To Editor in Chief: BMC- Public Health Journal.
Dear/Sir
We were requested to do revisions on the manuscript submitted to BMC- Public Health.
Manuscript copy edited by language expert for grammatical errors. We have also uploaded a
document containing the track changes made after revisions in order for reviewers pick the
changes quickly (the changes are written in red color).
With Regards,
Manay Kifle
Corresponding Author.
A document containing the track changes after edited by language expert for grammatical errors
(the changes are written in red color).
No
1.
Question/concern
Response
Title Section: Lines 2:
Revision is made as follow .
Immunization coverage and associated factors of 12-23 Immunization coverage of 12‒23 months old
months old children in Jijiga District, Somali Regional children and associated factors in Jigjiga
State, Ethiopia
District, Somali National Regional State,
Ethiopia
2.
Title Section: Lines 6:
a
Revision is made as follow .
Jijiga Health Science College, Jijiga , Somali Regional
State, Ethiopia.
a
Jigjiga Health Science College, Jigjiga ,
Somali National Regional State, Ethiopia.
3.
Title Section: Lines 7:
Revision is made as follow.
b
b
Health Service Management and Health Economics Unit,
Health Service Management and Health
College of Medicine and Health Science, University of Economics Department, College of Medicine
Gondar, P. O. Box. No. 196, Ethiopia
and Health Science, University of Gondar, P.
O. Box. No. 196, Ethiopia
4.
Abstract (background section): Lines 26-27 :
Revision is made as follow.
Vaccination is the most effective means of combating disease Vaccination is the most effective means of
among children and exists for a great many dangerous combating
infectious diseases especially.
5.
diseases
among
children
and
improves child health.
Abstract (background section): Lines 27-28 : Immunization Revision is made as follow.
coverage in Ethiopia has not reached the targeted figures and Immunization coverage in Ethiopia has not
the planned objectives.
reached the targeted figures and the realized
objectives.
6.
Abstract (background section): Lines 28-31:
Revision is made as follow.
In many parts of the country immunization coverage is less In many parts of the country, immunization
than the herd immunity level desired to prevent the spread of coverage is less than the herd immunity level
eight expanded program of immunization target diseases and desired to prevent the spread of eight target
there is worst scenario in Somali region of the country has by diseases
targeted
by
the
World
Health
far the lowest level of immunization coverage.
Organization’s
Expanded
Immunization .
Program
of
In particular, the Somali
region of the country still has by far the lowest
level of immunization coverage.
7.
Abstract (Objective section): Lines 32-33:
Revision is made as follow.
To measure immunization coverage and associated factors of To measure the immunization coverage of
12-23 months old children in the urban and rural areas of 12‒23 months old children and associated
Jigjiga district.
factors in the urban and rural areas of Jigjiga
district.
8.
Abstract (Method section): Lines 34-35:
Revision is made as follow.
A community based cross-sectional survey was conducted in A community based cross-sectional survey was
582 households with 12-23 months old children in two urban conducted in 582 households with 12‒23
and four rural wards.
months old children in two urban and four rural
wards.
9.
Abstract (Method section): Lines 35-37:
Revision is made as follow.
Data was collected from mothers or caregivers through The data were collected from mothers or
interviews and observation from vaccination cards by using caregivers through interviews based on prepre-tested and structured questionnaire.
tested and structured questionnaires and from
the review of vaccination cards.
10. Abstract (Method section): Lines 37-39:
Revision is made as follow.
The full immunization status of the child assessed from The data on the full immunization status of the
vaccination cards plus mothers recall were used in the analysis children as assessed from the vaccination cards
of both bivariate and multiple logistic regression and the data and their mothers/caregivers responses were
were entered into SPSS version 16.
used in analyzing both bivariate and multiple
logistic regression.
11. Abstract (Resul section): Lines 40-42:
Revision is made as follow.
Three fourth (74.6%) of children were ever vaccinated where Three‒fourth (74.6%) of the children surveyed
as 36.6% were fully vaccinated (card + mother’s verbal were ever vaccinated, whereas 36.6% were
response).
fully
vaccinated,
as
inferred
from
the
vaccination card and their mothers’/caregiver’s
verbal response.
12. Abstract (Resul section): Lines 42-45:
Revision is made as follow.
Immunization coverage from card were Bacillus Calmette- The immunization coverage rate from card
Guérin (BCG) 41.8%, Oral Polio Vaccine Zero (OPV0) assessment for Bacillus Calmette-Guérin was
10.4%,
OPV1/Pentavalent1
41.1%,
OPV2/Pentavalent2 41.8%, while for Oral Polio Vaccine Zero, Oral
33.9%, OPV3 /Pentavalent3 27.5%, and measles 24.9%.
Polio Vaccine One /Pentavalent1, Oral Polio
Vaccine
Two
/Pentavalent2,
Oral
Polio
Vaccine Three /Pentavalent3, and measles
were 10.4%, 41.1%, 33.9%, 27.5%, and 24.9%,
respectively.
13. Abstract (Resul section): Lines 45-49:
Revision is made as follow.
Maternal literacy (AOR=3.06, 95% CI=1.64, 5.71), Tetanus Maternal literacy (AOR=3.06, 95% CI=1.64,
Toxoid (TT) vaccine (AOR=2.43, 95% CI=1.56, 3.77), place 5.71), Tetanus Toxoid
of delivery (AOR=2.02, 95% CI=1.24, 3.28), place of 95%
CI=1.56,
3.77),
vaccine (AOR=2.43,
place
of
delivery
residence(AOR=2.04, 95% CI=1.33, 3.13), and household (AOR=2.02, 95% CI=1.24, 3.28), place of
visit by health workers (AOR=1.92, 95% CI=1.17, 3.16), were residence (AOR=2.04, 95% CI=1.33, 3.13),
significantly associated with of full immunization in the and household visits by health workers
multivariate logistic regression analysis.
(AOR=1.92, 95% CI=1.17, 3.16), were found
to be factors significantly associated with full
immunization in the multivariate logistic
regression analysis.
14. Abstract (Conclusions section): Lines 50:
Revision is made as follow.
Overall the immunization coverage was low.
The overall immunization coverage was found
to be low.
15. Abstract (Conclusions section): Lines 50-53:
Revision is made as follow.
Provision of health education about the values and the benefits Hence, to increase the immunization coverage
of vaccination for mothers, strengthening of the outreach and
reduce
the
incidences
of
missed
activities of the health institutions and increasing health opportunity, delivery in the health institution
service utilization of mothers should be encouraged to should be encouraged, the outreach activities
increase
immunization
coverage
and
reduce
missed of
opportunity.
the
health
institutions
should
be
strengthened and greater utilization of health
services by mothers should be encouraged.
16. Backgroun : Lines 56-57:(Page 1)
Revision is made as follow.
Vaccination is the most effective means of combating disease Vaccination is the most effective means of
and exists for a great many dangerous infectious diseases [1].
combating diseases, particularly dangerous
infectious diseases [1].
17. Backgroun : Lines 57-59:(Page 1)
Revision is made as follow.
In 1974, the World Health Organization (WHO) launched the In 1974, the World Health Organization
Expanded Program of Immunization (EPI) to make vaccines (WHO) launched the Expanded Program of
available to all children and to control vaccine preventable Immunization (EPI) to make vaccines available
diseases worldwide [2,3].
to all children and thereby control vaccine
preventable diseases worldwide [2,3].
