Behavioral determinants of immunization service utilization in Ethiopia: a cross-sectional community-based survey.
INTRODUCTION
According to the Ethiopian Health Sector Development Plan IV annual performance report (HSDP IV), Ethiopia targeted to reach 90% coverage with DPT-Hib-HepB 3 (Pentavalent3) vaccine and 86% coverage with measles vaccine in 2010- 2011. However, the actual performance fell-short of the intended targets due to several reasons. Therefore, a nationwide comprehensive study was conducted to examine the behavioral determinants of immunization practices in the Ethiopian context. The study employed the Modified Steps of Behavioral Change (SBC) Model as a theoretical lens.


METHODS
A cross-sectional study was conducted in May 2012 in all the nine regions and the two city administrations of Ethiopia. The study used a community-based quantitative survey design comprising of multistage cluster sampling to draw relevant data from a sample of 2,328 caretakers whose children were 12-23 months of age at the time of data collection.


RESULTS
Overall, the multivariate analysis findings revealed that caretakers, who had high knowledge were 2.24 times more likely to vaccinate their children than participants had low knowledge (OR= 2.24, 95%CI: 1.68-2.98). Participants who had high approval were 2.45 times more likely to vaccinate their children than participants who had unfavorable approval (OR= 2.45, 95%CI: 1.67-3.59); and participants who had high intention were 6.49 times more likely to vaccinate their children with pentavalent3 vaccines than participants who had low intention(OR= 6.49, 95%CI: 4.83-8). Also, it was clear from the regression analysis that aspects of caretakers' demographic characteristics were significant predictors of their immunization practice for the sample group.


CONCLUSION
We identified that caretakers' knowledge, approval, intention, parents' residence, and religious backgrounds were associated with immunization service utilization. To achieve sustainable behavioral change on immunization service utilization of the caretakers in Ethiopia, this study suggests investing in activities that enhance caretakers' knowledge, approval, intention, and practice components represented in the behavioral change model.
['Ababu|Yohannes|Y|', 'Braka|Fiona|F|', 'Teka|Aschalew|A|', 'Getachew|Kinde|K|', 'Tadesse|Tefera|T|', 'Michael|Yohannes|Y|', 'Birhanu|Zewdie|Z|', 'Nsubuga|Peter|P|', 'Assefa|Tersit|T|', 'Gallagher|Kathleen|K|']
D000293:Adolescent D000328:Adult D017028:Caregivers D003430:Cross-Sectional Studies D005002:Ethiopia D005260:Female D015438:Health Behavior D007722:Health Knowledge, Attitudes, Practice D006801:Humans D007114:Immunization D017589:Immunization Programs D007223:Infant D008297:Male D008875:Middle Aged D008962:Models, Theoretical D012067:Religion D014611:Vaccination D014612:Vaccines D055815:Young Adult
Behavior knowledge approval intention advocacy doses pentavalent vaccine