Full immunization coverage and associated factors among children aged 12–23 months in Somali Region, Eastern Ethiopia

Objective Despite those efforts in expanded programs of immunization, nearly one fifth of children in developing countries miss out basic vaccines. Moreover, many children who started vaccination fail to complete immunization.Identifying associated factorswhich is scarce in the study area, is crucial for interventions. This study assessed full-immunization and associated factors among children aged 12–23 months in Somali region, Eastern Ethiopia. Methods A community-based cross-sectional study design was conducted from October 1–30, 2018, in selected rural and urban kebeles in Somali regionamong 612 children. Cluster sampling was employed and data was collected using structured questionnaire. Full-immunization was measured by maternal recall and vaccination card.Data entry and analysis was done by EpiData3.1 and SPSSversion.20 respectively. Binary logistic regression with Bivariate and Multivariable model was usedto identify predictors of full-immunization. Odd ratios were computed and P-value <0.05 was considered as statistically significant. Results Based on maternal recall plus vaccination card 249(41.4%) of children were completed immunization, while vaccination only by card was 87(29.7%). Only 238(39.5%) of participants had good knowledge about vaccination. Not knowing to come back for next visits 197(55.8%) were the major reason for dropout. Residing in urban (AOR = 2.0, 95%CI: 1.0, 3.9),primary educated mothers(AOR = 2.2, 95%CI: 1.0, 5.0), married mothers (AOR = 4.2, 95%CI:1.0, 18), higher average monthly income (AOR = 2.5, 95%CI 1.1, 5.2)and delivered at health facilities (AOR = 3.8, 95%CI 1.9, 7.3)were significantly associated with full-immunization. Conclusion Coverage of full immunization was found to be low compared to the targets set in the Global Vaccine Action Plan(2011–2020).Two-third of the participants has poor knowledge about vaccination. Urban residence, mother education, higher family income, male child and institutional delivery were factors. This study suggests that awareness creation, behaviour change on vaccination and enhancing utilization of maternal health service including delivery service, should be stressed.

Agreement between maternal recall of distant first birth events with hospital birth records: A cohort study

BACKGROUND Inter and intra-generational birth cohorts could be particularly useful for predicting the likelihood of labour and birth events for nulliparous women. However, maternal recall of their first childbirth may be imprecise, and hospital records can be inaccurate. Establishing the extent of agreement between mothers’ recall and hospital reports of historical first birth events could be the basis of a prediction tool that could contribute to better health care practices during daughter’s perinatal period. METHODS In 2015, women who had their first baby between 1967 and 1997 were asked to recall gravidity, method of labour onset, type of pain relief, length of labour, birth outcome, and infant’s gender, birthweight and gestational age ≥17 years postpartum. Responses were compared to hospital birth records. Agreement was evaluated using Bland-Altman’s plots and Kappa statistics (k). Logistic regression modeling was used to determine factors influencing discrepant recall. RESULTS Of 150 questionnaires distributed, 101 records were complete. Up to 49 years after birth there was strong agreement for birthweight measured at interval (mean discrepancy -28.69g, SD =170.91g, Bland-Altman 95% limits of agreement (-363.66g, 306.28g)) and category level birthweight k=0.83, good agreement for gestational age (GA) in weeks, at interval level (mean difference=0, SD =0.90, Bland-Altman 95% limits of agreement (-1.766, 1.766)) and at category level GA k=0.56. There was moderate agreement for labour length (≤10hrs/>10hrs) k=0.54; 43% of records did not record this information. For gravidity k=0.43, labour onset k=0.79; any pain relief k=0.61; and birth outcome k=0.91. Univariate logistic regression showed better agreement on infant birthweight in women with higher levels of education, lower agreement for onset of labour method with increasing maternal age at birth, and higher agreement for use of pethidine, but lower agreement for use of epidural in women who had their first babies more recently. CONCLUSIONS Mothers accounts of first birth events generally agree with hospital records. Familial birth data may contribute to more individualised care for nulliparous women, and may limit rising interventions based on population level guidelines. Future research in other settings is warranted before diagnostic criteria may be used in clinical settings.

Validation of Maternal Recall of Iron Folic Supplementation During Antenatal Care in Rural Southern Nepal

Objectives This study's primary objective is to examine the validity of maternal recall of iron folate supplementation during antenatal care and factors associated with accuracy of maternal recall. Methods A longitudinal cohort design was employed for the validation study. The direct observation of all iron folate supplementation (IFA) received during all antenatal care visits at the five study health posts served as the “gold standard” to the maternal report of IFA received collected during a postpartum interview. Individual-level validity was assessed by calculating indicator sensitivity, specificity and area under the receiver operating curve (AUC). The inflation factor (IF) measured population-level bias, comparing the true coverage to the survey measure (maternal report) coverage of IFA. A multivariable log-binomial model was used to assess factors associated with accurate recall. Results The majority (95.8%) of women were observed receiving IFA during pregnancy. Women overreported the number IFA tablets received compared to what was observed during ANC visits. On average the reported number of tablets received was 45 tablets greater than the number observed. Individual-level accuracy of maternal report of any IFA receipt was moderate (AUC = 0.60) and population bias was low (IF = 1.01). However, the individual-level validity was poor across the seven IFA tablet count categories; the AUC for categories ranged from 0.47 to 0.58, indicating a performance that at best was slightly better than a random guess and at worst, misleading. Driven by the trend of maternal overreport, the inflation factor indicated that the survey measure drastically underestimated the prevalence of lower tablet categories and overestimated the prevalence of higher tablet counts. Accuracy of maternal report was not associated with months since last ANC observation nor any maternal characteristics. Conclusions Maternal report of the amount IFA supplementation received during pregnancy produced extremely biased population prevalence and performed comparably to or worse than a random guess for individual level validity. It's imperative to improve this indicator for future use, as it is included in global frameworks, initiatives and national program planning. Funding Sources This research was funded by the Bill and Melinda Gates Foundation.