18. Backgroun : Lines 59-61:(Page 1)
The introduction of vaccines, particularly among children, has
Revision is made as follow.
The vaccination of children, has led to
led to significant reductions in morbidity and mortality from a significant reduction in morbidity and
different diseases, thereby lowering the infant mortality rate mortality from different diseases, thereby
[1].
lowering the infant mortality rate [1].
19. Backgroun : Lines 61-62:(Page 1)
Revision is made as follow.
In 2012 globally the WHO recommended that around 1.5 However, in 2012 the WHO revealed that
million children were died from vaccines preventable around 1.5 million children worldwide died
diseases.
20. Backgroun : Lines 62-66:(Page 1)
from vaccine‒preventable diseases.
Revision is made as follow.
In the same year about 22.6 million children under one year of In the same year WHO further reported about
age did not receive DTP3 vaccine worldwide and more than 22.6 million children under the age of one
seventy percent of these children live in ten countries: worldwide
did
Democratic Republic of the Congo, Ethiopia, India, Indonesia, Pertussis-Tetanus
not
receive
Vaccine
Diphtheria-
Three
(DTP3)
Iraq, Nigeria, Pakistan, Philippines, Uganda and South Africa vaccine and more than 70 % of these children
[4].
lived in ten countries of the Democratic
Republic of Congo, Ethiopia, India, Indonesia,
Iraq, Nigeria, Pakistan, Philippines, Uganda
and South Africa [4].
21. Backgroun : Lines 66-68 :(Page 1)
In the Sub-Saharan Africa, despite the availability of
Revision is made as follow.
In the Sub-Saharan Africa, despite the
vaccines governments and their partners’ efforts mortality rate availability of vaccines and the efforts of
of under the age of five years remains highest [1].
governments and their partners’ mortality rate
of children under the age of five years remains
the highest [1].
22. Backgroun : Lines 69-70 :(Page 1)
In Ethiopia infectious and communicable diseases
Revision is made as follow.
In
Ethiopia,
infectious
and
account for about 60-80 % of the health problems of the communicable diseases account for about
country and remain major health problems [5].
23. Backgroun : Lines 70-71 :(Page 1)
60‒80 % of the health problems [5].
Revision is made as follow.
A substantial portion of under five year children deaths in A substantial number of deaths of children
Ethiopia is due to preventable diseases.
under five years of age in the country is due to
vaccine‒preventable diseases..
24. Backgroun : Lines 71-74:(Page 1)
Revision is made as follow.
Under five mortality stands at 123 per 1,000 and the plan is to The < 5 age mortality stands at 123 per 1,000
decrease to 54 per 1,000 in the year 2015 to meet Millennium with a plan to reduce to 54 per 1,000 up to the
Development Goal4 (MDG4) and one of the indicators used to year 2015 to meet Millennium Development
monitor progress is immunization coverage [5, 6].
Goal-4 (MDG-4) and immunization coverage
will be one of the indicators to monitor the
progress [5, 6].
25. Backgroun : Lines 74-77 :(Page 1)
Revision is made as follow.
Ethiopian EPI was launched in 1980, with the EPI was launched in Ethiopia in1980 with the
objective of achieving 100% immunization coverage of all objective of achieving 100% immunization
children under two by 1990 however, in 1986, the coverage
coverage of all children under two by 1990.
target was reviewed to 75% and the target age group was However, in 1986, the coverage was found
changed to under ones but progress in increasing coverage has upon review to be 75%, and the target age
been slow [3, 7, 8].
group was expanded to include children under
one, but the progress in increasing coverage
since then has been slow [3, 7, 8].
26. Backgroun : Lines 80-81 :(Page 1)
Revision is made as follow.
Based on the 2007 updated Ethiopian immunization policy, As per the updated Ethiopian immunization
children under one year of age and women 15-49 years age policy of 2007, children under the age of one
are the targets for the EPI vaccines (BCG, Measles, DPT- and women of 15‒49 years are the targets for
HepB-Hib or penta-valent vaccine, OPV and TT).
27. Backgroun : Lines 81-83 :(Page 1)
the EPI vaccines.
Revision is made as follow.
In Ethiopia immunization services are provided for Immunization services in Ethiopia are provided
free of charge in most of the health facilities and in outreach free of charge in most of the health facilities as
services for communities residing beyond 5km from the static well as and in the outreach services for
health facilities [3].
communities residing beyond 5km from the
health facilities [3].
28. Backgroun : Lines 84-87:(Page1- 2)
Revision is made as follow.
In 2004, Ethiopia received an award from the Task Force on
Immunization
(TFI)
for
showing
one
of
the
Ethiopia received an award from the
best WHO’s Task Force on Immunization in 2004
improvements in EPI coverage compared to other priority for this best improvement in EPI coverage
countries, and received a Global Alliance for Vaccine and compared to other priority countries, and
Immunization (GAVI) financial reward in 2005, 2006, and further received the Global Alliance for
2007 as a result of continuing to reach more children and Vaccine and Immunization (GAVI) financial
improved performance.
reward in 2005, 2006, and 2007 as a result of
its continuous improvements in immunizing
children.
29. Backgroun : Lines 87-91:(Page 2)
Revision is made as follow.
The improvement noted in EPI performance in the highly The
improvement
noted
in
the
EPI
populated regions has made a positive contribution to the performance in the highly populated regions
improvement in the national DPT-HepB–Hib3 coverage, has made a positive contribution to the
which reached the target of 81% as indicated in the improvement in the national DPT–Hepatitis B
Comprehensive Multi Year Plan (cMYP) 2006 -2010.
(HepB)–Haemophilus influenza type B three
(Hib3) coverage, which met 81% of the target,
as indicated in the Comprehensive Multi Year
Plan (cMYP) 2006‒2010.
30. Backgroun : Lines 91-93 :(Page 2)
According to the cMYP 2006 -2010 DPT3 coverage to be
Revision is made as follow.
According to the cMYP 2006‒2010
attained by 2008 was 81 % and the actual coverage was as the DPT3 coverage to be attained by 2008 was
planned (81%) which shows the EPI program has been doing 81 % and the actual coverage turned to be as
as planned and the targets set were realistic [3].
planned. This shows that the EPI program was
implemented as per the plan and the targets set
were realistic [3].
31. Backgroun : Lines 93-95 :(Page 2)
Revision is made as follow.
Vaccination coverage has increased from 14% in the 2000 According to Ethiopia Demographic and
Ethiopia Demographic and Health Survey (EDHS) to 20% in Health Survey (EDHS), vaccination coverage
the 2005.
increased from 14% in the 2000 to 20% in
2005.
32. Backgroun : Lines 95-97 :(Page 2)
Revision is made as follow.
According to the 2011 EDHS, 24% of Ethiopian children age The 2011 EDHS revealed that 24% of
12–23 months have received all recommended vaccines one Ethiopian children in the age group of 12–23
dose each of BCG and measles, and three doses each of DPT
months received all the recommended vaccines
and polio [9].
i.e. one dose each of BCG and measles, and
three doses each of DPT and polio [9].
33. Backgroun : Lines 97-100:(Page 2)
Revision is made as follow.
