed pertussis vaccination in the US. Pediatr Infect Dis J. (2016). Nina B. Masters, Yemesrach A. Tefera, Abram L. Wagner & Matthew L. Boulton (2018) Vaccine hesitancy among caregivers and association with childhood vaccination timeliness in Addis Ababa, Ethiopia, Human Vaccines & Immunotherapeutics, 14:10, 2340-2347. Federal Ministry of Health. National Expanded Programme on Immunization: Comprehensive Multi-Year Plan 2016–2020. Addis Ababa, Ethiopia: Federal Ministry of Health; 2015. Mekonnen ZA, Mekonnen ZA, Gelaye KA, Were MC, Tilahun B. Timely completion of vaccination and its determinants among children in northwest, Ethiopia: a multilevel analysis. BMC Public Health. (2020). Dirirsa K, Makuria M, Mulu E, Deriba BS. Assessment of vaccination timeliness and associated factors among children in Toke Kutaye district, central Ethiopia: a mixed study. PLoS One. (2022) 17:e0262320. doi: 10.1371/journal. Hu Y, Chen Y, Guo J, Tang X, Shen L. Completeness and timeliness of vaccination and determinants for low and late uptake among young children in eastern China. Hum Vaccin Immunother. 2014;10(5):1408–15. Schoeps A, Ouedraogo N, Kagone M, Sie A, Muller O, Becher H. Socio-demographic determinants of timely adherence to BCG, Penta3, measles, and complete vaccination schedule in Burkina Faso. Vaccine. 2013/11/05. 2013;32(1):96–102.). Tadesse L, Fisseha S. The relationship between facility delivery and infant immunization in Ethiopia. Int J Gynecol Obstet. (2013) 123:217–20). Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. 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Also discoverable on Platform About Our Team In Review Editorial Policies 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-4269919","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":291665662,"identity":"a6413c6c-3f95-4bab-96f7-9c1abf743d06","order_by":0,"name":"Temesgen Geta Hardido","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA/0lEQVRIiWNgGAWjYBAC9gYGNiiT+cCBD0CKjZ2AFp4DUC08DGyJB2eAtDATr4XH+DAP2DZCWtiPP3vws61Wzp79gMFhm1/b5PmYGRg/fMzBo4Unx9ywt+24MQ9PQsLh3L7bhm3MDMySM7fh1mLPkMMmwbvtWGIPQ8KBw7k9txmBWtiYefFo4eF//kzy77Zj9T38DxsOW/bctiesRSLBTJp3W00Cj0Qyw2GGH7cTidDyxkxa9t8Bw54bzxgO9jbcTm5jZmzG6xce/vRnkm/O1Mmz9+d//vDjz23b+e3NBz98xKMFCg5DKMY2MNlAUD0Q1EHpP8QoHgWjYBSMgpEGAJqNUxd7qJbsAAAAAElFTkSuQmCC","orcid":"","institution":"Wolaita Sodo University","correspondingAuthor":true,"submittingAuthor":false,"prefix":"","firstName":"Temesgen","middleName":"Geta","lastName":"Hardido","suffix":""},{"id":291665663,"identity":"2edc0866-c204-4628-85ab-51cb5e9eeaba","order_by":1,"name":"Bizuayehu Atinafu","email":"","orcid":"","institution":"Wolaita Sodo University","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Bizuayehu","middleName":"","lastName":"Atinafu","suffix":""},{"id":291665664,"identity":"84fd947e-144c-4c33-ab79-032f905e1478","order_by":2,"name":"Eshetu Elifios","email":"","orcid":"","institution":"Wolaita Sodo University","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Eshetu","middleName":"","lastName":"Elifios","suffix":""}],"badges":[],"createdAt":"2024-04-15 13:01:58","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-4269919/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-4269919/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":55113516,"identity":"3cce1266-d4f9-4659-b445-13e1b9301e3d","added_by":"auto","created_at":"2024-04-22 19:13:48","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":75927,"visible":true,"origin":"","legend":"\u003cp\u003eSchematic presentation of sampling techniques of study on vaccination timeliness in Wolaita zone public hospitals\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-4269919/v1/8646bbf6be75e4fe22c4456c.png"},{"id":55113517,"identity":"9601b5d6-4570-418b-942e-1b62e3734915","added_by":"auto","created_at":"2024-04-22 19:13:48","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":22495,"visible":true,"origin":"","legend":"\u003cp\u003eReasons for vaccination failure among partially vaccinated children\u003c/p\u003e","description":"","filename":"2.png","url":"https://assets-eu.researchsquare.com/files/rs-4269919/v1/0d3f6891ce5d78c73ce53d61.png"},{"id":57662202,"identity":"815f6942-c548-417b-8f56-12deb0440863","added_by":"auto","created_at":"2024-06-04 03:40:53","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":911452,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-4269919/v1/80e8640b-bcc9-4796-ad85-3792705d3c69.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Timely vaccination and its associated factors among parents with children aged from 0-23 months in Wolaita Zone Public hospitals, southern Ethiopia, 2024: a facility-based cross-sectional study","fulltext":[{"header":"Introduction","content":"\u003cp\u003eThe timeliness of vaccination refers to a child receiving their vaccination at the recommended time and is calculated by subtracting the date of birth from the vaccination date. Vaccines were administered on time if they were received within the first year of life and within the time limits set by the World Health Organization (WHO) [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eVaccination timeliness is defined as administering vaccines at the earliest age possible and adhering to the recommended intervals between doses. The timing of vaccinations is an important mechanism for developing protective antibodies and providing effective disease protection in children. Only when an effective vaccine is administered at the right time will it result in disease protection by strengthening community immunity and preventing the spread of infectious diseases, particularly during illness outbreaks; increased adherence to vaccination timeliness protects children before exposure and lowers morbidity.[\u003cspan additionalcitationids=\"CR3 CR4\" citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]\u0026ndash;[\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eIt is crucial, especially for diseases like pertussis and Haemophilus influenzae type B (Hib), which cause the majority of deaths within the first six months of life. Additionally, prompt vaccination protects infants who are too young to receive a full vaccination and maximizes herd immunity [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. On the other hand, early immunization may not produce an antibody that protects against the diseases [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. Because vaccinations given too soon or without a suitable time interval between doses, may not be totally protective (lead to a misleading sensation of protection) [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. Ad also, postponing immunizations raises a person's risk of contracting a potentially fatal VPD [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. These will lead to lower community-level herd immunity and intervention success rates [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e], full vaccination series completion rates [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e], and elevated risk of infectious illnesses under control [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eGlobally, immunization is one of the maximum cost-effective techniques in growing infant survival, saving 2\u0026ndash;3\u0026nbsp;million infant deaths every year from vaccine-preventable illnesses (VPDs) [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]. A vaccine can also additionally have avoided one disorder out of each twenty that claimed an infant\u0026rsquo;s life in 2019 [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]. Even with the excessive vaccination rate of 85% global in 2017, a few children nevertheless experience delays in receiving fundamental vaccinations, especially in low-profits countries [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]. Despite the truth that vaccination timing is an essential public health objective for monitoring vaccine adherence, this information is normally insufficient due to the fact the most extensively utilized metric is vaccination coverage [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eTimeliness of vaccination is a measure of the quality of vaccination programs, but it has received less attention than other program performance indicators [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]. Therefore, inadequate supply chain management, limited access to health care, and suboptimal performance of service providers are contributing to suboptimal vaccination schedule timeliness in low- and middle-income countries (LMICs) around the world [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]. Additional country-specific studies are also needed to elucidate the impact of schedule completion bottlenecks on dose-specific delays in sub-Saharan African (SSA) countries [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e].