Childhood Immunization in Ethiopia: Accuracy of Maternal Recall Compared to Vaccination Cards
Abstract
1. Introduction
2. Materials and Methods
3. Results
4. Discussion
Strengths and Limitations
5. Conclusions
Author Contributions
Funding
Acknowledgments
Conflicts of Interest
References
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Agreement of Card and Recall | Vaccination Status via Card | |||
---|---|---|---|---|
Yes | No | |||
Vaccination status via recall | Yes | True positives (TP) | False positives (FP) | TP + FP |
No | False negatives (FN) | True negatives (TN) | FN + TN | |
TP + FN | FP + TN | Total |
Variable | Frequency (Mean) | Percent (Standard Deviation) |
---|---|---|
Child characteristics | ||
Child’s sex | ||
Female | 122 | 52.59 |
Male | 110 | 47.41 |
Child’s age | ||
11–15 months | 82 | 35.34 |
16–20 months | 76 | 32.76 |
Older than 20 months | 74 | 31.90 |
Child’s age, continuous | (17.72) | (3.93) |
Child’s birth order | ||
1 | 76 | 32.76 |
2 | 53 | 22.84 |
3 | 42 | 18.10 |
4 or more | 61 | 26.29 |
Maternal characteristics | ||
Mother’s age, continuous | (27.81) | (5.01) |
Mother’s age, categorical | ||
25 or younger | 75 | 32.33 |
25–29 | 66 | 28.45 |
Older than 29 | 62 | 26.72 |
Do not know or missing | 29 | 12.50 |
Family monthly income, continuous | (1993.97) | (1436.11) |
Family monthly income, categorical | ||
Less than or equal to 1100 birr | 55 | 23.71 |
Between 1100 and 2000 birr | 52 | 22.41 |
Greater than 2000 birr | 54 | 23.28 |
Missing | 71 | 30.60 |
Religion | ||
Muslim | 201 | 86.64 |
Orthodox | 19 | 8.19 |
Catholic or Protestant | 12 | 5.17 |
Religion, collapsed | ||
Muslim | 201 | 86.64 |
Other | 31 | 13.36 |
Marital Status | ||
Married | 226 | 97.41 |
Other | 6 | 2.59 |
Number of children mother has | ||
1 | 74 | 31.90 |
2 | 54 | 23.28 |
3 | 39 | 16.81 |
4 or more | 65 | 28.02 |
Occupation of mother | ||
Housewife | 139 | 60.17 |
Merchant | 33 | 14.29 |
Government or private institution worker | 30 | 12.99 |
Farmer | 16 | 6.93 |
Daily job | 8 | 3.46 |
Student | 5 | 2.16 |
Occupation of mother, collapsed | ||
Housewife | 139 | 60.17 |
Other, employed outside of the home | 92 | 39.83 |
Education level of mother | ||
No formal education | 78 | 33.91 |
Elementary | 89 | 38.70 |
High school or higher | 63 | 27.39 |
How long does it take to reach the nearest immunization | ||
center (in minutes)? | ||
30 min or less | 107 | 46.72 |
More than 30 min | 122 | 53.28 |
Have you ever taken your child to a health facility to get a health service other than vaccination? | ||
Yes | 226 | 97.41 |
No | 6 | 2.59 |
Vaccine | Coverage via Recall (%) | Coverage via Card (%) | Net Reporting Bias |
---|---|---|---|
Full vaccination | 74.14 | 74.57 | −0.43 |
BCG | 98.70 | 97.84 | 0.86 |
OPV a | 94.37 | 94.8 | −0.43 |
Pentavalent b | 86.58 | 84.05 | 2.53 |
PCV b | 85.78 | 83.62 | 2.16 |
Rotavirus c | 94.40 | 93.10 | 1.30 |
Measles | 84.05 | 83.62 | 0.43 |
Vaccination Card | Maternal Recall | |||
---|---|---|---|---|