Implementation of the Reaching Every
Implementation of the RED approach continued GAVI ISS District (RED) approach with continued GAVI
support, technical and financial support from all partners in support, technical and financial support from
health and deployment of the health extension workers are all partners in health and deployment of the
factors that contributed towards the improvement of health extension workers were the factors that
immunization coverage [3].
contributed towards immunization coverage
improvement [3].
34. Backgroun : Lines 100-103: (Page 2)
Revision is made as follow.
However, system-wide barriers related to geographical
However, systemic barriers related to
coverage still remain, requiring bridging approaches such as geographical coverage still remain, requiring
the enhanced outreach strategy, even as the country moves bridging approaches such as the enhanced
towards a more equitable geographical coverage [3].
outreach strategy, even as the country moves
towards
a
coverage [3].
more
equitable
geographical
35. Backgroun : Lines 104-106: (Page 2)
Revision is made as follow.
All vaccines are provided freely and there has
Although, all vaccines are provided for free and there is been
improvement
in
the
immunization
improvement in coverage, the routine immunization coverage coverage, however, the routine immunization
in Ethiopia has not reached the targeted figures and the coverage in Ethiopia still has not reached the
planned objectives.
target figures
and realized
the planned
objectives.
36. Backgroun : Lines 106-108: (Page 2)
Revision is made as follow.
As a result in many parts of the country the coverage is less
As a result, in many parts of the
than the herd immunity level desired to prevent the spread of country, the coverage is less than the herd
the eight EPI target diseases.
immunity level desired to prevent the spread of
eight EPI‒targeted diseases.
37. Backgroun : Lines 108-109:(Page 2)
Revision is made as follow.
Similarly the Somali Region of the country has by far the In particular, the Somali National Regional
lowest level of immunization coverage [6].
State (SNRS) has by far the lowest level of
immunization coverage [6].
38. Backgroun : Lines 109-111:(Page 2)
Revision is made as follow.
The national EPI survey conducted in 2006 showed the The national EPI survey conducted in 2006
coverage level for full immunization to be 49.9% and that of revealed
that
the
coverage
for
full
DPT3 was 66.0%, which show significant improvement when immunization was 49.9% and that of DPT3
compared to EDHS 2005.
66.0%.
These
figures
show
significant
improvement when compared to those of
EDHS 2005.
39. Backgroun : Lines 112-113:(Page 2)
Revision is made as follow.
However, DPT3 coverage in many of the regions was below However, DPT3 coverage was below 80% in
80% and the lowest in Somali region which was 23.3% [10].
many of the regions and the lowest (23.3%) in
the SNRS [10].
40. Backgroun : Lines 112-116:(Page 2).
The Ethiopian annual performance report of the Health Sector
Revision is made as follow.
The Ethiopian annual performance
Development Program III (HSDP-III) revealed that, DPT3, report of the Health Sector Development
measles, and fully immunized coverage of Somali region were Program III (HSDP-III) revealed that, DPT3
(14.6%, 18.5%, and 9.5 %), respectively which are very much
and measles, and full immunization coverage
lower than the national standard for immunization of 73%, of SNRS were 14.6%, 18.5%, and 9.5 %,
65%, and 53% [6].
respectively figures much lower than the
national standard for immunization of 73%,
65%, and 53% [6].
41. Backgroun : Lines 117-120:(Page 3).
Revision is made as follow.
In Ethiopia there is uneven distribution, poor skill mix and
In Ethiopia, uneven distribution, poor
high attrition of trained health professionals remain the major skill mix and high attrition of trained health
concern impeding transfers of competency [5] similarly, professionals remain the major concern,
immunization coverage varies significantly by region, ranging impeding transfers of competency [5].
from only 9% of children fully vaccinated in the Affar region Similarly, immunization coverage varies
to 79% in Addis Ababa.
significantly from region to region, ranging
from only 9% of children fully vaccinated in
Affar region to 79% in Addis Ababa.
42. Backgroun : Lines 120-122:(Page 3)
Revision is made as follow.
Over 90% of children in SNNPR (Southern Nations Over 90% of age one children in Southern
Nationalities Peoples’ Region) region are immunized with Nations
Nationalities
Peoples’
Region
DPT3 by the age of one, while the figure dramatically drops (SNNPR) are immunized with DPT3 while the
to less than 50% in Somali, Afar, and Gambella regions[3,9].
figure dramatically drops to less than 50% in
Somali, Afar, and Gambella regions [3, 9].
43. Backgroun : Lines 123-125:(Page 3)
Revision is made as follow.
The pastoralist communities in Somali, Afar, Gambella and The pastoralist communities in Somali, Afar,
other areas have very low routine immunization coverage and Gambella and other areas have very low
the traditional static and outreach strategies are not working routine
well in these regions.
immunization
coverage
and
the
traditional static and outreach strategies are not
working well there.
44. Backgroun : Lines 125-126:(Page 3)
Revision is made as follow.
Thus, there is a need to design specific immunization service
delivering strategies for these regions [3].
Thus, there is a need to design
special
immunization
service
delivering
strategies for these regions [3].
45. Backgroun : Lines 126-127:(Page 3)
Revision is made as follow.
In some districts of Somali regions had conducted enhanced Enhanced routine immunization (ERI) was
routine immunization (ERI) in 2007 with good results.
conducted in some districts of SNRS in 2007
with good results.
46. Backgroun : Lines 127-130:(Page 3)
Revision is made as follow.
In Jigjiga Zone two districts conducted ERI and the coverage In Jigjiga zone, two districts conducted ERI
of Penta 3 increased from an average of 24% to 74% after two and the coverage of Penta 3 increased from
rounds of ERI [9] and as per 2008 coverage report, OPV3 in an average of 24% to 74% after two rounds
Gambella reached 44% and Benishangul/Gumuz reached 36% of ERI [9]. As per the 2008 coverage report,
and the Somali region had OPV3 coverage of 29% [3].
OPV3 coverage reached 44% in Gambella,
36% in Benishangul/Gumuz and 29% in the
SNRS [3].
47. Backgroun : Lines 130-132:(Page 3)
Revision is made as follow.
According to the annual performance report of HSDP-III According to the annual performance report of
(2009) Somali National Regional State (SNRS) has by far the HSDP-III (2009) SNRS had by far the lowest
lowest extreme level of immunization in Ethiopia compared to level of immunization in Ethiopia compared to
the other administrative regions [6].
48. Backgroun : Lines 132-134:(Page 3)
the other administrative regions [6].
Revision is made as follow.
So assessing factors that contribute to low coverage is So assessing the factors that contribute to low
important to devise evidence based strategies/polices and coverage is important in order to devise
intervention therefore raising overall immunization coverage evidence-based strategies/polices that would
which in turn will reduce the infant and child mortality.
raise the overall immunization coverage which
in turn reduce the infant and child mortality.
49. Method( Study design) : Lines 138-140:(Page 3)
Revision is made as follow.
A community based cross-sectional study was conducted to A community-based cross-sectional study was
assess factors associated with immunization coverage of conducted to assess the factors associated with
children aged between 12-23 months in Jigjiga district.
the immunization coverage of children aged
between 12-23 months in Jigjiga district from
April 10 to May 5, 2011.
50. Method (Study area) : Lines 143-144:(Page 3)
Revision is made as follow.
The study was conducted in Jigjiga district which is one of the The study was conducted in Jigjiga district,
six districts of Jijiga Zone and the capital city of SNRS.
which is one of the six districts of the Jigjiga
Administrative Zone and the capital city of
SNRS.