\u003c/p\u003e \u003cp\u003ePrevious literature shows that 87.5% in Ghana, 94% in Israel, 82% in Philadelphia, 64% in Ethiopia, 71% in New Zealand and 87% in Uganda were vaccinated on time[\u003cspan additionalcitationids=\"CR20 CR21 CR22 CR23\" citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]\u0026ndash;[\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e]. Previous studies have shown that the timeliness of vaccination is associated with place of delivery, lower education level, antenatal care visits, unplanned pregnancy and male gender of the child, and the oldest age of the mother/caregiver, maternal age, vaccine hesitancy, multipara, residency, and the poorest quintile. However, these variables vary depending on the study setting [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e], [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e], [\u003cspan additionalcitationids=\"CR26 CR27 CR28\" citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e]\u0026ndash;[\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e]. In Ethiopia, vaccinating children at an adequate time interval is the major method in minimizing avoidable childhood mortality from measles, pneumonia, diarrheal illnesses, and other VPDs [\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eIn general, advanced countries have given cautious concept to the timing of childhood vaccinations; however, comprehensive research in low-earnings nations\u0026mdash;specially Ethiopia\u0026mdash;has been few[\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e]. Untimely vaccinations have significant impact on immune system functioning and are likely to contribute greatly to the preventable disease burden in Ethiopia, allowing for transmission among those in the age group at which they are the most vulnerable to severe disease with tragic consequences [\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e]. Previously, most studies conducted in Ethiopia assessed complete vaccination coverage and related factors; however, there is limited information about timely vaccination and its influencing factors, illustrating an essential research gap that must be filled. Because of this, full vaccination is most effective in identifying the number of children vaccinated, however it does not provide adequate information about the countrywide vaccination schedule, which is critical for protecting children from vaccine-preventable illnesses if they receive vaccines within the recommended timeframe. In addition, this study included children aged zero-11 months, which was excluded from previous research performed in Ethiopia. In order to help program implementers and frontline health workers recognize vaccination timelines and its related factors to plan for default tracing mechanisms. So, this study aimed to evaluate vaccination timelines and its related factors among children aged zero to 23 months in the study area.\u003c/p\u003e"},{"header":"Methods and materials","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eStudy Area, design, and period\u003c/h2\u003e \u003cp\u003eA facility-based cross-sectional study was conducted in Wolaita zone public hospitals, Southern region, Ethiopia. Wolaita zone is located from 328 km from capital city of Ethiopia, Addis Ababa. Based on the 2020 Central Statistical Agency (CSA) report, the population of Wolaita zone was projected to be 5,385,782. From these, 2,687,021 populations are accounted by males and 2,698,261 populations were females. Currently, there are 8 public hospitals in this zone including Wolaita Sodo university comprehensive specialized hospital (WSUCSH), Bodit primary hospital PH, Gasuba PH, Tebela PH, Bale PH, Halale PH, Bombe PH, and Bitana PH. These public hospitals have been providing health service for all Wolaita zone population and some other surrounding zones.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec4\" class=\"Section2\"\u003e \u003ch2\u003eSource of population\u003c/h2\u003e \u003cp\u003eThe source of population for the study was children aged between 0\u0026ndash;23 months in Wolaita zone public hospitals.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec5\" class=\"Section2\"\u003e \u003ch2\u003eStudy population\u003c/h2\u003e \u003cp\u003eAll children aged between 0\u0026ndash;23 months who attended EPI in Wolaita zone public hospitals on the study period.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec6\" class=\"Section2\"\u003e \u003ch2\u003eInclusion and exclusion criteria\u003c/h2\u003e \u003cdiv id=\"Sec7\" class=\"Section3\"\u003e \u003ch2\u003eInclusion criteria\u003c/h2\u003e \u003cp\u003e The inclusion criterion was all mothers/care givers with children aged 0\u0026ndash;23 months came to each study area for EPI service during data collection period.\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003eExclusion criteria\u003c/h2\u003e \u003cp\u003e\u0026bull;Children under 24 months old who Immune-compromised children such as a child with clinical AIDS\u003c/p\u003e\u003cp\u003e\u0026bull;Those mothers/caregivers who are unable to respond after details of the study purpose were provided during data collection were excluded.\u003c/p\u003e\u003c/div\u003e \u003cdiv id=\"Sec9\" class=\"Section2\"\u003e \u003ch2\u003eSample size and sampling technique\u003c/h2\u003e \u003cp\u003eBased on the following assumptions, the sample size was calculated using a population proportion calculation formula. A 95% confidence interval (CI), an error rate of 5%, and a population proportion of 44% were taken from the previous study [\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e]. Based on the calculations, 378 participants were needed for the study. A total of four public hospitals in the Wolaita zone were included in the study. During six consecutive months, an average of 3,615 clients used EPI services. In addition, since the population was less than 10,000, we used the correction formula and got a sample size of 342. Taking into account the 10% non-response rate, the total sample for the study was 376. After considering these service centers' monthly customer flows, the final sample size is allocated proportionally. As a final step, a systematic random sampling was used to select the subjects (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cdiv id=\"Sec10\" class=\"Section3\"\u003e \u003ch2\u003eData collection tool and procedure\u003c/h2\u003e \u003cp\u003eAdapted structured questionnaire tool through reviewing numerous preceding research have been used to collect data [\u003cspan additionalcitationids=\"CR26 CR27 CR28 CR29\" citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e]\u0026ndash;[\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e]. It consisted of 4 parts, which include socio-demographic characteristics, obstetric characteristics, knowledge and attitudinal factors about vaccination timeliness. The questionnaires have been first prepared in English after which translated through the specialists into local languages (Wolaita version) after which translated again into English to test for consistency. Data have been gathered through face-to-face interviews and referring immunization card using pretested, structured questionnaires after the women have been briefed about the studies on the time of the EPI visit. Data have been collected through 4 BSC midwives who should hear, speak, and read the local language and M.Sc. nurses who already had data collection and supervising experience respectively.\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv id=\"Sec11\" class=\"Section2\"\u003e \u003ch2\u003eData quality and analysis\u003c/h2\u003e \u003cp\u003eTraining was held for data collectors and supervisors to ensure data quality.The questionnaire was initially pretested on 5% of women at Boditt Primary Hospital. Throughout the data collection process, the principal investigator and supervisor provided frequent monitoring and observation. After daily data collection, each questionnaire was checked for completeness and accuracy.