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Routine Immunization Status and Factors Associated with Immunization Coverage among Children Aged 12–23 Months in Tanzania
Gumi Abdallah
gabdallah@ihi.or.tz
Gumi Abdallah
Ifakara Health Institute, Dar es Salaam, Tanzania,
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Hajirani M. Msuya
Hajirani M. Msuya
Ifakara Health Institute, Dar es Salaam, Tanzania,
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Sally Mtenga
Sally Mtenga
Ifakara Health Institute, Dar es Salaam, Tanzania,
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Charles Festo
Charles Festo
Ifakara Health Institute, Dar es Salaam, Tanzania,
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Grace Mhalu
Grace Mhalu
Ifakara Health Institute, Dar es Salaam, Tanzania,
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Josephine Shabani
Josephine Shabani
Ifakara Health Institute, Dar es Salaam, Tanzania,
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Robert Tillya
Robert Tillya
Ifakara Health Institute, Dar es Salaam, Tanzania,
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William Mwengee
William Mwengee
World Health Organization, Tanzania Country Office, Dar es Salaam, Tanzania
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Honorati Masanja
Honorati Masanja
Ifakara Health Institute, Dar es Salaam, Tanzania,
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Abdallah Mkopi
Abdallah Mkopi
Ifakara Health Institute, Dar es Salaam, Tanzania,
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ABSTRACT.
Immunization has saved millions of lives globally from vaccine-preventable diseases. Childhood immunization is an effective public health strategy for decreasing morbidity and mortality among children in developing countries. Tanzania has one of the highest rates of coverage of routine child immunization among sub-Saharan African countries. However, obstacles to universal immunization still exist, particularly in rural areas of the country. Assessing routine immunization coverage is essential to inform vaccine policies and program implementation. This study aimed to assess routine immunization status and factors associated with its coverage among children aged 12–23 months. We conducted a cross-sectional, quantitative household survey in 31 regions with caretakers of children in Tanzania, where a total of 4,560 households were visited. Nationally, 85.5% of children aged 12–23 months had completed the full recommended course of vaccines. Overall, 14.5% of children aged 12–23 months did not complete routine immunization schedules in 2019. We found that factors associated with immunization coverage included having one to six family members, higher household wealth, the family’s head engaging in subsistence farming, caretakers’ age, children’s age, educational level, children with clinic cards, and children receiving the diphtheria, pertussis, tetanus–3 vaccine. The country is about to reach the vaccination coverage target set by the WHO and the United Nations Children Fund. Improving existing vaccination coverage and optimizing the use of recommended interventions are required. We strongly advise using the periodic micro-planning tool and satellite image technology, particularly in areas where immunization coverage is less than 80%.
- Supplemental Materials (PDF 209.90 KB)
Author Notes
Financial support: This research received funding from the
Disclosures: Ethical clearance and research permits were obtained from ethical review committees from Ifakara Health Institute’s Institutional Review Board (IHI-IRB), the National Institute for Medical Research (NIMR), the President’s Office of Regional Administration and Local Government (PORALG) for Tanzania Mainland, as well as the Zanzibar Medical Research and Ethics Committee (ZAMREC) from Zanzibar. Details of the clearances are further explained in Mkopi et al.40 Individual written informed consent was obtained from the head of the household. The study complied with the International Ethical Guidelines for Biomedical Research Involving Human Subjects.44
Data availability: Data collection tools and the data generated are available by emailing the corresponding author (gabdallah@ihi.or.tz or gumiabdallah@gmail.com).
Current contact information: Gumi Abdallah, Hajirani M. Msuya, Sally Mtenga, Charles Festo, Grace Mhalu, Josephine Shabani, Robert Tillya, Honorati Masanja, and Abdallah Mkopi, Ifakara Health Institute, Dar es Salaam, Tanzania. E-mails: gabdallah@ihi.or.tz, hmsuya@ihi.or.tz, smtenga@ihi.or.tz, cfesto@ihi.or.tz, gmhalu@ihi.or.tz, jshabani@ihi.or.tz, rtillya@ihi.or.tz, hmasanja@ihi.or.tz, and amkopi@ihi.or.tz. William Mwengee, World Health Organization, Tanzania Country Office, Dar es Salaam, Tanzania, E-mail: mwengeew@who.int.
ProCite
RefWorks
Reference Manager
BibTeX
Zotero
EndNote
-
1.