51. Method (Study area) : Lines 144-145:(Page 3)
It is located 632 km east of Addis Ababa, the capital
city of Ethiopia.
Revision is made as follow.
It is located 632 km east of Addis
Ababa, the capital of Ethiopia.
52. Method( Study design) : Lines 145-146:(Page 3)
Revision is made as follow.
The district has a population of
The district has a population of 277,560 of which 151,684 are
rural, 125,876 urban [11] and about 15.3 % are children of 277,560 of which 151,684 is rural and the rest
urban [11] and about 15.3 % are children under
under five.
five of age.
53. Method( Study design) : Lines 146-148:(Page 3-4)
Revision is made as follow.
There is one hospital, six health
There is one hospital, 6 health centers and 28 health
posts which routinely provide immunization to under 5 years centers and 28 health posts which routinely
provide immunization to children under five in
children in the district.
the district.
54. Method( Source population ) : Lines 151-154:(Page 4)
Revision is made as follow.
The source population comprised all
The source populations were all households of the
Jigjiga district having children aged between 12-23 months the households in Jigjiga district having
whereas the study populations were all mothers/caretakers that children aged between 12‒23 months, whereas
have one or more child aged 12-23 months old, selected by the study populations comprised all
simple random sampling method from the source population mothers/caretakers with one or more child aged
in urban and rural wards in the Jigjiga district.
12‒23 months old, that were selected by simple
random sampling method from the source
population in urban and rural wards in the
district.
55. Method(Sample size determination): Lines 157-159:(Page 4)
The sample size was calculated based on the full
Revision is made as follow.
The sample size was calculated using
immunization coverage of study conducted in northern two population proportion formulas on the
Ethiopia district which was 80% in the rural area and 67.5% basis of the study of full immunization
in urban area [12] by using two population proportion coverage conducted in northern Ethiopia
district. The immunization coverage was found
formulas.
to be 80% in the rural areas and 67.5% in
urban areas [12].
56. Method(Sample size determination): Lines 160-161:(Page 4)
Revision is made as follow.
then adding 10% non respondent final sample size was 303 then adding 10% non respondent, the final
sample size was 303 households for each urban
households for each urban and rural wards.
and rural wards.
57. Method( Sampling procedure ) : Lines 165-166:(Page 4)
The whole Jigjiga district was first stratified into urban 10 and
Revision is made as follow.
The whole Jigjiga district was first
rural 32 wards and out of the two strata 2 urban and 4 rural stratified into 10 urban and 32 rural wards. Out
of the two strata, two urban and four rural
wards were selected by lottery method.
wards were randomly selected by lottery.
58. Method( Sampling procedure ) : Lines 166-168:(Page 4)
A census was carried out in two urban and four rural
Revision is made as follow.
A census was carried out in selected
wards to identify the households with children aged between urban and rural wards to identify the
households with children aged between 12 and
12−23 months.
23 months.
59. Method( Sampling procedure ) : Lines 168-169:(Page 4)
Sampling frame was prepared after the identification of
households with eligible children.
Revision is made as follow.
A sampling frame was prepared after
the identification of households with children
eligible for the study.
60. Method( Sampling procedure ) : Lines 169-171:(Page 4)
The numbers were allocated proportionally to the selected
Revision is made as follow.
The
numbers
were
allocated
wards based on the population size of the children followed proportionally to the selected wards on the
by simple random sampling (SRS) to select the individual basis of the population size of the children,
child.
followed by simple random sampling to select
the individual child.
61. Method( Sampling procedure ) : Lines 171-172:(Page 4)
For those households having more than one child in
households, one child was selected randomly per household
by lottery method.
Revision is made as follow.
For those households having more than
one child, one child per household was
randomly selected by lottery.
62. Method(Data collection procedure and quality management) : Revision is made as follow.
The questionnaires were prepared in
Lines 177-178:(Page 5)
The questionnaire was prepared in English then translated into English then translated into Somali (native
Somali (native language) and back to English to keep language) and back into English to ensure
consistency.
consistency.
63. Method(Data collection procedure and quality management) : Revision is made as follow.
The questionnaire was pre-tested using 5% of
Lines 178-179 :(Page 5)
the sample size, and some modifications were
The pre-testing of the questionnaire was done using 5 % of the made on the basis of pre-test.
sample size, and some modifications were made based on the
pre-test.
64. Method(Data collection procedure and quality management) :
Lines 179-181:(Page 5)
Revision is made as follow.
The data were collected through face-
The data were collected through face-to-face interview from to-face interview with the mothers/caregivers
the mother/caregiver of the child and from vaccination cards based on the structured questionnaire and
using structured questionnaire.
through a review of the vaccination cards.
65. Method(Data collection procedure and quality management) : Revision is made as follow.
Vaccination cards were reviewed and
Lines 181-182:(Page 5)
Vaccination card review and mother was enquired about the the mothers/caregivers were inquired for
tracing the childrens’ immunization history.
child’s immunization history.
66. Method(Data collection procedure and quality management) : Revision is made as follow.
Ten trained diploma nursing students from the
Lines 182-184:(Page 5)
Ten trained diploma students of nursing from the Jigjiga Jigjiga Health Sciences College participated in
Health Sciences College were participated in the data the data collection.
collection.
67. Method(Data collection procedure and quality management) : Revision is made as follow.
Completeness and consistency of the collected
Lines 184-185:(Page 5)
Completeness and consistency of the collected data data were checked each day by the principal
investigator.
were checked each day of data collection.
68. Method(Data processing and analysis):Lines 187:(Page 5)
Data processing and analyzing
Revision is made as follow.
Data processing and analysis
69. Method( Data processing and analysis): Lines 188-189:(Page Revision is made as follow.
The collected data were cleaned,
5)
The data were entered and analysis using Statistical Package entered and analyzed using Statistical Package
of Social Sciences (SPSS) version 16.
of Social Sciences (SPSS) version 16.
70. Method (Data processing and analysis): Lines 189-190:(Page Revision is made as follow.
The dependent variable was dichotomized into
5)
The dependent variable was dichotomized into: fully
vaccinated and not fully vaccinated (unvaccinated and partial
fully vaccinated and not fully vaccinated
(unvaccinated and partially vaccinated).
vaccinated).
71. Method(Data processing and analysis): Lines 190-192:(Page Revision is made as follow.
The full immunization status of the
5)
The Full immunization status of the child assessed from children assessed from the vaccination cards as
vaccination cards plus mothers recall were used in the analysis well as the mother’s/caregiver’s responses
were used in the analysis of both bivariate and
of both bivariate and multiple logistic regression.
multiple logistic regression.
72. Method(Data processing and analysis): Lines 192-194:(Page Revision is made as follow.
To identify the factors associated with
5)
To
identify
factors
that
have
association
with
the
immunization status of children, bivariate and multiple
logistic regression analyses were worked out and p-value <
0.05 was considered to indicate statistical significance.
the immunization status of children, bivariate
and multiple logistic regression analyses were
worked out and p-value < 0.05 was considered
to indicate statistical significance.
73. Method(Data processing and analysis): Lines 195-196:(Page Revision is made as follow.
In this study, the Hoshmer and Lemeshow’s
5)
In our study, the Hoshmer and Lemeshow’s goodness-of-fit goodness-of-fit was used to assess whether a
was used to assess whether multiple logistic regression model multiple logistic regression model was fit.
was fit.