\u003c/p\u003e \u003cp\u003eCompleteness and consistency were checked, coded, and entered into Epidata Version 4.6 and exported to SPSS Version 23 for analysis. One variable with a p-value less than 0.25 in the bivariate analysis was recruited for the multivariable logistic regression analysis model. An adjusted odds ratio (AOR) along with a 95% confidence interval at a P-value less than 0.05 in the multivariable logistic regression model was used to declare factors significantly associated with the vaccination timeliness.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec12\" class=\"Section2\"\u003e \u003ch2\u003eStudy variables\u003c/h2\u003e \u003cp\u003e \u003cstrong\u003eDependent variable\u003c/strong\u003e \u003cp\u003eVaccination timelines\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cstrong\u003eIndependent variable\u003c/strong\u003e \u003cp\u003eSocio-demographic characteristics, children and obstetric related factors, knowledge about and attitude towards timely vaccination\u003c/p\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec13\" class=\"Section2\"\u003e \u003ch2\u003eOperational definitions\u003c/h2\u003e \u003cp\u003e \u003cstrong\u003eVaccination timeliness\u003c/strong\u003e \u003cp\u003e- The program of immunization are recommended as WHO at minimum interval at birth (BCG and Polio0), 6_weeks (Penta1, Polio1, Rota1, PCV1),\u003c/p\u003e \u003c/p\u003e \u003cp\u003e10_weeks (Penta2, polio 2, Rota2, PCV2), 14_weeks (penta3, Polio3, IPV, PCV3) and Measles at 9_months, and 15 months [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e], [\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e] (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e)\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003e\u003cb\u003eNational and WHO recommended vaccination timelines\u003c/b\u003e\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eVaccine\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003eWHO recommendation\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003eOperational definition\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMinimum age\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eMinimum interval\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eEarly\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eDelayed\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBCG and OPV 0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAt birth\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4 weeks\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u0026gt;\u0026thinsp;4weeks\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDTP-HepB1-Hib1, OPV1, PCV1, Rota1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e6 weeks\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4 weeks\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;42 days\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u0026gt;\u0026thinsp;10 weeks\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDTP-HepB2-Hib2, OPV2, PCV2, Rota2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e10 weeks\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4 weeks\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;72 days\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u0026gt;\u0026thinsp;14 weeks\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDTP-HepB3-Hib3, OPV3, PCV3, IPV\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e14 weeks\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4 weeks\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;98 days\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u0026gt;\u0026thinsp;18 weeks\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMeasles first dose\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e9 months\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4 weeks\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;270 days\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u0026gt;\u0026thinsp;10 months\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMeasles second dose\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e15\u0026ndash;18 months\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cb\u003eVaccination timely\u003c/b\u003e (Age-appropriate vaccination):- The delivery of vaccines within the World Health Organization (WHO) approved time frames and checked by immunization card. And /or the delivery of vaccines within one month after the minimum age to administer the dose as recommended by WHO [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e], [\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e].\u003c/p\u003e \u003cp\u003e \u003cb\u003eVaccination Untimely\u003c/b\u003e (Age-inappropriate vaccination):- The delivery of vaccines earlier and/or delayed than the recommended age by WHO[\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e], [\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e].\u003c/p\u003e \u003cp\u003e \u003cstrong\u003eDelay vaccination\u003c/strong\u003e \u003cp\u003e-was measured as not having received the recommended vaccine doses within one month beyond the minimum age [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e], [\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e].\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cstrong\u003eEarly vaccination\u003c/strong\u003e \u003cp\u003e- doses given before the minimum age [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e], [\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e].\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cstrong\u003eMaternal knowledge about vaccination timeliness\u003c/strong\u003e \u003cp\u003eWas measured using six questions related to vaccination timeliness. Each correct answer was given a point of one (1) and zero (0) point was given to the incorrect ones. Those who scored mean and less than the mean value were categorized as having poor knowledge and those who scored above the mean were categorized as having good knowledge [\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e].\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cstrong\u003eMaternal attitude towards vaccination timeliness\u003c/strong\u003e \u003cp\u003eWas assessed using nine [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e] items rated on a five-point Likert scale as [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e] strongly agree, [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e] agree, [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e] not sure, [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e] disagree, and [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e] strongly disagree. For the purpose of ease of analysis, attitude of mothers towards vaccination timeliness items were condensed into three categories as \u0026ldquo;agree\u0026rdquo;, \u0026ldquo;disagree,\u0026rdquo; and \u0026ldquo;not sure\u0026rdquo;. Furthermore, the attitude measurement Likert scale was summarized as \u0026ldquo;positive attitude\u0026rdquo; (those who scored the mean and above on attitude measuring items) and \u0026ldquo;negative attitude\u0026rdquo; (those who scored below the mean on attitude measuring items) [\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e].\u003c/p\u003e \u003c/p\u003e \u003c/div\u003e "},{"header":"Results","content":"\u003cdiv id=\"Sec14\" type=\"Results\" class=\"Section2\"\u003e\n \u003cdiv id=\"Sec15\" class=\"Section3\"\u003e\n \u003ch2\u003eSocio-demographic Characteristics\u003c/h2\u003e\n \u003cp\u003eOf 376 mothers/caregivers, all participants responded to the interviews, making a response rate of 100%. Table \u003cspan class=\"InternalRef\"\u003e1\u003c/span\u003e shows the social and demographic characteristics of the study participants. Among the sample, 186(49.5%) were Relationship with Mother, 34 (9%) were Relationship with Father, 72 (19.2%) were Relationship with Relative, and 84 (22.3%) were Relationship with Sister or brother And from a total of 376 study participants, 9 (2.4%) were Age of mother below 18,115(30.6%) were the age of 18\u0026ndash;28,169(44.9%) were the age of 28\u0026ndash;38, and 83 (22.1%) had 38 and above age of mother. The majorities respondent 345 (92%) were married and 12(3%) were widowed. 267 (71%) were protestant religion followers and 16 (4.2%) were Muslim religion followers (Table \u003cspan class=\"InternalRef\"\u003e2\u003c/span\u003e).