Vaccination Status, as per Vaccination Card | Frequency | Percent | Frequency | Percent |
Receipt of BCG vaccine | 226 | 97.84 | 227 | 98.70 |
Number of doses of OPV child has received | ||||
0 | 2 | 0.87 | 2 | 0.87 |
1 | 2 | 0.87 | 5 | 2.16 |
2 | 8 | 3.46 | 6 | 2.60 |
3 | 28 | 12.12 | 40 | 17.32 |
4 | 191 | 82.68 | 178 | 77.06 |
Number of doses of pentavalent vaccine child has received | ||||
0 | 4 | 1.72 | 1 | 0.43 |
1 | 8 | 3.45 | 8 | 3.46 |
2 | 25 | 10.78 | 22 | 9.52 |
3 | 195 | 84.05 | 200 | 86.58 |
Number of doses of PCV vaccine child has received | ||||
0 | 4 | 1.72 | 2 | 0.86 |
1 | 8 | 3.45 | 8 | 3.45 |
2 | 26 | 11.21 | 23 | 9.91 |
3 | 194 | 83.62 | 199 | 85.78 |
Number of doses of rotavirus vaccine child has received | ||||
0 | 5 | 2.16 | 2 | 0.86 |
1 | 11 | 4.74 | 9 | 3.88 |
2 | 216 | 93.10 | 219 | 94.40 |
3 | 0 | 0.00 | 2 | 0.86 |
Child has received measles vaccine | 194 | 83.62 | 195 | 84.05 |
Child is fully vaccinated | 173 | 74.57 | 172 | 74.14 |
Measure of Accuracy | Full Vaccination | BCG | OPV a,b | Pentavalent a,b | PCV a,b | Rotavirus a,b | Measles |
---|---|---|---|---|---|---|---|
Concordance, % (95% CI) | 96.12 (92.76, 98.21) | 98.69 (96.22, 99.73) | 98.28 (95.64, 99.53) | 98.71 (96.27, 99.73) | 99.14 (96.92, 99.90) | 98.71 (96.27, 99.73) | 97.84 (95.04, 99.30) |
Cohen’s Kappa Coefficient, % (95% CI) | 89.83 (83.32, 96.33) | 56.49 (12.24, 100.00) | — c | 39.58 (−14.54, 93.71) | 66.28 (22.47, 100.00) | 56.61 (12.66, 100.00) | 92.05 (85.16, 98.93) |
Sensitivity, % (95% CI) | 97.11 (93.38, 99.06) | 99.56 (97.55, 99.99) | 99.13 (96.89, 99.89) | 100.00 (98.40, 1.00.00) | 100 (98.40, 100.00) | 100.0 (98.39, 100.00) | 98.97 (96.33, 99.87) |
Specificity, % (95% CI) | 93.22 (83.54, 98.12) | 50.00 (6.76, 93.24) | — c | 25.00 (0.63, 80.59) | 50.00 (6.67, 93.24) | 40.00 (5.27, 85.34) | 92.11 (78.62, 98.34) |
Positive Predictive Value, % (95% CI) | 97.67 (94.15, 99.36) | 99.12 (96.84, 99.89) | 99.13 (96.89, 99.89) | 98.70 (96.25, 99.73) | 99.13 (96.89, 99.89) | 98.70 (96.24, 99.73) | 98.46 (95.57, 99.68) |
Negative Predictive Value, % (95% CI) | 91.67 (81.61, 97.24) | 66.67 (9.43, 99.16) | — c | 100.00 (2.50, 100.00) | 100.00 (15.81, 100.00) | 100.00 (15.81, 100.00) | 94.59 (81.81, 99.34) |
Accuracy of Recall | Frequency | Percent |
---|---|---|
Accuracy of caregiver recall compared to vaccination card—full vaccination | ||
Accurate (card and recall have the same value) | 223 | 96.12 |
False positive (card says child is not vaccinated but recall says child is vaccinated) a | 4 | 1.72 |
False negative (card says child is vaccinated but recall says child is not vaccinated) b | 5 | 2.16 |
False positive or false negative (combined) | 9 | 3.88 |
Accuracy of caregiver recall compared to vaccination card—BCG | ||
Accurate (card and recall have the same value) | 226 | 98.69 |
False positive (card says child is not vaccinated but recall says child is vaccinated) a | 2 | 0.87 |
False negative (card says child is vaccinated but recall says child is not vaccinated) b | 1 | 0.44 |