74. Method(Data processing and analysis): Lines 196-197:(Page Revision is made as follow.
A model with p-value > 0.05 of Hoshmer and
5)
A model with p-value >0.05 of Hoshmer and Lemeshow’s test was considered as fit for
Lemshow’s test were consider as fitted for multiple logistic multiple logistic regressions.
regression.
75. Method(Operational definitions of the terms used in the Revision is made as follow.
study): Lines 199 :(Page 5)
Operational definitions of the terms used in
the study
76. Method(Operational definitions of the terms used in the Revision is made as follow.
study): Lines 200 :(Page 5)
The following operational definitions were
The following operational definition were used.
used:
77. Method(Operational definitions of the terms used in the Revision is made as follow.
Fully Immunized:
study): Lines 201-202 :(Page 5)
Fully vaccinated: A child 12-23 months old who received A 12‒23 months old child who received one
one dose of BCG and dose of measles, and three doses of dose of BCG and measles, and three doses of
pent/OPV before his/her first birthday.
pent/OPV before his/her first birthday.
78. Method(Operational definitions of the terms used in the Revision is made as follow.
study): Lines 203-204: (Page 5)
Partially Immunized: A 12‒23 months old
Partially vaccinated: A child 12-23 months old who received child who received at least one vaccine but not
at least one vaccine but did not complete all the EPI vaccines.
all the EPI vaccines.
79. Method(Operational definitions of the terms used in the Revision is made as follow.
Unimmunized: A 12‒23 months old child who
study): Lines 205 :(Page 5)
Unvaccinated: A child 12-23 months old did not receive any did not receive any of the EPI vaccines.
of the EPI vaccines.
80. Method(Operational definitions of the terms used in the Revision is made as follow.
Not fully immunized: a combination of
study): Lines 206 :(Page 6)
Not fully vaccinated: Is a combination of partially vaccinated partially vaccinated and unvaccinated children.
and unvaccinated children.
81. Method(Operational definitions of the terms used in the Revision is made as follow.
Immunization coverage
study): Lines 207-208:(Page 6)
by
card:
the
coverage
calculated
with
Vaccination coverage by card: the vaccination coverage vaccination
calculated with numerator based only documented on the card, numerator based only on card documentation,
excluding from the numerator those vaccinated by history.
excluding from the numerator those vaccinated
by history.
82. Method(Operational definitions of the terms used in the Revision is made as follow.
Immunization coverage by history: the
study): Lines 209-210 :(Page 6)
coverage
calculated
with
Vaccination coverage by history: the vaccination coverage vaccination
numerator based only on mother’s/caregiver’s
calculated with numerator based only mother’s report.
report.
83. Ethical clearance: Lines 213-214 :(Page 6)
Revision is made as follow.
Ethical clearance was obtained from the Institutional Review Ethical clearance was obtained from the
Board of Institute of Public Health, University of Gondar.
Institutional Review Board of the Institute of
Public Health, University of Gondar.
84. Ethical clearance: Lines 214-215 :(Page 6)
Revision is made as follow.
Collaboration letter was obtained from SNRS Health Bureau Collaboration letter was obtained from SNRS
(Office),
Jijiga
District
Health
Office
and
wards Health Bureau, Jigjiga District Health Office
administration.
85. Ethical clearance: Lines 215-217 :(Page 6)
and wards administration.
Revision is made as follow.
Study participants were briefly informed about the objective
Study
and significance of the study and finally their consent was informed
obtained.
participants
about
the
were
objective
briefly
and
the
significance of the study and finally their
consent was obtained.
86. Ethical clearance: Lines 217-218 :(Page 6)
Revision is made as follow.
The respondents were told that they could withdraw from the The respondents were told that they could
study at any time they want.
withdraw from the study at any time they
wanted.
87. Ethical clearance: Lines 218-219 :(Page 6)
Revision is made as follow.
Confidentiality of the data was maintained throughout
Confidentiality
of
the
data
was
the study period and the names of study participants were maintained throughout the study period and the
omitted from the questionnaires.
names of the study participants were omitted
from the questionnaires.
88. Results Section: Lines 222 :(Page 6)
Characteristics of the study participants
89. Results Section: Lines 223-224 :(Page 6)
Revision is made as follow.
Characteristics of study participants
Revision is made as follow.
A total of 582 mothers/caregivers who had about 12 to 23
months children were participated in the study.
A total of 582 mothers/caregivers who
had 12‒23 months old children participated in
the study.
90. Results Section: Lines 224 :(Page 6)
Revision is made as follow.
The majorities (92.4%) of mothers/caregiver were married
and 87 % were illiterate.
The
majority
(92.4%)
of
mothers/caregivers were married and 87 %
were illiterate.
91. Results Section: Lines 224-225 :(Page 6)
Revision is made as follow.
Table 1 shows the socio-demographic characteristics of study Table
participants.
92. Results Section: Lines 225-226 :(Page 6)
About half (52.6%) of the children were males and 47.4%
females.
1
shows
the
socio-demographic
characteristics of the study participants.
Revision is made as follow.
About 52 % of the children were male
and the rest were female.
93. Results Section: Lines 226-227 :(Page 6)
Revision is made as follow.
Seventy five percent of the children were in the age range of
Seventy five percent of children were
15 to 23 months while the remaining 25% were in the age in the age group of 15 to 23 months while the
range of 12 to 14 months.
remaining 25% were in the age group of 12-14
months.
94. Results Section: Lines 228:(Page 6)
Revision is made as follow.
Table 2 shows the selected characteristics of children.
Table
2
shows
the
selected
characteristics of the children.
95. Results Section: Lines 228-229:(Page 6)
Revision is made as follow.
Nearly equal urban (49.8%) and rural (50.2%) of mothers Nearly an equal number of urban (49.8%) and
were participated in the study.
rural
(50.2%)
mothers/caregivers
were
participated in the study.
96. Results Section: Lines 229-231 :(Page 6)
The majority (75.6%) of the mothers reported that health
Revision is made as follow.
The
majority
workers did not come to their homes for vaccination of mothers/caregivers
children.
reported
(75.6%)
that
of
health
workers did not come to their homes for child
vaccination.
97. Results Section: Lines 231 :(Page 6)
Table 3 presents the selected characteristics of study
participants.
98. Results Section: Lines 234-236 :(Page 6)
Based on the vaccination card out of the 582 children, 74.6%
Revision is made as follow.
Table
3
presents
the
selected
characteristics of the study participants.
Revision is made as follow.
A review of the vaccination cards and
were ever vaccinated, 36.6% fully vaccinated and 25.4% not mothers’/caregivers verbal responses revealed
vaccinated at all, 80.3% of the urban and 68.8 % of the rural that out of the 582 children, 74.6% were ever
children were ever vaccinated.
vaccinated, 36.6% fully vaccinated and 25.4%
not vaccinated at all. Around 80.3% of urban
and 68.8 % of rural children were ever
vaccinated.
99. Results Section: Lines 236-238 :(Page6- 7)
One hundred thirty eight (47.6 %) urban and 25.7%
Revision is made as follow.
About 47 % urban and 25.7% rural
rural area children were fully vaccinated and 19.7% urban and children were fully vaccinated, and 19.7% of
31.1% the rural children were not vaccinated at all according urban and 31.1% of rural children were not
to the card.
vaccinated at all.
