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Background: Vaccination programs are one of the priority health interventions, and all children in every country should be vaccinated. The World Health Organization (WHO) aims for 90% coverage of the Expanded Program on Immunization (EPI) by the age of 12 months. The CORE Group Polio Project (CGPP) Ethiopia implemented interventions in pastoral and semi-pastoral regions to increase routine immunization coverage and support supplemental immunization campaigns.Objective: Assess vaccination coverage, estimate dropout rates and identify associated factors. Methods: A cross-sectional study using the modified WHO EPI cluster survey method was conducted as part of the mid-term evaluation in 2015 in six pastoral and semi-pastoral zones in Ethiopia. A sample of 600 children age 12 to 23 months was selected, and mothers/caregivers were interviewed at home using face-to-face interviews, supported by mobile data collection using the Open Data Kit (ODK) system. Data were exported from the server, cleaned, and analysed using STATA 12.0.Both descriptive analytical methods were used and p-values less than 0.05 were used to declare statistical significance.Results: Of the estimated sample, 577 (96.6%) children were included in the analysis. The overall rate of full vaccination was estimated to be 44.0% (21.2% in pastoral areas and 71.6% in semi-pastoral areas). With vaccine specific coverage of 53.7% for Bacillus Calmette-Guérin (BCG); 58.8% for oral polio vaccine 3 (OPV 3); 58.8% for pentavalent 3; 56.3% for OCV 3 and 53.6% for measles. Mothers’/caregivers’ residence, age and education were found to be significant predictors for children not being fully vaccinated, i.e. children of mothers living in pastoralist communities, young age, and with no education were at a significantly higher risk of being not fully vaccinated. Among those children who had at least one vaccine, 20.5% failed to take at least one of the next higher doses. Specifically, among those who took BCG and pentavalent 1, 10.1% and 14.1%, respectively, failed to take the measles vaccination. Conclusions and recommendations: The proportion of children who were fully vaccinated in pastoral and semipastoral zones was low. Dropout rates for measles, BCG and pentavalent 1 immunization were above the acceptable rate of less than 10%. Therefore, efforts should focus on mobilizing the community to complete all child vaccinations, and community-based approaches with the integration of community volunteers, health extension workers and health center staff should be strengthened so that dropout children can be traced so that they can complete their vaccinations. More information is also required on why mothers/caregivers fail to ensure that their children take all available vaccinations. [Ethiop.J. Health Dev. 2019;33(Special issue):3-9]Key words: Vaccination coverage, vaccination dropout, pastoralist, semi-pastoralist, CGPP, Ethiopia

Background: Adequate knowledge is key for immunization service provision and related practices, such as providing the right vaccine at the right time, keeping vaccines potent, and to prevent vaccine failures. This study was conducted to assess the knowledge, attitude and practices of immunization service providers in primary health care units in pastoral and semi-pastoral areas of Ethiopia. Methods: A facility-based cross-sectional study was conducted of 1,280 health workers drawn from health centers (233) and health posts (632) in five regions of Ethiopia: Somali, Gambella, Benishangul-Gumuz, Oromiya and SNNPR. Data were collected using a self-administered questionnaire prepared in English and translated into three local languages, and analyzed using STATA version 13.0. Descriptive statistics and binary logistic regression analysis were carried out to determine the magnitude of, and identify associated factors for, knowledge, attitude and practice. A p-value of less than 0.05 was used to declare statistical significance.Results: Of all health center respondents, 389 (61.3%) had a good knowledge of the vaccination schedule; 403 (63.5%) had poor practices relating to vaccine placement in refrigerators; and 321(54%) had poor attitudes in relation to vaccines and vaccination. With respect to the vaccination schedule, midwives and Health officers/Medical Doctors were 0.28(95% CI: 0.08-0.95) times less knowledgeable than nurses; and health workers with more than five years’ work experience were 2.78 (95% CI: 1.54-5.01) times more knowledgeable than health workers who had three years’ work experience.Conclusions and recommendations: In this study, gaps were observed in health service providers’ knowledge, attitudes and practices in relation to immunization. Support to address these gaps – through training, supervision, monitoring and other mechanisms should focus on HEWs whose education is less than or equal to grade 12 at health post level, and on midwives and Health Officers (HOs)/MDs at the health center level. Similarly, attention should be given to enhance the vaccine and vaccination knowledge of semi-pastoral health facility service providers. The government, immunization working partners and other responsible bodies should give attention and take corrective measures to use maximum vaccine preventive potency.[Ethiop.J. Health Dev. 2019;33(Special issue):10-15] Key words: Immunization, Knowledge, Attitude, Practice, Health Worker

In 1980, the Expanded Program on Immunization (EPI) was initiated by the Ministry of Health, with the objective of reaching 90% coverage among children under 1year of age by the year 1990 (1). The vaccination schedule since then has been in accordance with that recommended by WHO for developing countries (2).

