Factors associated with incomplete immunization among children aged 11-23 months in Swaziland, 2014
Background Incomplete immunization and non- immunization remain a global public health problem. Swaziland is not an exception and is also faced with challenges in achieving the WHO recommended routine immunization coverage target of 90%. The factors associated with incomplete immunization in Swaziland have never been explored. The reason for conducting this study is to determine the proportions of non - immunization, incomplete immunization and complete immunization and to investigate the factors associated with incomplete immunization among children aged 11- 23 months.Objective To determine predictors of incomplete immunization among children aged 11- 23 months in Swaziland during the period 2014. Materials and methods This study was a cross- sectional secondary data analysis from the Multiple Indicator Cluster Survey (MICS5) conducted in Swaziland in 2014. Data were collected on socio-demographics of mothers and childhood immunization using structured questionnaires. Children were classified as incompletely immunized if they have missed at least one of the recommended antigens (BCG, OPV, DPT and MCV1). A multivariable logistic regression model was selected to identify the predictors of incomplete immunization among children aged 11- 23 months. Results A total number of 520 mother- baby pairs aged between 11- 23 months old were included in this analysis. The majority 468 (90.4%) had immunization cards that were seen. The proportion of incomplete immunization was 24%. BCG had the lowest percent (1.7%) of incomplete immunization and DPT2 had the highest percentage (11.4%). Seven factors (hospital delivery, unavailability of immunization card, religion, postnatal care, antenatal care, exposure to media and birthweight) were associated with incomplete immunization in the univariable analysis. In the multivariable logistic regression, it was found that children with immunization cards that were not available at the first visit were 7.1 times (Adjusted Odds Ratio [AOR] = 7.11; 95% CI= 3.19, 15.86) more likely to be incompletely immunized compared to children for whom the immunization cards were available and seen. Children not having an immunization card were 15.3 times (AOR = 15.32; 95% CI= 1.89, 124.17) more likely not to be immunized compared to children with available and seen immunization cards. Children who were delivered at home were 3.4 times (AOR= 3.46; 95% CI= 0.92, 12.92) more likely to be incompletely immunized compared to children who were delivered in health facilities. Children of mothers who attended the traditionalist or other religions were 14.1 times (AOR=14.09; 95% CI= 0.76, 260.96) more likely to be incompletely immunized compared to children of mothers who were in the Christian religion. Conclusion Despite the EPI’s efforts to increase the immunization coverage in Swaziland the proportions of incomplete immunization still remain high. Targeted interventions are needed to increase immunization coverage. These interventions need to be given to all women of childbearing age, and shouldespecially emphasize the importance of utilizing the health facilities during pregnancy, vi delivery and for postnatal care. These factors have been found to play an important role in childhood immunization.
A research report submitted in partial fulfillment of the requirements for the degree of Master of Science in Epidemiology and Biostatistics to the Faculty of Health Sciences, School of Public Health, University of the Witwatersrand, Johannesburg, 2020