100. Results Section: Lines 238-239 :(Page 7)
Revision is made as follow.
Figure 1 shows the immunization status (vaccination card+ Figure 1 shows the immunization status
mothers’ verbal response) of the children by residence.
(vaccination card+ mothers’/caregivers’ verbal
responses) of the children by residence.
101. Results Section: Lines 240-241 :(Page 7)
According to the vaccination card, the highest percentage of
Revision is made as follow.
According to the review of the
vaccination was 41.8% for BCG, while the lowest percentage vaccination cards, the highest percentage of
was 24.9% for measles vaccine.
vaccination was 41.8% for BCG, while the
lowest percentage was 24.9% for measles.
102. Results Section: Lines 241-243 :(Page 7)
From table 4, we can see that the percentage receiving DPT
and polio vaccines is decreasing from early to late vaccines.
Revision is made as follow.
From table 4, we can observe that the
percentage of children receiving DPT and polio
vaccines shows a decrease from early to late
vaccines.
103. Results Section: Lines 244-245 :(Page 7)
Revision is made as follow.
The percentage of receiving each polio vaccination is also The percentage of children receiving each
decreasing, that is 41%, 33.8% and 27.4% of polio 1, polio 2, polio vaccine shows a reduction i.e. 41%,
and polio 3, respectively.
33.8% and 27.4% of polio 1, polio 2, and polio
3, respectively.
104. Results Section: Lines 245-247 :(Page 7)
Revision is made as follow.
The main reasons given by mothers for not fully The main reasons given by mothers/caregivers
vaccinating their children were included lack of information, why their children were not fully vaccinated
lack of motivation, and obstacles related to immunization were lack of information, lack of motivation,
(Table 5).
105. Results Section: Lines 250-253 :(Page 7)
In the multiple logistic regression analyses, maternal
and obstacles to immunization (Table 5).
Revision is made as follow.
In the multiple logistic regression
age and literacy, place of residence, TT vaccine status, place analysis, maternal age and literacy, place of
of delivery, household visit by health workers, travelling time
residence, TT vaccine status, place of delivery
to health facility and provision of health education at health and household visit by health workers were
facility were found to be the most important predictors of found to be the most important predictors of
complete immunization (according to card) (p<0.05) (Table completing immunization (according to the
6).
vaccination cards plus mothers/care givers
response) (p <0.05) (Table 6).
106. Disscusion Section: Lines 256-261:(Page 7)
Revision is made as follow.
Overall, the immunization coverage
Overall the immunization coverage was low, as by convention was low, as by convention the immunization
the immunization coverage of DPT3 or in our case coverage of DPT3 or in our case Pentavalent 3
Pentavalent 3(as per vaccination card) was 27.5 % (Table 4) (as per the vaccination cards) was 27.5 %
which is higher than the study done among Pastoral (Table 4) which is higher than the percentage
Community in Amibara District, Afar Regional State (10%) of coverage (10%) reported from the pastoral
[13] and lower than that from northern rural district of community of Amibara district, ANRS [13]
Ethiopia 92.7% [12], Ambo Woreda, Central Ethiopia 35.6% and much lower than those from the northern
[14], Kenya 88% [15] and rural Nigeria 80.8% [16].
rural district of Ethiopia (92.7%) [12]; Ambo
Woreda, in Central Ethiopia (35.6%) [14];
Kenya (88%) [15] and rural Nigeria (80.8%)
[16].
107. Disscusion Section: Lines 262-264:(Page 7)
Revision is made as follow.
Another reason that may contribute for low coverage in the
Another reason could be the high
study area was high missed opportunities 74 %, which is percentage of missed opportunity (74%), which
higher when compared with studies done in Wango district of is higher than those in Wango district of
Ethiopia 46.3% [17] and Mozambique 25.7% [18].
Ethiopia
(46.3%)
[17]
and
Mozambique
(25.7%) [18].
108. Disscusion Section: Lines 264-267:(Page 7-8)
Revision is made as follow.
Proper screening might not be done by the health Proper screening of immunization status might
personnel when mothers/caretakers come to health facilities not have been done by the healthcare personnel
with their children for preventive and curative services.
when
mothers/caretakers came
to health
facilities with their children for preventive and
curative services.
109. Disscusion Section: Lines 268-273:(Page 8)
The finding of this study revealed that the fully vaccinated
Revision is made as follow.
The study reveals that out of the total
children (card + history ) was only 36.6%, and higher in urban number of children studied, fully vaccinated
(47.50%) than rural (25.7%) settings which is higher ones (as per the card and mothers/caregivers
compared to the study done among Pastoral Community in response) constituted only 36.6%, and were
Amibara District, Afar Regione (8.3%) [13] and almost near more numerous in urban (47.50%) than in rural
to those reported in Ambo Woreda, Central Ethiopia (36%) (25.7%) settings. The percentage of fully
[14].
vaccinated children was also found to be
higher than that among pastoral community of
Amibara district, ANRS (8.3%) [13] and
almost close to that reported from Ambo
Woreda of Central Ethiopia (36%) [14].
110. Disscusion Section: Lines 273-274:(Page 8)
Revision is made as follow.
But it is low compared with study carried out in north rural
But it was lower than that reported
district of Ethiopia with 75.5% (80% urban and 67.5% rural) from the northern rural district of Ethiopia
[12].
111. Disscusion Section: Lines 274-276:(Page 8)
[75.5% (80% urban and 67.5% rural)] [12].
Revision is made as follow.
The reasons of difference within same country might be due
The reasons for such differences in
to better access to immunization service in the north rural immunization
district of Ethiopia as evidenced by the 97.3% coverage of country
OPV1/DPT1 [12].
coverage
within
the
be
better
access
might
same
to
immunization services in the northern rural
district of Ethiopia as evinced by the 97.3%
coverage of OPV1/DPT1 there [12].
112. Disscusion Section: Lines 277-278 :(Page 8)
Revision is made as follow.
The fully immunized were also low compared to Istanbul
The percentage of fully immunized
(84.5%) [19] and Mali (59.9%) [20], this might be due to low children was also lower than that in Istanbul
educational status of mothers/caretakers, high defaulters, (84.5%) [19] and Mali (59.9%) [20], this might
inadequate knowledge and low health service utilization in the be
study area.
due
to
low
educational
status
of
mothers/caretakers, high defaulters, inadequate
knowledge and low health service utilization in
the study area.
113. Disscusion Section: Lines 279-281:(Page 8)
About 25.4 % children were without immunization of any
Revision is made as follow.
About 25.4% of children were without
type which is very high when compared from Istanbul where immunization of any type, a very high figure
the percentage was only 3.2 % [19].
114. Disscusion Section: Lines 281-283:(Page 8)
when compared to only 3.2% in Istanbul [19].
Revision is made as follow.
The reason could be due to mothers/care taker not aware the The reason could be that the mothers/caretakers
importance of immunization, not knew place and/or time of in the study area were not of aware the
immunization, feared of side reactions and wrong ideas about importance of immunization, and the place
contraindications.
and/or time of immunization, feared side
effects of vaccines or had wrong ideas about
contraindications.
115. Disscusion Section: Lines 283-286:(Page 8)
Revision is made as follow.