\u0026nbsp;\u003c/p\u003e\n \u003ctable id=\"Tab2\" border=\"1\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cp\u003eSocio demographic characteristics of the respondent in Wolaiata zone public hospitals, (n\u0026thinsp;=\u0026thinsp;376)\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003eVariables\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eCategories\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eFrequency\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003ePercentage\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colspan=\"2\" rowspan=\"2\"\u003e\n \u003cp\u003eIs the child 0\u0026ndash;24 months of age\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e376\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003e100\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colspan=\"2\" rowspan=\"4\"\u003e\n \u003cp\u003eRelationship with the child\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMother\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e186\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003e49.5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eFather\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e34\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003e9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eRelative\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e72\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003e19.2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eSister or brother\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e84\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003e22.3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colspan=\"2\" rowspan=\"4\"\u003e\n \u003cp\u003eAge of caregivers in year\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eBelow 18\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003e2.4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e18\u0026ndash;28\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e115\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003e30.6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e28\u0026ndash;38\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e169\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003e44.9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e38 and above\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e83\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003e22.1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colspan=\"2\" rowspan=\"4\"\u003e\n \u003cp\u003eMarital status of the mother or care giver\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMarried\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e345\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003e92.0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eSingle\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eDivorced\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e18\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003e5.0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eWidowed\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003e3.0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colspan=\"2\" rowspan=\"5\"\u003e\n \u003cp\u003eReligion of mother or care giver\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eOrthodox\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e87\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003e23.1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eProtestant\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e267\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003e71.0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMuslim\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e16\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003e4.2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eCatholic\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003e1.2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eOther\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003e0.5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colspan=\"2\" rowspan=\"5\"\u003e\n \u003cp\u003eEthnicity of mother or care giver\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eOromo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003e2.4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eGurage\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e16\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003e4.3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eAmhara\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e13\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003e3.5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eWolaita\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e310\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003e82.4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eOther\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e28\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003e7.4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" rowspan=\"4\"\u003e\n \u003cp\u003eOccupation of mother or care giver\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003eHousewife\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003e160\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e42.6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003eMerchant\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003e96\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e25.5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003eGovernment employer\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003e106\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e28.2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003eStudent\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003e14\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3.7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" rowspan=\"4\"\u003e\n \u003cp\u003eEducation status of mother or care giver\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003eNo formal education\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003e34\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e9.3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003ePrimary school\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003e168\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e44.7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003eSecondary school\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003e96\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e25.7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003eCollege or above\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003e76\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e20.3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" rowspan=\"2\"\u003e\n \u003cp\u003eDistance from home\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003e\u0026lt;\u0026thinsp;30 minute\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003e300\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e79.8\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003e\u0026ge;\u0026thinsp;30 minute\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"2\"\u003e\n \u003cp\u003e76\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e20.2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n \u003cp\u003e\u003cbr\u003e\u003c/p\u003e\n \u003c/div\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec16\" class=\"Section2\"\u003e\n \u003ch2\u003eObstetric characteristics of the study\u003c/h2\u003e\n \u003cp\u003eMajority children 98.7% were born at health institution, while 1% of them at home. In addition, majority of the children were ever took more doses of vaccine, out of these only 2% of them had no vaccination card during the study. Out of 376 (100%) respondents 367 (97.6%) said their child has received at least one vaccine and, 9 (2.4%) of them not vaccinated. Out of 376 (100%) respondent 368 (98%) were able to provide the vaccinated card and 8 (2%) were no vaccinated card. This study revealed that from 376 participants, 259(69%) had good knowledge about vaccination timeliness whereas 117(31%) of them had a poor knowledge. It also revealed that 241(64%) participants had positive attitude about vaccination timeliness whereas 135(36%) of them had negative attitude. The majority of the children were in the age of 0\u0026ndash;8 months group 228(60.6%) followed by the age group of 9\u0026ndash;16 months group 91(24.2%) (Table \u003cspan class=\"InternalRef\"\u003e3\u003c/span\u003e).