Women's Independent Household Decision Making Power and its influence on their Autonomy in relation to Child Vaccinations: a mixed-method study among Women of Reproductive Age in Northwest Ethiopia

AbstractBackground: The importance of women’s empowerment in influencing health outcomes has received attention globally, but there is limited information in Ethiopia on the relationship between women's household decision making power and the autonomy of decision making in relation to child vaccinations.Aim: The study aimed to assess the role of women's household decision making power on their autonomy in relation to child vaccinations.Methods: A community based mixed method study design was conducted among women who had 12–23-month-old children in Wogera district, Ethiopia. The sample size was determined using a single population proportion formula for the quantitative aspect of the study and the data collection for the qualitative study continued until saturation. The quantitative data was collected using a piloted questionnaire. SPSS software was used for quantitative data analyses. X2-square test was conducted to explore the association between women's household decision making power and their autonomy in relation to decision making around child vaccinations. Framework analysis was employed to analyse qualitative data using open code software.Results: A total of 584 women participated in the quantitative study and 13 In-depth interviews (IDI) with 13 key informants (KII)were conducted for the qualitative study. Majority, 88.2% (95% CI: 85.7, 90.6) of the respondents have autonomy to vaccinate children. This study showed that nearly two-thirds, 61.6% of the women had household decision making power. Respondents of the qualitative study noted that women had low household decision making power. Women's household decision making power is associated with women's autonomy to vaccinate children (x2=92.775a, df=1, P<0.001).Conclusions: The overall level of women’s household decision making power was relatively low compared to EDHS reports whereas women's autonomy to chid vaccination was high. There was a strong relationship between women’s household decision making power and their autonomy in relation to child vaccinations. It is therefore important to implement activities, for example, provision of behavioural change communication (BCC) in the community, that can improve women’s household decision making power which in turn will influence child vaccination coverage. [Ethiop. J. Health Dev. 2021; 35(SI-3):86-97]Key words: Women, Household decision making power, Women's autonomy, Vaccinatio

Full immunization coverage and its determinants among children aged 12-23 months in Wogera district, Northwest Ethiopia

AbstractBackground: Immunization is considered one of the most affordable health initiatives for children. Though there is good progress in Ethiopia, the amount of fully vaccinated children, is still below the target. Possible challenges include women having home visits and men’s’ involvement in vaccination uptake. Therefore, this study aimed to determine full immunization coverage and its determinants among children aged 12- 23 months in Wogera districts, Northwest Ethiopia.Aim: This study aimed to determine the full immunization coverage and its determinants among children aged 12-23 months, and to assess the level of immunization coverage and its determinants in Wogera districts, Northwest Ethiopia.Methods: A community-based cross-sectional study was conducted in Wogera district from May 28-June 25/2020. Cluster sampling method was used to recruit 598 study participants. Interviewer administered questionnaire was used to collect data. A bivariable and multivariable logistic regression analysis was done to identify factors associated with full immunization. Odds ratios with 95% Confidence intervals were used to determine significant variables.Results: A total of 584 mothers who had children aged 12-23 months participated in this study. The full immunization coverage was 76.5% (95%CI 73.2-79.8). Mother age >40 years (AOR=7.37, 95% CI: 1.65, 32); mothers who initiate vaccine uptake(woman empowerment) (AOR=1.57, 95% CI: 1.13-2.39); mothers who had 1-3 ANC visit (AOR=2.51, 95% CI:1.14, 5.52), and 4+ ANC follow up (AOR=2.73,95% CI: 1.26, 5.91); r health extension worker's home visit during the first weeks of postpartum period (AOR=1.76,95% CI:1.10, 2.84), and males involved in child immunization (AOR=3.27, 95% CI:1.84, 5.81) was positively associated with being fully vaccinated , however, birth order of 6 and above (AOR=0.35, 95% CI: 0.14, 0.86) was negatively associated with being fully vaccinated.Conclusion: In this study, the full immunization coverage is found to be suboptimal, and it is far from the expected national target coverage. Maternal health care uptake; women empowerment; home visits by HEW during the first week of the postpartum period and male involvement in child immunization were found to be predictors of being fully vaccinated. [Ethiop. J. Health Dev. 2021; 35(SI-3):16-27]Keywords: Full immunization, Children12-23 months, Northwest Ethiopia, Male involvemen

Embedding implementation research to strengthen efforts towards improving primary health care in resource limited settings