For instance, among non immunized children, unaware For
instance,
the
mothers/caregivers
of
regarding the need for immunization, lack confirmed unimmunized children cited reasons such as
information and becoming too busy to vaccinate their children unawareness of the need for immunization, lack
were reasons mention by mothers/caretakers which were in of confirmed information and lack of time to
accordance with the reasons stated in Mali [20].
get their children vaccinated reasons that are
same as those cited by mothers/caregivers in
Mali [20].
116. Disscusion Section: Lines 286-289:(Page 8)
Revision is made as follow.
The additional reasons as reported in Mozambique The
additional
reasons
as
reported
by
study were long waiting time, no personnel at the health mothers/caregivers in Mozambique were that
facility, no information about vaccination day, no vaccination the waiting time was long, there were no
given due to child sickness, and forgetting the day of healthcare personnel at health facilities, they
immunization [18].
were unaware of or forgot the day of
vaccination, and no vaccines could be given
due to child sickness [18].
117. Disscusion Section: Lines 290-293:(Page 8)
For the high defaulter it might indicate that many of the
Revision is made as follow.
This could be due to the fact that many
children were lost to follow up in later months, which may be children
not
subjected
to
follow‒up
due to low access to immunization services as evidenced in vaccination in later months, which may be due
case of low Pentavalent1 coverage and high missed to low access to immunization services, as
opportunity.
evidenced by low Pentavalent1 coverage and
high missed opportunity.
118. Disscusion Section: Lines 293-295:(Page 8)
Reasons mentioned by the mothers/care taker of the children
Revision is made as follow.
Reasons
mentioned
who defaulted from the immunization among partially mothers/caregivers
immunized children’s mothers/caretakers were related to lack immunized
children
of information, motivation and, obstacles.
were
vaccination
of
such
who
lack
by
partially
defaulted
of
the
on
information,
motivation and obstacles.
119. Disscusion Section: Lines 295-296:(Page 8)
Revision is made as follow.
Similarly obstacles (67%), lack of information (19%) and lack Similarly, obstacles (67%), lack of information
of motivation (14%) were the commonest reason for the (19%) and lack of motivation (14%) were the
partially vaccination of the children in Amibara District [13].
commonest
reasons
cited
for
partial
vaccination of children in Amibara district
[13].
120. Disscusion Section: Lines 297-298:(Page 9)
Revision is made as follow.
As per vaccination card, higher coverage was found for
pentavalent1 (41.1 %) and lower for pentavalence3 (27.5%).
Upon the review of vaccination cards,
a higher immunization coverage was found for
pentavalent1 (41.1 %) and a lower one for
pentavalence3 (27.5%).
121. Disscusion Section: Lines 298-300:(Page8-9)
Revision is made as follow.
These could be due to the absence of vaccinators at health
This difference could be due to the
facilities, low utilization of maternal and child health and due absence of vaccinators at health facilities, low
to health workers and health services side which supported by utilization of maternal and child health care
discussion with health workers and mothers.
122. Disscusion Section: Lines 300-301:(Page 9)
services.
Revision is made as follow.
The dropout rate of pentavalent1 to pentavalent3 was 33.1% The
dropout
rate
of
pentavalent1
to
which is less than 43% of EDHS of 2011 (43%) [21], but pentavalent3 was 33.1% which is less than
higher than 22.6% of Kenya (22.6%) [15].
43% as reported in the EDHS 2011 [21], but
higher than 22.6% reported from Kenya [15].
123. Disscusion Section: Lines 301-303:(Page 9)
BCG to measles dropout rate in present study was 40.3%
Revision is made as follow.
The dropout rate from BCG to measles
which is comparatively higher than other districts of Ethiopia in the present study was 40.3% which is
[12, 17].
comparatively higher than that in other districts
of Ethiopia [12, 17].
124. Disscusion Section: Lines 303-305:(Page 9)
The deference might be due to high defaulter, lack of local
Revision is made as follow.
The difference might be due to high
motivators for reminding/tracking and absence of health percentage
workers at health facilities.
of
defaulters,
lack
of
local
motivators for reminding/tracking and absence
of health workers at health facilities.
125. Disscusion Section: Lines 306-308:(Page 9)
Revision is made as follow.
Maternal education was positively influenced the child
Maternal
immunization completion as, 63.9% of the literate mothers influenced
the
education
completion
positively
of
child
and 32.7% of the illiterate mothers fully vaccinated their immunization. This can be seen in the
children.
difference between the percentage of literate
(63.9%) and illiterate (32.7%) mothers fully
vaccinating their children.
126. Disscusion Section: Lines 308-309:(Page 9)
Revision is made as follow.
Literate mothers were 3.06 times more likely to fully Literate mothers were 3.06 times more likely to
vaccinate their children than those who were illiterate mothers fully vaccinate their children than illiterate
(AOR=3.06, 95% CI=1.64, 5.71).
127. Disscusion Section: Lines 311-312:(Page 9)
ones (AOR=3.06, 95% CI=1.64, 5.71).
Revision is made as follow.
This may be due to better knowledge of vaccine preventable This may be due to the literate mothers having
diseases and the importance of vaccination among literate better
mothers.
knowledge
of
vaccine-preventable
diseases and recognizing the importance of
vaccination.
128. Disscusion Section: Lines 313-315:(Page 9)
Revision is made as follow.
Fully immunization had significant association with
Full immunization was found to have a
outreach activity of the health institution, the probability of a significant association with the outreach
child to be fully vaccinated was higher when the health activities of the health institutions. The
workers visit homes for vaccination (AOR=1.92, 95% probability of a child to be fully vaccinated
CI=1.17, 3.16).
was higher when the health workers visited
homes for vaccination (AOR=1.92, 95%
CI=1.17, 3.16).
129. Disscusion Section: Lines 315-316:(Page 9)
Revision is made as follow.
This is in line with the study done in Murshidabad district of
India [22].
This is in line with the study done in
Murshidabad district of West Bengal, India
[22].
130. Disscusion Section: Lines 316-319:(Page 9)
Household visits contributed to higher rate of immunization,
Revision is made as follow.
Household visits contributed to higher
especially in case of illiterate mothers, when mothers had rates of immunization, especially in case of
delivery outside health facility and mother without health illiterate mothers, mothers who had delivered
education attendance for immunization [23, 24].
outside health facilities and mothers who had
no health education on immunization [23, 24].
131. Disscusion Section: Lines 320-323:(Page 9)
Revision is made as follow.
The rate of complete vaccination of children increases with
The rate of complete vaccination of
the age of the mothers, as 15.2% of mothers in the age group children increases with the age of their
15-19 years, 32.1% in 20-24 years, 41.6% in 25-29 years and mothers, as 15.2% of mothers between 15 and
52% in ≥ 30 years were vaccinated their children fully.
19 years of age, 32.1% between 20 and 24
years, 41.6% between 25 and 29 years and
52% of 30 years or more were found to have
vaccinated their children fully.
132. Disscusion Section: Lines 323-325:(Page 9)
Revision is made as follow.
Mothers in the age ≥30 years were 3.79 times more likely to Mothers/caregivers of 30 years or more were
fully vaccinate their children than mothers aged 15-19 years 3.79 times more likely to fully vaccinate their
(AOR=3. 79, 95% CI=1. 76, 8.16).
children than mothers/caregivers aged between
15 and 19 years (AOR=3. 79, 95% CI=1. 76,
8.16).