\u003c/p\u003e\n \u003ctable id=\"Tab3\" border=\"1\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cp\u003eObstetric characteristics of the study in Wolaita zone public hospitals, 2024 (n\u0026thinsp;=\u0026thinsp;376)\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eVariable\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eCategory\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eFrequency\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003ePercent\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" rowspan=\"2\"\u003e\n \u003cp\u003eNumber of \u0026lt;\u0026thinsp;2year children\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0\u0026ndash;12 month\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e363\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e96.5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e13\u0026ndash;24 month\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e13\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3.5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" rowspan=\"2\"\u003e\n \u003cp\u003eSex of children\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e162\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e43.1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eFemale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e264\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e56.9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" rowspan=\"2\"\u003e\n \u003cp\u003eAge of children in month\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0\u0026ndash;8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e228\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e60.6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e9\u0026ndash;16\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e91\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e24.2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" rowspan=\"2\"\u003e\n \u003cp\u003ePlace of delivery\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eHome\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eHealth institution\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e371\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e98.7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" rowspan=\"2\"\u003e\n \u003cp\u003eEver vaccinated\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e360\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e95.7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e16\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e4.3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" rowspan=\"2\"\u003e\n \u003cp\u003eHad vaccination card\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e368\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e98\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" rowspan=\"2\"\u003e\n \u003cp\u003eKnowledge about VT\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eGood\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e259\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e69\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePoor\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e117\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e31\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" rowspan=\"2\"\u003e\n \u003cp\u003eAttitude towards VT\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePositive\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e241\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e64\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNegative\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e135\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e36\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" rowspan=\"2\"\u003e\n \u003cp\u003eANC follow up\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e336\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e89.4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e40\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e10.6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003ctfoot\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"4\"\u003eVT-Vaccine timeliness\u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tfoot\u003e\n \u003c/table\u003e\n \u003cp\u003e\u003cbr\u003e\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec17\" class=\"Section2\"\u003e\n \u003ch2\u003eVaccination timelines by card plus maternal recall\u003c/h2\u003e\n \u003cp\u003eBy combining the evidence of cards and parents recall vaccination timelines, 128(83.1%) took vaccination timely and 26(16.9%) took it untimely at birth respectively. Regarding six week schedule, 57(72.2%) took vaccination timely on the recommended period whereas 22(27.8%) vaccinated untimely. 45(72.5%) took vaccination timely at ten week whereas 17(27.5%) took vaccination untimely at ten week. 26(49.1%) took vaccination timely fourteen week whereas 27(50.9%) took vaccination untimely at fourteen week. 9(52.9%) Vaccinated timely at nine month whereas 8(47.1%) unvaccinated timely at nine month. 4(36.4%) took fifteen month whereas 3.6% took vaccination untimely at fifteen month. Overall 269(71.5%) took vaccination timely and 107(28.5%) took untimely. Of the total 107 of children who did not received vaccination at the recommended interval, 32% and 68% received their vaccination earlier and later than the recommended schedule respectively(Table \u003cspan class=\"InternalRef\"\u003e4\u003c/span\u003e).\u003c/p\u003e\n \u003ctable id=\"Tab4\" border=\"1\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cp\u003eVaccination timelines by card plus maternal recall in Wolaita zone public hospitals, 2024 (n\u0026thinsp;=\u0026thinsp;376)\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eVaccination schedule\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eVaccination timely N (%)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\" colspan=\"3\"\u003e\n \u003cp\u003eVaccination untimely (%)\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eEarly N (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eDelayed N (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eTotally N (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eAt birth\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e128(83.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0(0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e26(16.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e26(16.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eAt six week\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e57( 72.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e5(6.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e17(24.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e22(27.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eAt ten week\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e45(72.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e7(11.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e10(16.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e17(27.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eAt fourteen week\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e26(49.1))\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e8(15.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e19(35.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e27(50.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eAt nine month\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e9(52.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2(11.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e6(35.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e8(47.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eAt fifteen month\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e4(36.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2(18.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e5(45.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e7(63.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eTotal\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e269(71.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e34(9.1`)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e73(19.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e107(28.