Reliability of maternal recall of delivery and immediate newborn care indicators in Sarlahi, Nepal

Background The intrapartum period is a time of high mortality risk for newborns and mothers. Numerous interventions exist to minimize risk during this period. Data on intervention coverage are needed for health system improvement. Maternal report of intrapartum interventions through surveys is the primary source of coverage data, but they may be invalid or unreliable. Methods We assessed the reliability of maternal report of delivery and immediate newborn care for a sample of home and health facility births in Sarlahi, Nepal. Mothers were visited as soon as possible following delivery (< 72 h) and asked to report circumstances of labor and delivery. A subset was revisited 1–24 months after delivery and asked to recall interventions received using standard household survey questions. We assessed the reliability of each indicator by comparing what mothers reported immediately after delivery against what they reported at the follow-up survey. We assessed potential variation in reliability of maternal report by characteristics of the mother, birth event, or intervention prevalence. Results One thousand five hundred two mother/child pairs were included in the reliability study, with approximately half of births occurring at home. A higher proportion of women who delivered in facilities reported “don’t know” when asked to recall specific interventions both initially and at follow-up. Most indicators had high observed percent agreement, but kappa values were below 0.4, indicating agreement was primarily due to chance. Only “received any injection during delivery” demonstrated high reliability among all births (kappa: 0.737). The reliability of maternal report was typically lower among women who delivered at a facility. There was no difference in reliability based on time since birth of the follow-up interview. We observed over-reporting of interventions at follow-up that were more common in the population and under-reporting of less common interventions. Conclusions This study reinforces previous findings that mothers are unable to report reliably on many interventions within the peripartum period. Household surveys which rely on maternal report, therefore, may not be an appropriate method for collecting data on coverage of many interventions during the peripartum period. This is particularly true among facility births, where many interventions may occur without the mother’s full knowledge.

Reliability of maternal recall of delivery and immediate newborn care indicators in Sarlahi, Nepal

Background: The intrapartum period is a time of high mortality risk for newborns and mothers. Numerous interventions exist to minimize risk during this period. Data on intervention coverage are needed for health system improvement. Maternal report of intrapartum interventions through surveys is the primary source of coverage data, but they may be invalid or unreliable. Methods: We assessed the reliability of maternal report of delivery and immediate newborn care for a sample of home and health facility births in Sarlahi, Nepal. Mothers were visited as soon as possible following delivery (<72 hours) and asked to report circumstances of labor and delivery. A subset was revisited 1-24 months after delivery and asked to recall interventions received using standard household survey questions. We assessed the reliability of each indicator by comparing what mothers reported immediately after delivery against what they reported at the follow-up survey. We assessed potential variation in reliability of maternal report by characteristics of the mother, birth event, or intervention prevalence.Results: 1502 mother/child pairs were included in the reliability study, with approximately half of births occurring at home. A higher proportion of women who delivered in facilities reported “don’t know” when asked to recall specific interventions both initially and at follow-up. Most indicators had high observed percent agreement, but kappa values were below 0.4, indicating agreement was primarily due to chance. Only “received any injection during delivery” demonstrated high reliability among all births (kappa: 0.737). The reliability of maternal report was typically lower among women who delivered at a facility. There was no difference in reliability based on time since birth of the follow-up interview. We observed over-reporting of interventions at follow-up that were more common in the population and under-reporting of less common interventions.Conclusions: This study reinforces previous findings that mothers are unable to report reliably on many interventions within the peripartum period effectively. Household surveys which rely on maternal report, therefore, may not be an appropriate method for collecting data on coverage of many interventions during the peripartum period. This is particularly true among facility births, where many interventions may occur without the mother’s full knowledge.

Validation of maternal recall on exclusive breastfeeding 12 months after childbirth

Objective:We aimed to assess the validity of maternal recall of exclusive breastfeeding (EBF) at 3 months obtained 12 months after childbirth.Design:A population-based birth cohort study. The gold standard is maternal report of EBF at the age of 3 months (yes or no) and age of introduction of other foods in the infant’s diet. EBF was considered when the mother reported that no liquid, semi-solid or solid food was introduced up to that moment. The variable to be validated was obtained at 12 months after childbirth when the mother was asked about the age of food introduction. The prevalence of EBF at 3 months, and sensitivity, specificity, positive (PPV) and negative predictive values (NPV), and accuracy of 12-month recall with 95 % CI were calculated.Setting:Pelotas, Brazil.Participants:3700 mothers of participants of the Pelotas 2004 Birth Cohort.Results:The prevalence of EBF at 3 months was 27·8 % (95 % CI 26·4, 29·3) and 49·0 % (95 % CI 47·4, 50·6) according to gold standard and maternal recall, respectively. The sensitivity of maternal recall at 12 months was 98·3 % (95 % CI 97·4, 99·0), specificity 70·0 % (95 % CI 68·2, 71·7), PPV 55·8 % (95 % CI 53·4, 58·1), NPV 99·1 % (95 % CI 98·6, 99·5) and accuracy 77·9 % (95 % CI 76·6, 79·2). When the analyses were stratified by maternal and infant characteristics, the sensitivity remained around 98 %, and the specificity ranged from 64·4 to 81·8 %.Conclusions:EBF recalled at the end of the first year of infant’s life is a valid measure to be used in epidemiological investigations.