133. Disscusion Section: Lines 325-326:(Page 9)
Revision is made as follow.
Middle-age mothers were more likely to have their children Old-aged mothers/caregivers were more likely
immunized whereas mothers at older ages were more likely to
to have their children fully immunized than
have them fully immunized as compared to teen-age mothers teenage mothers/caregivers [25].
[25].
134. Disscusion Section: Lines 326-327:(Page 9)
In Bangladesh, mother’s age was found to be the most
important predictors for full immunization of children [26].
Revision is made as follow.
In
Bangladesh,
the
mother’s/caregivers’ age was found to be the
most important predictor for full immunization
of children [26].
135. Disscusion Section: Lines 328-330:(Page 9-10)
In agreement with study done in Amibara District [14] and
Revision is made as follow.
In agreement with the studies carried
Bangladesh [26], the present study revealed that mother’s TT out in Amibara district of Ethiopia [14] and
immunization acceptance was found to be the most important Bangladesh [26], the present study also
predictors for full immunization of children.
revealed
that
mother’s/caregivers’
TT
immunization acceptance was found to be the
most important predictor for full immunization
of children.
136. Disscusion Section: Lines 331-333:(Page 10)
Revision is made as follow.
Mothers who took any TT vaccine were 2.43 times more Mothers/caregivers who took any TT vaccine
likely to fully vaccinate their children than their counterparts during pregnancy were 2.43 times more likely
(AOR=2.43, 95% CI=1.56, 3.77).
to
fully
vaccinate
their
children
than
mothers/caregivers who took none (AOR=2.43,
95% CI=1.56, 3.77).
137. Disscusion Section: Lines 333-335:(Page 10)
In another study in Bangladesh mother who did not receive
Revision is made as follow.
In
another
study
in
Bangladesh,
the TT vaccination during pregnancy were 70% less likely to mothers/caregivers who did not receive TT
have their children fully immunized than those who received vaccination during pregnancy were 70% less
TT [25].
likely to have their children fully immunized
than those who received it [25].
138. Disscusion Section: Lines 336-337:(Page 10)
Regarding place of delivery, the prevalence of complete
Revision is made as follow.
Regarding the place of delivery, the
immunization among the children who were born in health study showed that 56.1% of children born in
care facilities was 56.1% and at home 29.4%, respectively.
health care facilities were fully immunized as
against 29.4% of children born at homes.
139. Disscusion Section: Lines 337-339:(Page 10)
Children born in health institution were 2.02 times more likely
to vaccinated completely than those
Revision is made as follow.
Further,
children
born
in
health
born at home institutions were 2.02 times more likely to be
(AOR=2.02, 95% CI=1.24, 3.28).
vaccinated completely than those born at home
(AOR=2.02, 95% CI=1.24, 3.28).
140. Disscusion Section: Lines 339-342:(Page 10)
Similarly study conducted within the country like in Amibara
Revision is made as follow.
Similarly, the studies conducted in
District and Ambo Woreda, and in Nigeria children born in Amibara district and Ambo district within the
the health facility were more likely to complete vaccination country, and in Nigeria showed that children
than those children born at the at home [13,14, 27].
born in health facilities were more likely to
complete vaccination than those born at homes
[13, 14, 27].
141. Disscusion Section: Lines 342-344:(Page 10)
The reason might be due to government hospitals and health
Revision is made as follow.
The reason might be that government
centers policy to provide BCG, OPVO vaccination and health hospitals and healthcare centers, as matter of
education about vaccination benefits to the mothers after policy provide BCG and OPVO vaccination, as
delivery in the health facilities [27].
well as health education about benefits of
vaccination to the mothers/caregivers after
delivery [27].
142. Conclusion Section: Lines 347-350:(Page 10)
Revision is made as follow.
The residence area and mother’s age, education, TT vaccine Our
study,
upon
investigation
of
low
and place of delivery, household visit by the health worker, immunization coverage and high dropout rate
provision of immunization information at the health facility, found
that
the
area
of
residence;
the
waiting time at the health facility, were found to be important mother’s/caregivers’ age at the time of
predictors in children complete immunization.
delivery, her educational status, and the status
of her TT vaccination; the place of delivery;
household visits by health workers all were
important
predictors
for
complete
immunization.
143. Conclusion Section: Lines 351-354:(Page 10)
Revision is made as follow.
To prevent defaulters, health workers must regularly
Further, our study makes several
visit the households in order to provide health education, crucial recommendations like to prevent
vaccines and to track defaulters.
mothers/caregivers
from
defaulting
on
immunization of their children, health workers
must regularly visit the households with
children aged between 12 and 23 months, in
order to provide health education and vaccines
as also track defaulters.
144. Conclusion Section: Lines 354-356:(Page 10)
Revision is made as follow.
Eligible children visiting health facility for any Such
children
when
taken
by
purpose with mothers/caretakers should be screened for mothers/caretakers to health facilities for any
immunization in order to prevent missed opportunities.
purpose should be screened to check their
immunization status in order to prevent missed
opportunities.
145. Conclusion Section: Lines 356-358:(Page 10)
Establishing an outreach site and urban health extension
Revision is made as follow.
Outreach sites should be established to
workers to reach the mothers who are busy with the encourage urban health extension workers to
housework should be strengthened.
reach out to mothers/caregivers who are busy
with housework and hence ignore or default on
immunization.
146. Conclusion Section: Lines 358-361:(Page 10-11)
Revision is made as follow.
Training on immunization and communication skills
Training
in
immunization
and
should be provide to health workers to convince mothers for communication skills should be provided to
next visit and benefit of vaccine.
health workers so that they can convince
mothers/caregivers
of
the
benefits
of
vaccination and encourage them to visit health
facilities.
147. Limitation Section: Lines 364-366:(Page 11)
Revision is made as follow.
In Ethiopia majorities of the population lives in rural
In Ethiopia, majority of the population
areas, but due to financial problem we failed to take large lives in rural areas. However, due to financial
study participants from rural area so we simply took equal constraints we failed to take many study
number of study participants from urban and rural areas.
participants from rural areas and hence simply
took an equal number of study participants
from both urban and rural areas.
148. Competing interests Section: Lines 369:(Page 11)
Revision is made as follow.
The authors declare that they have no competing interests.
The authors declare that they have no
competing interests in this study.
149. Authors' contributions Section: Lines 372-373:(Page 11)
ANM
contributed
to
the
development,
Revision is made as follow.
study
ANM contributed to the development,
methodology and objectives, questionnaire, data collection, methodology and objectives of this study,
analyzed and first draft of the manuscript.
prepared
analyzed
questionnaire,
and
wrote
first
collected
draft
data,
of
the
manuscript.
150. Authors' contributions Section: Lines 373-375:(Page 11)
Revision is made as follow.
AF and WW supervised the development of the study
AF
and
WW
supervised
the
design and literature review provided comments for the study development of the study design, and carried
questionnaire, analyzed, participated in writing the final out literature review and helped in manuscript
version of the manuscript and co-wrote the manuscript.
151. Authors' contributions Section: Lines 375-376:(Page 12)
writing.
Revision is made as follow.
MK and HRS supervised the development of the study design, MK and HRS developed and supervised the
objectives, and literature review, provided comments in the research, edit and prepared the manuscript for
study questionnaire, and wrote the final draft of the publication.
manuscript.