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n \u003cp\u003e\u003cbr\u003e\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec18\" class=\"Section2\"\u003e\n \u003ch2\u003eReasons for vaccination untimely\u003c/h2\u003e\n \u003cp\u003eAmong the reasons given for untimely vaccination, majority of the respondents 43(40.2%) indicated that they have forgotten their vaccination schedules, 35(32.7%) lack of awareness on the importance of vaccination, 19 (17.8%) of them reported that they lost their children\u0026rsquo;s vaccination card and afraid of poor welcoming of the health professionals, 10(9.3%) reported that they were afraid that their children may get sick (Fig. \u003cspan class=\"InternalRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec19\" class=\"Section2\"\u003e\n \u003ch2\u003eFactors associated with vaccination timeliness\u003c/h2\u003e\n \u003cp\u003eDistance from home to health facility, ANC follow up, place of delivery, knowledge about vaccination timeliness, and attitude toward vaccination timeliness remained significantly associated with vaccination timeliness in multivariable logistic regression. When compared to those who never attended formal education, the odds of timely vaccination were nearly six times [AOR\u0026thinsp;=\u0026thinsp;5.7; 95% CI (1.81,17.55)] higher among women who went more than 30 minute to reach health facility. Moreover, the odds of vaccinating child on the recommended schedule were 3.45 times [AOR\u0026thinsp;=\u0026thinsp;3.45; 95% CI (1.61, 10.62)] higher among women who had good knowledge about timely vaccination compared to opposite group.\u003c/p\u003e\n \u003cp\u003eThe odds of timely vaccination were 8 times higher [AOR\u0026thinsp;=\u0026thinsp;8; 95% CI (5.81, 25.01)] among women who had ANC visit versus those who did not have it. Moreover, the odds of receiving vaccine on the recommended time were nearly 5 times [AOR\u0026thinsp;=\u0026thinsp;4.91; 95% CI (2.85, 10.83)] higher among women who gave birth at health facility compared to their contrast. Furthermore, women who had a positive attitude toward timely vaccination were four times [AOR\u0026thinsp;=\u0026thinsp;2.5; 95% CI (1.23,4.3)] more likely to vaccine their children on the recommended period compared to those who had a negative attitude (Table \u003cspan class=\"InternalRef\"\u003e5\u003c/span\u003e).\u003c/p\u003e\n \u003ctable id=\"Tab5\" border=\"1\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 5\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cp\u003eFactors associated with vaccination timeliness in Wolaita public hospitals, 2024 (n\u0026thinsp;=\u0026thinsp;376)\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eVariables\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eCategory\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eCOR\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eAOR\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eP-values\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" rowspan=\"2\"\u003e\n \u003cp\u003eTime taken to reach health facility\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026lt;\u0026thinsp;30 minute\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u0026ge;\u0026thinsp;30minute\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e7.2(2.34,20.21)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e5.7(1.81,17.55)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.002\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" rowspan=\"2\"\u003e\n \u003cp\u003eKnowledge about VT\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePoor\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eGood\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e4.35(1.51, 12.49)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3.45(1.61,10.62)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.034\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" rowspan=\"2\"\u003e\n \u003cp\u003eANC follow up\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e6.8(3.35,10.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e8(5.81,25.01)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.021\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" rowspan=\"2\"\u003e\n \u003cp\u003ePlace of birth\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eHome\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eHospital\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3.96(2.47, 6.35)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e4.91(2.85,10.83)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.004\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\" rowspan=\"2\"\u003e\n \u003cp\u003eAttitude towards VT\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNegative\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePositive\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e4.5(2.5, 7.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2.5(1.23,4.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.026\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n\u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eVaccination is one of the most cost-effective interventions in promoting child survival, preventing 2\u0026ndash;3\u0026nbsp;million child deaths annually from vaccine-preventable diseases [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. This study assessed vaccination timelines among the children aged 0\u0026ndash;24 months. Accordingly 71.5% of children received their recommended vaccination timely. This study is supported by previous study [\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e]. However, this finding is higher than previous study carried out in North Shewa Zon (33.7%) [\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e], Gondar city (31.9% ) [\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e], West Shewa Zone (23.9%) [\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e]. The possible reason for the discrepancy might be due to difference in study period, geographical location, methodological, quality of EPI service, and care giver\u0026rsquo;s attitude and knowledge toward timely vaccination. Current study is lower than study done in Ghana 87.5% [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e], 94% in Israrel [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e], 82% in Philadelphia [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e], and 87% in Uganda [\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e]. Study participants, geographical location, methodological differences, participant\u0026rsquo;s socio-demographic characteristics, policy and strategy, women perception, infrastructure, and quality of EPI service could be possible cause for the difference.\u003c/p\u003e \u003cp\u003eTime taken from home to health facility, previous ANC follow up, place of delivery, knowledge about and attitude toward vaccination timeliness were identified as associated factors that affected timely vaccination. Women who reach health facility less 30 minutes were 5.7 times more likely to vaccinate their children with in recommended period compared to the opposite group. This indicate that the time spent to spent to reach the vaccination time expenses a high opportunity cost to caregivers by creating the need for multiple visits. To enhance timely vaccination accessibility, it is better to expanded immunization program through health extension program in community-based service. This is consistent with other studies [\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e], [\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eHaving good knowledge about timely vaccination increases the odds of vaccinating child at recommended schedule. This study consistent with previous studies [\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e], [\u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e]. The possible explanation is that knowledge lessens likelihood of negative feelings about timely child vaccination, which the usage and timeliness. Also knowing appropriate vaccination time, vaccine preventable diseases, and reasons for vaccination will increase the chance for timely [\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e]. This implies that adequate maternal knowledge is critical to vaccinate their child on time and needs special attention.