Eze P, Agu UJ, Aniebo CL, Agu SA, Lawani LO, Acharya Y, 2021. Factors associated with incomplete immunization in children aged 12–23 months at subnational level, Nigeria: A cross-sectional study. BMJ Open 11: e047445.
-
2.
Mekonnen ZA, Gelaye KA, Were MC, Tilahun B, 2020. Timely completion of vaccination and its determinants among children in northwest, Ethiopia: A multilevel analysis. BMC Public Health 20: 908.
-
3.
Ntenda PAM, Sixpence A, Mwenyenkulu TE, Mmanga K, Chirambo AC, Bauleni A, Nkoka O, 2022. Determinants of pentavalent and measles vaccination dropouts among children aged 12–23 months in The Gambia. BMC Public Health 22: 520.
-
4.
Ekouevi DK, Komlanvi GFA, Yaya I, Zida-Compaore WI, Boko A, Sewu E, Lacle A, Ndibu N, Toke Y, Landoh DE, 2018. Incomplete immunization among children aged 12–23 months in Togo: A multilevel analysis of individual and contextual factors. BMC Public Health 18: 952.
-
5.
Shchelkunova GA, Shchelkunov SN, 2017. 40 Years without smallpox. Acta Naturae 9: 4–12.
-
6.
Mekonnen AG, Bayleyegn AD, Ayele ET, 2019. Immunization coverage of 12–23 months old children and its associated factors in Minjar-Shenkora district, Ethiopia: A community-based study. BMC Pediatr 19: 198.
-
7.
Gebeyehu NA, Adela GA, Tegegne KD, Assfaw BB, 2022. Vaccination dropout among children in sub-Saharan Africa: Systematic review and meta-analysis. Hum Vaccin Immunother 18: 11.
-
8.
Bobo FT, Asante A, Woldie M, Dawson A, Hayen A, 2022. Child vaccination in sub-Saharan Africa: Increasing coverage addresses inequalities. Vaccine 40: 141–150.
-
9.
Mmanga KM, Mwenyenkulu TE, Nkoka O, Ntenda PAM, 2022. Tracking immunization coverage, dropout and equity gaps among children ages 12–23 months in Malawi – Bottleneck analysis of the Malawi Demographic and Health Survey. Int Health 14: 250–259.
-
10.
Zunino FC, Keskinocak P, Nazzal D, Freeman MC, 2021. Health spending and vaccination coverage in low-income countries. BMJ Glob Health 6: e004823.
-
11.
Ali HA, et al., 2022. Vaccine equity in low and middle income countries: A systematic review and meta-analysis. Int J Equity Health 21: 1–30.
-
12.
Rachlin AM, Danovaro-Holliday C, Murphy P, Sodha SV, Aaron S, Wallace AS, 2022. Routine vaccination coverage – Worldwide, 2021. MMWR Morb Mortal Wkly Rep 71: 1396–1400.
-
13.
Ostermann J, Hair NL, Moses S, Ngadaya E, Mfinanga SG, Brown DS, Baumgartner JN, Vasudevan L, 2023. Is the intention to vaccinate enough? Systematic variation in the value of timely vaccinations and preferences for monetary vs non-monetary incentives among pregnant women in southern Tanzania. Vaccine X 13: 100266.
-
14.
UNICEF, 2019. Over 20 Million Children Worldwide Missed Out on Measles Vaccine Annually in Past 8 Years, Creating a Pathway to Current Global Outbreaks. Available at: https://www.unicef.org/press-releases/over-20-million-children-worldwide-missed-out-measles-vaccine-annually-past-8-years. Accessed March 21, 2024.
-
15.
IA2030, 2022. IMMUNIZATION AGENDA 2030 GLOBAL REPORT 2021: Advancing the Immunization Agenda 2030 during the COVID-19 Pandemic. Available at: http://www.immunizationagenda2030.org/images/documents/IA2030_Global_Report_2021_Final_18_May_2022.pdf. Accessed July 5, 2024.
-
16.
Dimitrova A, Escobar G, Carrasco-Richardson R, Benmarhnia T, 2023. Essential childhood immunization in 43 low- and middle-income countries: Analysis of spatial trends and socioeconomic inequalities in vaccine coverage. PLoS Med 20: 1–20.
-
17.
Guillaume D, Meyer D, Waheed DN, Schlieff M, Muralidharan K, Chou VB, Limaye R, 2023. Factors influencing the prioritization of vaccines by policymakers in low- and middle-income countries: A scoping review. Health Policy Plan 38: 363–376.
-
18.
