title: Correlates of complete childhood vaccination in East African countries.
abstract: BACKGROUND
  Despite the benefits of childhood vaccinations, vaccination rates in low-income countries (LICs) vary widely. Increasing coverage of vaccines to 90% in the poorest countries over the next 10 years has been estimated to prevent 426 million cases of illness and avert nearly 6.4 million childhood deaths worldwide. Consequently, we sought to provide a comprehensive examination of contemporary vaccination patterns in East Africa and to identify common and country-specific barriers to complete childhood vaccination.
  
  
  METHODS
  Using data from the Demographic and Health Surveys (DHS) for Burundi, Ethiopia, Kenya, Rwanda, Tanzania, and Uganda, we looked at the prevalence of complete vaccination for polio, measles, Bacillus Calmette-Guérin (BCG) and DTwPHibHep (DTP) as recommended by the WHO among children ages 12 to 23 months. We conducted multivariable logistic regression within each country to estimate associations between complete vaccination status and health care access and sociodemographic variables using backwards stepwise regression.
  
  
  RESULTS
  Vaccination varied significantly by country. In all countries, the majority of children received at least one dose of a WHO recommended vaccine; however, in Ethiopia, Tanzania, and Uganda less than 50% of children received a complete schedule of recommended vaccines. Being delivered in a public or private institution compared with being delivered at home was associated with increased odds of complete vaccination status. Sociodemographic covariates were not consistently associated with complete vaccination status across countries.
  
  
  CONCLUSIONS
  Although no consistent set of predictors accounted for complete vaccination status, we observed differences based on region and the location of delivery. These differences point to the need to examine the historical, political, and economic context of each country in order to maximize vaccination coverage. Vaccination against these childhood diseases is a critical step towards reaching the Millennium Development Goal of reducing under-five mortality by two-thirds by 2015 and thus should be a global priority.
authors.affiliation: Yale School of Public Health, New Haven, Connecticut, United States of America.
authors.forename: Maureen E
authors.initials: ME
authors.lastname: Canavan
authors.affiliation: Yale School of Public Health, New Haven, Connecticut, United States of America.
authors.forename: Heather L
authors.initials: HL
authors.lastname: Sipsma
authors.affiliation: University of Addis Ababa, Addis Ababa, Ethiopia.
authors.forename: Getnet M
authors.initials: GM
authors.lastname: Kassie
authors.affiliation: Yale School of Public Health, New Haven, Connecticut, United States of America.
authors.forename: Elizabeth H
authors.initials: EH
authors.lastname: Bradley
mesh_terms: D000351:Africa, Eastern; D005260:Female; D006801:Humans; D007223:Infant; D016015:Logistic Models; D012959:Socioeconomic Factors; D014611:Vaccination / Q000706:statistics & numerical data*
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