Socio Demographic characteristics
A total of 300 individuals (100 cases and 200 controls) were approached for interview.
Children's caretakers were interviewed and the response rate was 93.75%. Protestant
is the dominant religion for both caretakers of cases and controls with a percentage
of 85% and 93.5% respectively. Additionally almost all of the cases (98%) and controls
(98.5%) were Gedeo in ethnicity. Equal percentage (78%) of the cases and controls
mothers/caretakers earns ≤ 500 birr monthly. While a small group of cases (5%) and
controls (3%) caretakers have a monthly income of ≥1000. The mean and median income
of the interviewees was 400 and 300 birr respectively with a Standard Deviation (SD)
of 436.04 birr. Among the interviewed caretakers of cases and controls, more than
half (68%) and (56.5%) respectively, were housewives and about two third of cases
(70%) and controls (62.5%) caretaker’s were illiterate. From the total study participants,
55% were males. In addition to this, among the cases, 57% were males. On the other
hand, more than half of the cases and controls fall in the 12-18 months age group
and the mean and median age was 17.84 months and 18 months respectively with a SD
of 3.94. Regarding birth order, 40% of cases and 38% of controls were fourth or above
child for their mothers. The mean and median birth order was 3.46 and 3 respectively
with SD of 2.47.Fifty-five (55%) percent of the cases and 58% of the controls had
5 or less family members. The mean family member was 5.41 and the median was 5 with
SD of 2.2 (Table 02).
Maternal behavior related characteristics
Maternal behavior related factors regarding measles immunization were also assessed
and out of the total caretakers of cases and controls, 72% and 92.5% respectively
heard about measles vaccination. Of those cases of mothers/caretakers heard about
measles, 86% got the information from health professionals. Only 8% and 4% cases and
controls mothers/caretakers respectively got the information from mass media. Participants
were also asked if all children should be vaccinated and only 26% of the cases mothers/caretakers
answered yes. However 76% of the controls mothers/caretakers knew that all children
should be vaccinated against measles. Of the cases mothers/caretakers, only 31% had
awareness about the right age of vaccination, while74% of the controls mothers/caretakers
had knowledge that it was at 9 months. Moreover interviewees were also asked if vaccinating
a child was important and its benefit. More than two third of the cases and almost
all of the controls mothers/caretakers agreed that vaccination is important. However
only half of the cases mothers/caretakers knew its benefit is to prevent disease while
more than three fourth of the control’s mothers/caretakers knew the benefit of measles
vaccination. On the other hand, 60% and 92% of cases and controls mothers/caretakers
respectively agreed that measles is vaccine preventable and 65% of cases and 91% of
controls mothers/caretakers knew that it is contagious (Table 03).
Health service-related factors associated with measles vaccination
The nearest health facility in 84% of the cases and 78% of controls kebele provide
routine immunization and health post is the dominant health facility. Health extension
workers live in almost all cases and controls kebele. Forty five percent (45%) of
the cases mothers/caretakers will walk 15-30 min to reach the nearest health facility
while only 24% took more than one hour.
Only around a quarter (23%) of the cases mothers/caretakers had vaccination card.
However, vaccination card was available in 79% of the control’s household. Majority
of the cases and controls didn’t face delay in any EPI services. Moreover 25% of cases
and 33% of controls experienced delay in other EPI services. Additionally, 45% of
the cases mothers/caretakers had Ante Natal Care (ANC) follow up while more than three
fourth of the control’s mothers/caretakers visited the health facility during their
pregnancy. On the other hand, 30% of the cases and 56% of the control’s mothers/caretakers
had post-natal care follow-up.
Regarding place of delivery, 73% of cases mothers/caretakers gave birth to their last
child in their home and 67% were attended by non-professional attendants. However,
for the controls, the percentage of home delivery was 49%. Additionally, mothers/caretakers
of cases who took tetanus toxoid (TT) vaccine during their pregnancy were 42% while
controls were 77.5% (Table 04).
Independent predictors of non-immunization against measles
In Bivariate analysis, 9 variables: religion, availability of vaccination card, if
a child was ever vaccinated when they go to health facility for other purposes, ANC
follow up, TT vaccine, place of delivery, birth attendant, PNC follow up, heard about
measles vaccination, knowledge on right age of vaccination, if measles is vaccine
preventable and contagious, importance and benefit of vaccination, were significant.
The variables that showed statistical significant in the bivariate analysis, variables
with p value less than 0.2 and variables that were significant in most previous studies
were further analyzed in multivariable logistic regression to adjust for potential
confounders and to identify independent factors that affect measles vaccination.
Therefore income, availability of vaccination card, if a child was ever vaccinated
when they go to health facility for other purposes, ANC follow up, TT vaccine, place
of delivery, birth attendant, PNC follow up, heard about measles vaccination, knowledge
on right age of vaccination, if measles is vaccine preventable and contagious, importance
and benefit of vaccination, mothers/caretakers educational status, source of information
about measles immunization, availability of HEWs in the kebele, availability of immunization
in the nearest health facility, distance to reach health facility, delay in other
EPI services and if there is any child went to health facility but not vaccinated
were the variables identified for further analysis.
The multivariable analysis showed that knowing if vaccinating a child is important,
having ANC follow up, knowledge if all children should take measles vaccine and if
it is contagious were independent risk factors related to child’s non vaccination
against measles (Table 05).
Knowledge if vaccinating a child is important was a significant variable for child
vaccination against measles. According to this study the odds that being unvaccinated
against measles was because of mothers/caretaker’s lack of knowledge on the importance
of vaccination was 6.81 as compared to being vaccinated against measles.
It was also found that the odds are 3.57 times higher given those children born from
mothers who don’t have ANC follow up will be unvaccinated against measles compared
to those born from mothers who had ANC follow up.
Knowing that all children should be vaccinated against measles was also another predictor
found to be associated with non-vaccination against measles. Thus; the odds of mothers/caretakers
who didn’t know that all children should be vaccinated against measles among non-vaccinated
children were 4.29 as great as the odds among the vaccinated children.
Furthermore, mothers/caretaker’s knowledge if measles was contagious was another independent
predictor for child vaccination against measles. According to this study, the odds
are 8.97 times greater given those children of caretakers/mothers who don’t know that
measles is contagious will be unvaccinated against measles compared to those born
from mothers who knew measles is contagious.