Immunization reaches more people than any other health service and it is a vital component of primary health care (PHC) (1,2). The Immunization Agenda 2030 emphasizes building strong national immunization programs integrated into primary health care services as the basis for achieving high vaccination coverage (2). In Ethiopia, immunization services are the backbone of PHC and are delivered in all public health facilities across the country (1). Even though the national EPI target is to reach a coverage of 90%(1), achieving and maintaining high immunization coverage is challenged by multifaceted demand and supply side implementation barriers (3–5). These barriers are related to community engagement, immunization service delivery, supply chain management, and surveillance and data management of the immunization program (5). Consequently, the national full vaccination coverage stalled at 43% (6)

Immunization data quality and factors influencing data generation, handling and use in Wogera District, Northern Ethiopia, 2020

Abstract Background: Data quality is a vital metric in health information systems to ascertain improved health of individuals and community as well. Immunization data are critical inputs in assessing national performance of expanded program on immunization and child health improvement. Inconsistent health data happens when variations arise in the report and re-count from the source documents. Aim: This study aimed to assess immunization data quality and factors influencing data generation, handling, and use. Methods: Both qualitative and quantitative data were used. Immunization recording and reporting documents were reviewed at 41 health facilities of primary health care units. Twenty health workforces were interviewed on healthcare data quality, generation, handling, and use. The Statistical Package for the Social Sciences (SPSS) for windows version 26 was used to perform quantitative data analysis and open code version 4.02 was used for qualitative data analysis. Data accuracy was presented using mean and standard deviation of data verification factor. Results: Over-reporting of immunization data elements was observed. The highest accuracy (75%) was reported for full immunization at health center level followed by 62.5% for measles. The difference between verification factor of ideal reports and observed values, indicates that there is over reporting in all immunization data elements by 44% (27-61%), 46% (=31-61%), 40% (12-61%), 37% (11-63%), and 38% (12-64%) in BCG, Penta 1, Penta 3, measles, and full immunization, respectively. Supervision, availability of recording and reporting tools, training, motivation, attitudes towards healthcare data, hard to reach areas and manual documentation were influencing factors of immunization data quality, generation, handling, and use. Conclusion: The study revealed that health facilities over-reported immunization data elements in primary health care units. Attentions should be given to address organization, behavioral, technical, and contextual factors influencing immunization data quality, generation, handling, and use. [Ethiop. J. Health Dev. 2021; 35(SI-3):56-64] Keywords: Immunization data quality, Factors influencing, Verification factor, Wogera distric

The Implementation of Social and Behavior Change Communication Intervention to Improve Immunization Demand: A qualitative study in Awabel District, Northwest Ethiopia

AbstractBackground: Immunization coverage in Ethiopia is low, and dropout rates are high. Social Behavior Change Communication (SBCC) interventions were introduced as a means of combating the ‘demand-side’ immunization barriers. However, Little research exists in terms of the efficacy of the SBCC intervention, in terms of promoting uptake, and improving the immunization demands in Ethiopia.Aim: To explore the current implementation status, and perceived effectiveness of SBCC intervention, barriers and facilitators with new strategies aimed at effective implementation of the SBCC intervention in Awabel District, Northwest Ethiopia.Methods: A phenomenological qualitative study was conducted from January 1- October 31, 2020. In-dept interviews were conducted with fifteen key-informants using a piloted semi-structured interview guide. Participants were purposively selected, which comprised of mangers, Expanded Program of Immunization (EPI) focal personnel, Health Extension Workers (HEWs), Women Development Armies (WDAs), mothers and community representatives. Six vaccination sessions were observed. Coding was done to identify patterns. Thematic analysis was performed using Open Code 4. 02.Results: Interpersonal communication, community conversation, social mobilization and family modeling were used as SBCC approaches. HEWs were the key source of information. Religious leaders were among the major stakeholders that encourage immunization. SBCC was perceived as an effective measure to improve immunization demand. There were multiple barriers for implementation of SBCC interventions including limited resources, lack of awareness, geographic barriers, traditional beliefs, lack of incentives, and limited EPI staff and health facility operating hours. Engagement of fathers and religious leaders, strengthening the WDA, and allocation of more resources were listed as possible strategies to tackle barriers.Conclusion: The implementation of SBCC interventions is important to improve immunization demand. Despite its effectiveness, there are several multi-level barriers to its successful implementation. Further, greater investments are required to improve infrastructures, staff employment and capacity building. [Ethiop. J. Health Dev. 2021; 35(SI-3):49-55]Keywords: Immunization, SBCC, Ethiopi