\u003c/p\u003e \u003cp\u003eAccording to this study women who had ANC follow history were more likely to vaccinate their child on-time. During ANC follow up the caregivers would informed adequately about child vaccination, which could enhance their knowledge about timely vaccination and its utilization among them. Study done in Ethiopia supported and found that ANC utilization have increased timely vaccination (34). In this study, giving a birth at health facility was statistically associated with vaccination timeliness. Outcome of this study in line with other studies [\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e], [\u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e], which indicated if the mother deliver child at a health facility this increases the timely initiation of vaccination at the recommended interval. This is why mothers who give a birth in health facility had a greater opportunity of being advised about the benefit and risk of timely vaccination and getting health education. Furthermore, women who gave birth at home might be exposed to wrong cultural perception and practice about disease prevention for children than vaccine. Finally, attitude toward timely vaccination was significantly associated with vaccination timeliness. This is could be related to women or caregiver feeling towards it. Having positive attitude helps increase mother health care seeking behavior from the facility.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThis study revealed that 71.5% of caregivers vaccinated their child on the national recommended vaccination time. It also identified time taken from home to health facility, previous ANC follow up, place of delivery, Knowledge about and attitude toward vaccination timeliness as significant factors that affect the timely vaccination. Thus, in collaboration with non-governmental organization, all stake holders such as top hospital management, zonal health departments, and southern regional office should place emphasis on regular supervision and periodic in-service training of health workers to practice timely vaccine commencement, and maintain proper intervals between doses. Strong interpersonal communication or counseling between mothers and health care providers should be in place to improve timely vaccine doses. To enhance good knowledge and bring positive attitude toward timely vaccination, all caregivers need health education about vaccine-preventable disease, creating caregiver awareness about the benefit and risk of timely vaccination, an adequate counseling women during ANC follow up about advantaged of delivery at health facility which has more chance take vaccine at birth and adequate advice for the future vaccine schedule. Finally, home-to-home visit to address those who were far from health facility and vaccinating their children through campaign is also strongly recommended.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthical Approval and participant consent:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAn ethical clearance was obtained from the institutional review board of Wolaita Sodo University with the reference number of 9/877/2023 and then submitted to the Wolaita Zone Health Office. Then a permission and cooperation letter was obtained from the zonal health office and distributed to each selected Hospital prior to data collection. Written informed consent was obtained from the study participant and data was collected after assuring the confidentiality nature of responses. All methods throughout the study were carried out in accordance with relevant guidelines and regulations. \u0026nbsp; \u0026nbsp;\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\u003eAvailability of Data and Materials\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe datasets generated and/or analysed during the current study are not publicly available to prevent any kinds of misuse by the public before publication but are available from the corresponding author upon reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interest\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe author declared no competing interests. \u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNo funding was received \u0026nbsp; \u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor\u0026apos;s Contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eTG: Conceived data and designed the study, supervised the data collection, performed the analysis and interpretation of data, drafted the manuscript, and finally approved the revision for publication. TG had full access to all the data in the study and takes responsibility for the integrity of data and the accuracy of data analysis. EE, BA, and TG assisted in designing the study and data interpretation, and critically reviewed the manuscript. All authors read and approved the final manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgment\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWe would like to express our appreciation to Wolaita Sodo University for continued support and follow-up. We acknowledge the study participants and health care providers for their commitment and cooperation.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eWorld Health Organization of WHO Recommended Routine Immunizations for Children. Geneva: World Health Organization (2012).\u003c/li\u003e\n\u003cli\u003eSu\u0026aacute;rez-Castaneda E, Pezzoli L, Elas M, Baltrons R, Crespin-El\u0026iacute;as EO, Pleitez OAR, et al. Routine childhood vaccination programme coverage, El Salvador, 2011-In search of timeliness. Vaccine. (2014) 32:437\u0026ndash;44. doi: 10.1016/j.vaccine.\u003c/li\u003e\n\u003cli\u003eScott S, Odutola A, Mackenzie G, Fulford T, Afolabi MO, Jallow YL, et al. Coverage and timing of children\u0026rsquo;s vaccination: an evaluation of the expanded programme on immunisation in the Gambia. PLoS One. (2014).\u003c/li\u003e\n\u003cli\u003eMasters NB, Wagner AL, Carlson BF, Boulton ML. Vaccination timeliness and co-administration among Kenyan children. Vaccine. (2018).\u003c/li\u003e\n\u003cli\u003eMasters NB, Tefera YA, Wagner AL, Boulton ML. Vaccine hesitancy among caregivers and association with childhood vaccination timeliness in Addis Ababa, Ethiopia. Hum Vaccines Immunother. (2018).\u003c/li\u003e\n\u003cli\u003ePatel MM, L\u0026oacute;pez-collada VR, Mattos M, De Oliveira LH, M\u0026aacute;rquez AB, Flannery B, et al. Intussusception risk and health benefits of rotavirus vaccination in Mexico and Brazil. N Engl J Med. (2011).\u003c/li\u003e\n\u003cli\u003eKmatov MK, Mikolajczyk RT. Timeliness of childhood vaccinations in 31 low and middle-income countries. J Epidemiol Community Health. (2012).\u003c/li\u003e\n\u003cli\u003eWalton S, Cortina-Borja M, Dezateux C, Griffiths LJ, Tingay K, Akbari A, et al. Measuring the timeliness of childhood vaccinations: using cohort data and routine health records to evaluate quality of immunisation services. Vaccine. (2017) 35:7166\u0026ndash;73.\u003c/li\u003e\n\u003cli\u003eCenters for Disease Control and Prevention [CDC]. Vaccines for Your Children. (2021).\u003c/li\u003e\n\u003cli\u003eGuerra FA. Delays in immunization have potentially serious health consequences. Pediatr Drugs. (2007).\u003c/li\u003e\n\u003cli\u003eWashington State Department of Health. Childhood and Adult Immunizations. Tumwater, WA: Washington State Department of Health (2015).\u003c/li\u003e\n\u003cli\u003eClark A, Sanderson C. Timing of children\u0026rsquo;s vaccinations in 45 low-income and middle-income countries: an analysis of survey data. Lancet. (2009) 373:1543\u0026ndash;9.\u003c/li\u003e\n\u003cli\u003eWorld Health Organization [WHO]. Immunization Coverage. (2020.\u003c/li\u003e\n\u003cli\u003eCenters for Disease Control and Prevention [CDC]. CDC in Ethiopia. (2019).\u003c/li\u003e\n\u003cli\u003eVanderende K, Gacic-dobo M, Diallo MS, Conklin LM, Wallace AS, R\u0026ouml;st G, et al. Global routine vaccination coverage\u0026ndash;2017. Morb Mortal Wkly Rep. (2020).\u003c/li\u003e\n\u003cli\u003eChoudhary TS, Reddy NS, Apte A, Sinha B, Roy S, Nair NP, et al. Delayed vaccination and its predictors among children under 2?years in India: insights from the national family health survey\u0026ndash;4. Vaccine. (2019).\u003c/li\u003e\n\u003cli\u003eGram L, Soremekun S, ten Asbroek A, Manu A, O\u0026rsquo;Leary M, Hill Z. Socio-economic determinants and inequities in coverage and timeliness of early childhood immunisation in rural Ghana. Trop Med Int Health. (2014).\u003c/li\u003e\n\u003cli\u003eJanusz CB, Frye M, Mutua MK, Wagner AL, Banerjee M, Boulton ML. Vaccine delay and its association with undervaccination in children in Sub-Saharan Africa. Am J Prev Med. (2021).\u003c/li\u003e\n\u003cli\u003eDennis OL , Emmanuel AP\u0026amp; Ebenezer F. Timeliness of childhood vaccine uptake among children attending a tertiary health service facility-based immunization clinic in Ghana .BMC Public Health 14, Article number: 90 (2014).