IMMUNIZATION DROPOUT RATE AND ITS ASSOCIATED FACTORS AMONG CHILDREN AGED 15 – 23 MONTHS OLD AT SHASHAMENE CITY ADMINISTRATION, OROMIA, ETHIOPIA, 2023: A MIXED METHODS STUDY.

Abstract

Introduction: Immunization – proven tool for controlling vaccine preventable diseases and save lives of millions of children. However, most children in developing countries are not fully immunized and dropout rate is high compared to national cut – off points. Despite the vast study by Ethiopians and other scholars on immunization dropout rate, little is known about vaccine dropout and reasons for it throughout all regions. There are also discrepancies in dropout rate in different studies. Therefore, the study aimed to identify immunization dropout rate and its associated factors among children age 15 – 23 month old in Shashamene City administration, Oromia, Ethiopia, 2023. Methods and Materials: A mixed methods community– based cross sectional study design was employed from May19 – June 28/2023. The sample size was calculated using single population proportion formula and with Epi-Info 7 software. Accordingly, a total of 434 study subjects were recruited to the study after considering a 10% non – response rate and 2 design effect. Four focus group discussions and 12 In-depth interviews were conducted for the qualitative study sampled purposively. The data were collected and entered into Epi-Data Version 4.6 and exported and analyzed using SPSS Version 25. A variable with P value less than 0.25 were transferred to multivariate logistic regression model and a P value less than 0.05 considered significant. The qualitative data collected, transcribed, coded, and analyzed using open code software and triangulation made accordingly. Results: The overall immunization dropout rate from completion in the current study setting was found to be 11.5% (95% CI = 0.084 – 0.154). Factors like missed vaccination schedule (AOR = 2.42; 95% CI = 1.110 - 5.296), availability of seat (AOR = 0.03; 95% CI = 0.011 - 0.068)), possession of immunization card (AOR = 0.43; 95% CI = 0.192 – 0.939) and accessibility of facility (AOR = 0.16; 95% CI = 0.057 – 0.430) were significantly associated with immunization dropout rate. The qualitative finding showed that load on vaccinators, shortage of antigens, loss of immunization card, and socio – economic routines contributed to high immunization dropout rate. Conclusion: The immunization dropout rate was higher compared with the national cut of point (< 5%) and WHO reference (< 10%). Staff workload, respondent’s forgetfulness, antigen shortages, lack of reminder systems, unavailability of seats and immunization card possession are main reasons contributed for vaccination dropout.