Bangura JB, Xiao S, Qiu D, Ouyang F, Chen L, 2020. Barriers to childhood immunization in sub-Saharan Africa: A systematic review. BMC Public Health 20: 1108.
-
19.
Haji A, Lowther S, Ngan’ga Z, Gura Z, Tabu C, Sandhu H, Arvelo W, 2016. Reducing routine vaccination dropout rates: Evaluating two interventions in three Kenyan districts, 2014. BMC Public Health 16: 152.
-
20.
World Health Organization, 2018. Business Case for WHO Immunization Activities on the African Continent 2018–2030. Brazzaville, Republic of the Congo: WHO.
-
21.
Chanie MG, Ewunetie GE, Molla A, Muche A, 2021. Determinants of vaccination dropout among children 12–23 months age in north Gondar zone, northwest Ethiopia, 2019. PLoS One 16: 1–13.
-
22.
Adebowale AS, Fagbamigbe AF, Morakinyo O, Obembe T, Afolabi RF, Palamuleni ME, 2020. Parental educational homogamy and under-five mortality in sub-Saharan Africa: Clarifying the association’s intricacy. Sci Am 7: 1–17.
-
23.
Ayipe FI, Tanko M, 2023. Public health expenditure and under-five mortality in low-income sub-Saharan African countries. Soc Sci Humanit Open 8: 100570.
-
24.
Galadima AN, Zulkefli NAM, Said SM, Ahmad N, 2021. Factors influencing childhood immunisation uptake in Africa: A systematic review. BMC Public Health 21: 1475.
-
25.
Mbonigaba E, Nderu D, Chen S, Denkinger C, Geldsetzer P, McMahon S, Bärnighausen T, 2021. Childhood vaccine uptake in Africa: Threats, challenges, and opportunities. J Glob Health Rep 5: e2021080.
-
26.
Vasudevan L, Baumgartner JN, Moses S, Ngadaya E, Mfinanga SG, Ostermann J, 2020. Parental concerns and uptake of childhood vaccines in rural Tanzania – A mixed methods study. BMC Public Health 20: 1573.
-
27.
Fain L, 2020. Immunization Tanzania: USAID. Available at: https://2017-2020.usaid.gov/sites/default/files/documents/Immunization_Fact_Sheet_October_2020.pdf.
-
28.
Yelverton V, Hair NL, Ghosh SH, Mfinanga SG, Ngadaya E, Baumgartner JN, Ostermann J, Vasudevan L, 2022. Beyond coverage: Rural-urban disparities in the timeliness of childhood vaccinations in Tanzania. Vaccine 40: 5483–5493.
-
29.
UNICEF, 2019. Immunization for All: No Child Too Far from a Vaccine Clinic. Available at: https://www.unicef.org/tanzania/stories/immunization-all. Accessed February 18, 2024.
-
30.
Vaughan K, Clarke-Deelder E, Tani K, Lyimo D, Mphuru A, Manzi F, Schutte C, Ozaltin A, 2020. Immunization costs, from evidence to policy: Findings from a nationally representative costing study and policy translation effort in Tanzania. Vaccine 38: 7659–7667.
-
31.
Mutua MK, Mohamed SF, Porth JM, Faye CM, 2020. Inequities in on-time childhood vaccination: Evidence from sub-Saharan Africa. Am J Prev Med 60: S11–S23.
-
32.
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34.
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-
35.
Cutts FT, Claquin P, Danovaro-Holliday MC, Rhoda DA, 2016. Monitoring vaccination coverage: Defining the role of surveys. Vaccine 34: 4103–4109.
-
36.
World Health Organization Vaccines and Immunization. Available at: https://www.who.int/health-topics/vaccines-and-immunization#tab=tab_1. Accessed February 19, 2024.
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37.
World Health Organization Immunization Analysis and Insights. Available at: https://www.who.int/teams/immunization-vaccines-and-biologicals/immunization-analysis-and-insights/global-monitoring/immunization-coverage/survey-methods. Accessed February 15, 2024.
-
38.
Dolan SB, Carnahan E, Shearer JC, Beylerian EN, Thompson J, Gilbert SS, Werner L, Ryman TK, 2019. Redefining vaccination coverage and timeliness measures using electronic immunization registry data in low-and middle-income countries. Vaccine 37: 1859–1867.
-
39.
Mkopi A, et al., 2021. Factors affecting non-coverage of measles-rubella vaccination among children aged 9–59 months in Tanzania. Vaccine 39: 6041–6049.
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