\u003c/li\u003e\n\u003cli\u003eChen Stein-Zamir , Avi Israeli . Timeliness and completeness of routine childhood vaccinations in young children residing in a district with recurrent vaccine-preventable disease outbreaks, Jerusalem, Israel. ES.2019.24.6.1800004. DOI: 10.2807/1560-79.\u003c/li\u003e\n\u003cli\u003eMatilde M, Susan M, Andrew M et al.Timeliness of Immunizations in Centering Parenting. Academic Pediatrics Volume 21, Issue 6, August 2021, Pages 948-954. Doi:https://doi.org/10.1016/j.acap.2020.11.022.\u003c/li\u003e\n\u003cli\u003eZeleke Abebaw M , Kassahun AG, Martin C et al. Timely completion of vaccination and its determinants among children in northwest, Ethiopia: a multilevel analysis BMC Public Health 20, Article number: 908 (2020).\u003c/li\u003e\n\u003cli\u003ePriya V , Cameron C Grant , Carol Chelimo , Kathryn Philipson, Vaccine Education During Pregnancy and Timeliness of Infant Immunization Pediatrics 2017 Sep;140(3):e20163727. doi: 10.1542/peds.2016-3727.\u003c/li\u003e\n\u003cli\u003eJasper A, Amir K, and Carol KN. Predictors of Adherence to Routine Immunization Schedule Among Caretakers of Children Aged 10 to 18Months in Lira City, Uganda. Global Pediatric Health Volume 9: 1\u0026ndash;7. https://doi.org/10.1177/2333794X221140518).\u003c/li\u003e\n\u003cli\u003eNoh JW, Kim YM, Akram N, Yoo KB, Cheon J, Lee LJ, et al. Determinants of timeliness in early childhood vaccination among mothers with vaccination cards in Sindh province, Pakistan: a secondary analysis of cross-sectional survey data. BMJ Open. (20.\u003c/li\u003e\n\u003cli\u003ePrasad Sahoo D, Rupraoji Jadhao A, Sukhdeo Deshmukh J, Vinod Tekam A, Umedlal Raut R. Timeliness of childhood vaccine uptake among children attending immunoprophylaxis clinic in central India. J Evol Med Dent Sci. (2017).\u003c/li\u003e\n\u003cli\u003eMarefiaw TA, Yenesew MA, Mihirete KM. Age-appropriate vaccination coverage and its associated factors for pentavalent 1-3 and measles vaccine doses, in northeast Ethiopia: a community-based cross-sectional study. PLoS One. (2019).\u003c/li\u003e\n\u003cli\u003eKidanne L, Solomon M, Bisrat F, Asres M, Tadesse T, Asress A, et al. Child vaccination timing, intervals and missed opportunities in pastoral and semi-pastoral areas in Ethiopia. Ethiop J Health Dev.\u003c/li\u003e\n\u003cli\u003eMoore HC, Fathima P, Gidding HF, de Klerk N, Liu B, Sheppeard V, et al. Assessment of on-time vaccination coverage in population subgroups: a record linkage cohort study. Vaccine. (2018).\u003c/li\u003e\n\u003cli\u003eBoulton ML, Carlson BF, Wagner AL, Porth JM, Gebremeskel B, Abeje Y. Vaccination timeliness among newborns and infants in Ethiopia. PLoS One. (2019).\u003c/li\u003e\n\u003cli\u003eCurran D, Terlinden A, Poirrier JE, Masseria C, Krishnarajah G. Vaccine timeliness: a cost analysis of the potential implications of delayed pertussis vaccination in the US. Pediatr Infect Dis J. (2016).\u003c/li\u003e\n\u003cli\u003eNina B. Masters, Yemesrach A. Tefera, Abram L. Wagner \u0026amp; Matthew L. Boulton (2018) Vaccine hesitancy among caregivers and association with childhood vaccination timeliness in Addis Ababa, Ethiopia, Human Vaccines \u0026amp; Immunotherapeutics, 14:10, 2340-2347.\u003c/li\u003e\n\u003cli\u003eFederal Ministry of Health. National Expanded Programme on Immunization: Comprehensive Multi-Year Plan 2016\u0026ndash;2020. Addis Ababa, Ethiopia: Federal Ministry of Health; 2015.\u003c/li\u003e\n\u003cli\u003eMekonnen ZA, Mekonnen ZA, Gelaye KA, Were MC, Tilahun B. Timely completion of vaccination and its determinants among children in northwest, Ethiopia: a multilevel analysis. BMC Public Health. (2020).\u003c/li\u003e\n\u003cli\u003eDirirsa K, Makuria M, Mulu E, Deriba BS. Assessment of vaccination timeliness and associated factors among children in Toke Kutaye district, central Ethiopia: a mixed study. PLoS One. (2022) 17:e0262320. doi: 10.1371/journal.\u003c/li\u003e\n\u003cli\u003eHu Y, Chen Y, Guo J, Tang X, Shen L. Completeness and timeliness of vaccination and determinants for low and late uptake among young children in eastern China. Hum Vaccin Immunother. 2014;10(5):1408\u0026ndash;15.\u003c/li\u003e\n\u003cli\u003eSchoeps A, Ouedraogo N, Kagone M, Sie A, Muller O, Becher H. Socio-demographic determinants of timely adherence to BCG, Penta3, measles, and complete vaccination schedule in Burkina Faso. Vaccine. 2013/11/05. 2013;32(1):96\u0026ndash;102.).\u003c/li\u003e\n\u003cli\u003eTadesse L, Fisseha S. The relationship between facility delivery and infant immunization in Ethiopia. Int J Gynecol Obstet. (2013) 123:217\u0026ndash;20).\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Ethiopia. Mothers, vaccination timelines, 0–23 months Children, Wolaita Zone, Public hospitals","lastPublishedDoi":"10.21203/rs.3.rs-4269919/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-4269919/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003eIn Ethiopia, vaccination is mentioned as the vital preventive measure of undue childhood mortality from measles, pneumonia, diarrheal diseases, and other VPDs. Although there are studies conducted on full vaccine coverage, there is relatively no data available about timely vaccination and its related factors in southern Ethiopia. Thus, this study assessed timely vaccination and related factors in children who age from 0 to 23 months in the study area.\u003c/p\u003e\u003ch2\u003eMethods and material:\u003c/h2\u003e \u003cp\u003eAn institution-based cross-sectional study was undertaken in Wolaita zone Public hospitals, from December 2023, G.C to January 2024, G.C. A total of 376 study subjects were randomly selected through systematic sampling method among parents with children who are 0\u0026ndash;23 months old. Data were gathered by questionnaire with a structure which was based on mother\u0026rsquo;s recalling as well as vaccination cards. A basic questionnaire was completed by respondents and the responses were entered into Epidata Version 4.6, which was later transferred to SPSS Version 23 for analysis. Data were entered into Epidata Version 4.6 and exported to SPSS Version 23 for analysis. An adjusted odds ratio (AOR) along with a 95% confidence interval at a P-value less than 0.05 was used to declare significance level.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eA total of 376 study participants responded to the interview with 100% response rate. This study found that 269 children (71.5%) were timely vaccinated and 107 children (28.5%) had not got their children vaccinated timely. The independent variables, like time to reach the health facility[AOR\u0026thinsp;=\u0026thinsp;5.7; 95% CI (1.81,17.55), place of delivery[AOR\u0026thinsp;=\u0026thinsp;4.91; 95% CI (2.85, 10.83)], ANC follow-up[AOR\u0026thinsp;=\u0026thinsp;8; 95% CI (5.81, 25.01)], attitude[AOR\u0026thinsp;=\u0026thinsp;2.5; 95% CI (1.23,4.3)] and knowledge [AOR\u0026thinsp;=\u0026thinsp;3.45; 95% CI (1.61, 10.62)] on the vaccine time, significantly attributed to timely vaccination.\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e \u003cp\u003e71.5% of study participants vaccinated their children on the national recommended vaccination schedule. The research also revealed statistical correlation between time taken from home to health facility, antenatal care follow up, place of delivery, maternal attitude and knowledge of the prompt vaccination and vaccination timeline. For the all stake holders, highly strategic interventions like promoting maternal knowledge about the benefits versus risks of timely vaccination, community-based vaccination programs or campaigns, routine supervision, and counseling during antenatal visits are very effective ways of improving timely vaccination.\u003c/p\u003e","manuscriptTitle":"Timely vaccination and its associated factors among parents with children aged from 0-23 months in Wolaita Zone Public hospitals, southern Ethiopia, 2024: a facility-based cross-sectional study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-04-22 19:13:43","doi":"10.21203/rs.3.rs-4269919/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":"15567473-5136-4882-bb7b-95690ce71bc2","owner":[],"postedDate":"April 22nd, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2024-06-04T03:32:42+00:00","versionOfRecord":[],"versionCreatedAt":"2024-04-22 19:13:43","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-4269919","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-4269919","identity":"rs-4269919","version":["v1"]},"buildId":"cTy_lsJlmDsVRNrSptgXS","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}