The Burden of Internal Conflict on Expanded Programs on Immunization in Northwest Ethiopia: Implementation Science Study

AbstractBackground: Despite the rapid progress in immunization service delivery systems worldwide, populations in areas of conflict often have limited or no access to lifesaving vaccines. Hence, evidence generation and translation for context-specific strategies and tailored action would be important, before, during and after an acute humanitarian emergency.Aim: To explore factors affecting immunization service delivery during and after conflict among internally displaced communities in Northwest Ethiopia.Methods: Qualitative and quantitative (record review) methods were applied, phenomenological study design and in-depth interviews were applied to collect the lived experiences of participants in the affected areas. Transcribed and translated data were analyzed and thematized using open code software. A Twenty-four-month record review of quantitative data was analyzed descriptively using an excel sheet to develop immunization coverage trends for tracer antigens.Results: We found that the immunization program had seriously deteriorated during and after the conflict in the study area. The monthly EPI service report in the affected areas showed a decline with the lowest records in December and January when the internal conflict was peak. Security problems, displacement of health workers, destruction of health infrastructures, mixing of the displaced community in the host community and poor coordination among stakeholders and partners, clients having other emergent needs and shortages of resources were important factors for immunization services.Conclusion: Vaccination service delivery was found to have significantly declined in the study area. Security problems affected not only the service utilizers but also the service providers’ wing as well. Coordination of stakeholders and strong leadership systems are crucial in maintaining optimum vaccination service delivery even at the time of conflict. [Ethiop. J. Health Dev. 2021; 35(SI-3):39-48]Key words: Conflict, internally displaced, Immunization service

Implementation fidelity and challenges of optimal cold chain management in Assossa district health system, Benshangul-Gumuz region, Western Ethiopia

AbstractIntroduction: Preventive programs which have proven to be effective in clinical trials may not necessarily impact the health and wellbeing of the community unless they are implemented with fidelity. While cold chain is the backbone of immunization programs, limited studies exist to explain fidelity implementation which likely contributes to a lack of evidence-based instructional practices of cold chain management.Aim: This study aimed to explore the fidelity implementation and challenges of optimal cold chain management in the Benshangul-gumuz region.Methods: A qualitative approach was utilized to explore the underlying challenges to optimum implementation of cold chain management in Benshangul-gumuz region. Observational techniques and key informant interviews with 12 key-informants were conducted. Data was collected at all levels of the health system including, the regional health bureau, Ethiopian Pharmaceuticals Supply Agency hub, district health offices, Health centers, and health posts. Data analysis and interpretation was performed using the framework analysis approach. Open Code 4.02 software was used for analysis.Findings: This study identified three main themes including adherence to intervention, human resource development, and availability and use of resources. The findings also revealed that a significant number of the employees were not adhering to the optimal cold chain management guidelines. Staff development, availability and utilization of equipment and related finances were major fidelity implementation challenges of cold chain management.Conclusions: Across the health facilities under study, implementation fidelity of cold chain management was considered poor. Human resource development, proper allocation and effective management of logistics and related finance could facilitate optimal cold chain management practices, and efforts to save lives through delivery of safe and quality vaccines. [Ethiop. J. Health Dev. 2021; 35(SI-3):03-08]Keywords: Cold chain management, Implementation fidelity, Challenges, Ethiopi

Vaccine safety practices and its implementation barriers in Northwest Ethiopia: A qualitative study

AbstractIntroduction: Even if immunization coverage increases over time, it is imperative to ascertain the safety and efficient coverage of immunization services. However, evidence on the safety practices of vaccines is limited. Assessing the implementation status of vaccine safety practices and its implementation barriers is crucial for program monitoring, interventions, and improvements. Therefore, this study aimed to assess vaccine safety practices and its implementation barriers in the public health facilities of Northwest Ethiopia.Aim: The objective of this study was to assess the safety practices of vaccines and to explore its implementation barriers.Methods: A qualitative research approach was adopted for this study. Face-to-face in-depth interviews with key-informants and immunization session-observations were the main data collection methods used in this study. Study participants were purposively selected based on their experience and knowledge about the subject matter and framework analysis was performed.Result: The study's findings revealed that the safety practices of vaccines from the cold chain system, vaccine administration and waste disposal and management perspective was suboptimal. Many barriers influencing vaccine safety practices were also explored. They are 1) vaccine storage and handling, 2). vaccine administration/delivery, 3) waste disposal and management, 4) communication, 5) monitoring and evaluation and 6) and resource.Conclusion: Efforts to promote the safety of vaccines and vaccination practices is a complex phenomenon and demands multidisciplinary action. Based on our findings, improved vaccine storage and handling, proper administration of vaccines based on guidelines, proper disposal and management of waste, and effective communication, and monitoring can contribute to the safe delivery of vaccination practices. Furthermore, improving the financial freedom of the facilities could increase the availability of essential resources and equipment that can safely store vaccines. [Ethiop. J. Health Dev. 2021; 35(SI-3): 111-117]Keywords: Immunization safety practice, Qualitative study, Framework analysis, Northwest Ethiopi