False positive or false negative (combined) | 3 | 1.31 |
Accuracy of caregiver recall compared to vaccination card—Pentavalent | ||
Accurate (card and recall have the same value) | 229 | 98.71 |
False positive (card says child is not vaccinated but recall says child is vaccinated) a | 3 | 1.29 |
False negative (card says child is vaccinated but recall says child is not vaccinated) b | 0 | 0.00 |
False positive or false negative (combined) | 3 | 1.29 |
Accuracy of caregiver recall compared to vaccination card—Rotavirus | ||
Accurate (card and recall have the same value) | 229 | 98.71 |
False positive (card says child is not vaccinated but recall says child is vaccinated) a | 3 | 1.29 |
False negative (card says child is vaccinated but recall says child is not vaccinated) b | 0 | 0.00 |
False positive or false negative (combined) | 3 | 1.29 |
Accuracy of caregiver recall compared to vaccination card—Measles | ||
Accurate (card and recall have the same value) | 227 | 97.84 |
False positive (card says child is not vaccinated but recall says child is vaccinated) a | 3 | 1.29 |
False negative (card says child is vaccinated but recall says child is not vaccinated) b | 2 | 0.86 |
False positive or false negative (combined) | 5 | 2.16 |
Variable | Chi-Square Test Statistic | p-Value | Fisher’s Exact Test Two-Sided Probability | % of Cells with Expected Counts <5 |
---|---|---|---|---|
Child sex | 0.0331 | 0.8556 | 1.0000 | 50 |
Child age | 0.8526 | 0.6529 | 0.6388 | 50 |
Birth order | 1.9914 | 0.5742 | 0.6592 | 50 |
Caregiver age | 5.0750 | 0.1664 | 0.2349 | 50 |
Education | 1.1569 | 0.5608 | 0.6899 | 50 |
Religion | 3.2259 | 0.0725 | 0.1038 | 25 |
Marital status | 0.2486 | 0.6181 | 1.0000 | 25 |
Parity | 1.6841 | 0.6405 | 0.7112 | 50 |
Occupation | 0.9667 | 0.3255 | 0.4893 | 25 |
Family monthly income | 3.0426 | 0.3851 | 0.4803 | 50 |
Distance to vaccination site | 0.0196 | 0.8887 | 1.0000 | 50 |
Ever been to a health facility for a health service other than vaccination | 0.2486 | 0.6181 | 1.0000 | 25 |
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Porth, J.M.; Wagner, A.L.; Tefera, Y.A.; Boulton, M.L. Childhood Immunization in Ethiopia: Accuracy of Maternal Recall Compared to Vaccination Cards. Vaccines 2019, 7, 48. https://doi.org/10.3390/vaccines7020048
Porth JM, Wagner AL, Tefera YA, Boulton ML. Childhood Immunization in Ethiopia: Accuracy of Maternal Recall Compared to Vaccination Cards. Vaccines. 2019; 7(2):48. https://doi.org/10.3390/vaccines7020048
Chicago/Turabian StylePorth, Julia M., Abram L. Wagner, Yemesrach A. Tefera, and Matthew L. Boulton. 2019. "Childhood Immunization in Ethiopia: Accuracy of Maternal Recall Compared to Vaccination Cards" Vaccines 7, no. 2: 48. https://doi.org/10.3390/vaccines7020048
APA StylePorth, J. M., Wagner, A. L., Tefera, Y. A., & Boulton, M. L. (2019). Childhood Immunization in Ethiopia: Accuracy of Maternal Recall Compared to Vaccination Cards. Vaccines, 7(2), 48. https://doi.org/10.3390/vaccines7020048