Measles second dose vaccine uptake and its associated factors among children aged 2435 months in Northwest … – Nature.com

Study setting, design and period

A community-based cross-sectional study was conducted in Shebel Berenta district in northwest Ethiopia between January 2022 and February 2022. Shebel Berenta is one of the 22 districts in Northwest Ethiopia, located 372km from Bahir Dar, the capital city of Amhara National Regional State. It is bordered on the south by Dejen District, on the north by Enarj Enawuga, and on the east by the Abay River32. It is located at an elevation of 18002150m above sea level. Approximately 72.3% of the district is desert (kola), with Woyinadega accounting for the rest (

Figure1)33, and the map of the study area of interest, Shebele Berenta was generated. Based on the 2021 population projection, the district has an estimated population of 136,948. Of those, 68,200 are males and 68,748 are females. There are nineteen kebels (15 rural and 4 urban kebeles) in the district. There are 6 health centers, 23 health posts, 1 primary hospital, 4 private clinics, and 3 drug stores that provide community health services34.

Map of the study area (Shebel Berenta district) (generated using GIS software version 10.5; URL: https://arcgis.software.informer.com/10.5/).

The source population was all mothers or caregivers with children aged less than 60months who have been residing in Shebel Berenta for at least six months. Whereas mothers/caretaker with children aged 2435months who lived in selected kebeles of Shebel Berenta district for at least six months and received the first dose of the measles vaccine were the study population. We exclude mothers/caretakers with children aged 2435months who did not receive the first dose of measles vaccination, were ill or unable to respond, and/or residents of less than six months in the study area.

The sample size was calculated using the single population proportion formula by considering the following assumptions of sample size determination in a cross-sectional study: 50% proportion of MCV2 uptake (since there are no previous studies in the study area of interest), a 95% level of confidence interval (CI), and a margin of error of 5%. Then, the sample size of the study was determined using the general formula:

$${text{n}}=frac{{({text{Z}}1-mathrm{alpha }/2)}^{2}*pq}{{(d)}^{2}}=frac{{(3.84)}^{2}*0.5*0.5}{{(0.05)}^{2}}=385$$

where n=minimum required sample size, p=proportion of MCV2 uptake, q=1-p=50%, d=a margin of error (5%), Z1-/2=level of confidence interval, 1.96 (95% CI).

Then, by considering 10% non-response rates, the required final sample size was 424.

There are a total of nineteen kebeles in Shebel Berenta district. Out of the total, eight kebeles were selected using a computer-generated random sampling system. The study participants were mothers who had children aged 2435months in the selected kebeles. Then, the sample size was proportionally allocated to each selected kebele. A sampling frame (a list of mothers who had children aged 2435months) was prepared at the health post, which was obtained from the family folder (community health information system). Finally, the required subjects were chosen by a simple random sampling technique using a list of children aged 2435months.

It is the uptake of the measles second dose vaccine after being vaccinated for measles first dose 35.

The proportion of children aged 2435months who had received the measles second dose of vaccine before the age of 24months35.

Measles second dose vaccine utilization.

Family size, educational status, marital status, religion, age of the mother, residence, occupation, age of the child, sex of the child, number of births, birth order, distance to health facility, place of delivery, antenatal care service, awareness of measles second dose schedule, knowledge on vaccine preventable disease, utilization of other vaccine antigen such as BCG, MCV1, Pentavalent3, OPV3, Pneumococcal vaccine3, MCV1 and vitamin A supplementation.

A structured, pretested face-to-face interviewer-administered questionnaire adapted from different published literature17,25,26,27,28,29,36 and Ethiopia Mini Demographic Health Survey 201922 was used to collect socio-demographic, socioeconomic, and maternal and health facility-related variables, and child vaccination status. Participants were approached and interviewed after explaining the purpose of the study and requesting to participate. Six well-trained public health professionals with previous experience in data collection have participated in the data collection. The data collection process started immediately after preparing the list of children aged 2435months at the health post from the selected kebeles. The vaccination information of the children was obtained by requesting mothers or caregivers to show the vaccination cards to the data collectors and mothers' or caregivers' verbal reports if the vaccination cards were not available.

The data collection tool was prepared in English, translated into the local language (Amharic), and then returned to English to ensure consistency. Supervisors and data collectors have received two-day data collection training. The training mainly focused on data quality, confidentiality, and privacy. Sampling procedures and instruction sheets were prepared and given to data collectors and supervisors. One week before the actual fieldwork, a pretest was conducted on 5% of mothers/caregivers with children aged 2435months from other kebeles that did not participate in the actual study, and amendments were made based on the results of the pretest. The data were checked for completeness and accuracy by investigators and supervisors daily.

The data was cleaned manually, coded, and entered into Epi Data 6.4 and exported to SPSS version 25 software for further analysis. Descriptive statistics such as frequency, mean, median and proportion were used to describe the study population concerning relevant variables. Before the analysis was done, the assumptions of the binary logistic regression model were checked. Then, bivariate analysis was carried out to find candidate variables for multivariate analysis. Those variables with a p-value<0.25 in the bivariate analysis were included in the multivariate analysis to adjust for confounders. An adjusted odd ratio with 95% CIs was estimated to identify factors associated with measles second dose vaccine uptake, and they were declared statistically significant at a p-value<0.05. HosmerLemeshows goodness of fit test model coefficient was found to be insignificant with a large p-value (0.89), which indicates the fitness of the model.

This study involves human subject and all research methods and procedures were performed in accordance with the Declaration of Helsinki and approved by the Debre Markose University Health Science College Institutional Research Ethics Review Committee (IRERC). Further supporting letters were also obtained from the Shebel Berenta district health office. After the purpose and objective of the study had been explained, informed consent was obtained from each subject. Confidentiality of information was maintained, and the collected data was kept in the form of a file in a secure place where no one could access it except the investigators. Mothers/caretakers with unvaccinated or seriously ill children during data collection were advised by data collectors to go to the nearby health post and cluster health center.

All procedures involving human subject were approved by Debre Markose University, Health Science College Institutional Research Ethics Review Committee (IRERC). Verbal consent was obtained from all subjects.

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Measles second dose vaccine uptake and its associated factors among children aged 2435 months in Northwest ... - Nature.com