Strategies to revitalize immunization service provision in urban settings of Ethiopia

AbstractBackground: Improving routine immunization in the urban population is an essential element to address immunization coverage and equity. In rural areas, deliberate efforts are made to reach the populations using adapted strategies such as outreaches while specificities of urban populations are generally not considered in immunization programs of Ethiopia.Aim: To explore the barriers and alternative strategies for immunization service provision in urban settings of Ethiopia.Methods: A qualitative study with a phenomenological study design was conducted in selected cities of Addis Ababa, Dire Dawa and Mekele from June to August 2020. Data was collected at different levels of the health system and the community by using a piloted interview guide. Thirty-five key informants and nine in-depth interviews were conducted. Audio-records of interviews were transcribed verbatim, coded and thematic analysis was performed using Open code version 4.02. software.Results: Our finding revealed that the routine immunization service provision strategy in Addis Ababa, Dire Dawa and Mekele cities was a static approach. Service inaccessibility, poor defaulter tracking mechanisms, substandard service in private facilities, shortage of supplies, and lack of training were the main barriers. We explored alternative strategies to revitalize the Expanded Program on Immunization (EPI) including, expanding services to marginalized populations, outreach/home to home service provision, expanding services to private health facilities, and inter-facility linkage through digitalization.Conclusions: The existing immunization service provision strategies in urban settings are not adequate to reach all children. Immunization service inaccessibility and substandard services were the main barriers hindering service provision. Program managers should expand routine service access to marginalized populations through outreach services, by strengthening the public-private partnership, and integrating technological innovations (like digitalization of the EPI program and application of mHealth reminders) to facilitate inter-facility linkage. [Ethiop. J. Health Dev. 2021; 35(SI-3):98-110]Keywords: Immunization, Vaccination, Urban, Revitalize, Private Facility, Ethiopi

How to optimize Immunization Supply Management at different levels of the health system in Oromia Region? An implementation science research

AbstractBackground: In programs like immunization having strong supply management is important to benefit all the necessary inputs of the health system. In Ethiopia, it has been found, that vaccine availability at service delivery points is low. Moreover, the implementation barriers related to Immunization Supply Management are vague at each level of the health system.Aim: This study aimed to explore the practice, barriers and alternative strategies related to immunization supply management in the Oromia region, west Ethiopia.Methods: A phenomenological qualitative approach was used. The data was collected using interview guides among 27 key informants from health posts, health centers, woreda health office, regional hub and Ethiopian Pharmaceutical supply Agency from June 15 to July 10, 2020. All the audio data were independently transcribed verbatim from Amharic and Afaan Oromo languages after repeatedly listening to the records and then translated into the English. The translated transcription documents were imported into Open Code software 4.02 for the purpose of coding. The coding was performed by three experts independently. Thematic analysis was utilized for the analysis of the data.Results: The immunization supply management practices were categorized into three themes: Vaccine forecast, vaccine request & delivery and stock management of vaccines. Organizational (lack of reviewing processes, lack of transportation, lack of refrigerators, interrupted power supply, absence of vaccine forecasting team, unavailability of performance evaluation reports and lack of electricity), technical (lack of standard leger book and lack of vaccine requisition form) and behavioral (lack of accountability, skill gaps and negligence) barriers were the main determinants that affect vaccine availability. The alternative strategies to optimize the ISM include local data-based forecasting, direct delivery of the vaccine to health facilities, transforming the ISM through digitalization and to establish accountability.Conclusion: This study showed that the existing immunization supply management practice is not optimal. Organizational, technical, and behavioral barriers were the identified determinants for low availability. Therefore, program managers and policymakers should emphasize addressing the identified barriers and tailoring the alternative strategies to ensure the availability of vaccines at the point of service delivery. [Ethiop. J. Health Dev. 2021; 35(SI-3):65-74]Keywords: Immunization, Implementation research, Supply Management, Health system, Ethiopi