Background: The availability of immunization services and the readiness of skilled health workers in health institutions to deliver potent vaccines to end users when required to do so are important inputs that contribute to the reduction of child morbidity and mortality from vaccine-preventable diseases (VPDs). Objective: Assess immunization service availability and readiness in primary health care units (PHCUs) in pastoral and semi-pastoral regions of CGPP Ethiopia implementation districts. Methods: A facility-based cross-sectional survey was employed on 14–23 August 2016 in all health centers (HCs) and three randomly selected health posts (HPs) in each HC catchment area in 85 CGPP implementation districts. An observation checklist was filled in by trained data collectors for all study PHCUs. Results: Immunization service availability and service delivery, based on 19 tracer items, were assessed in 860 PHCUs in both pastoral and semi-pastoral areas. In total, 92% of the PHCUs reported providing an immunization service. However, only 18.1% of the PHCUs were observed and 32.4% reported providing immunization on the day data were collected. Overall, immunization service readiness was 56.6%: 85% of the HCs and 46.6% of the HPs were ready for immunization service over the study period. The proportion of PHCUs found to have functional refrigerators was 65%. Conclusions and recommendations: Great variability observed in terms of service readiness among HCs and HPs in this study. All PHCUs should be equipped with functional refrigerators that are regularly maintained; all immunization antigens and schedule immunization services should be available at the PHCUs daily to avoid missed opportunities; cold chain managers/immunization service providers should be given supervisory support to ensure that they record refrigerator temperatures.[Ethiop .J. Health Dev. 2019; 33(Special issue):24-30]Key words: Service availability, Service readiness, Pastoralist and semi-pastoralist, Hard to reach community

Background: Immunization is one of the most powerful and cost-effective public health interventions. Most vaccines in the immunization schedule require two or more doses to trigger adequate immune response; appropriate timing, proper interval between vaccine doses, and completion of all vaccine doses are important to attain optimal protection. Objective: To evaluate and identify factors associated with the timeliness of vaccine doses; assess the interval between vaccine doses; and identify missed opportunities among children aged 12 to 23 months. Methods: A cross-sectional descriptive study was conducted that employed the 30 by 10 modified WHO immunization coverage cluster sampling technique. Considering pastoral and semi-pastoral areas, a total of 60 clusters with a sample of 600 children aged 12 to 23 months and mothers/caregivers were included. Data were collected using smartphones loaded with the Open Data Kit (ODK) system and exported to STATA 12.0 for data description and analysis. Results: The response rate was 97%, with 54.8% of the sample from pastoral areas. About 51% of the respondents were Muslim, 68% had no education, and 67% were aged 30 or above. More than one fifth (21.9%) of children received at least one vaccine dose earlier than the recommended minimum age. Nearly half (47.7%) of children received at least one subsequent dose earlier than an interval of four weeks. The overall rate of missed opportunities was 42.7%, which was higher in pastoral (61.4%) compared to semi-pastoral areas (30.9%) (P

Background: Ethiopia has been implementing immunization programs for the past four decades. However, coverage remains low, especially in pastoral and semi-pastoral regions. Among the obstacles to achieving immunization targets is the level of health workers’ readiness to provide immunization services, measured in terms of levels of motivation, capacity and involvement.Objective: To assess the extent of healthcare providers’ readiness to provide immunization services at primary healthcare units in pastoral and semi-pastoral areas of Ethiopia. Methods: A cross-sectional survey was conducted on a sample of 1,283 healthcare providers involved in immunization services in 233 health centers, and 699 health posts in the health center catchment areas. From five CORE Group Polio Project intervention regions in Ethiopia, interviews were held with personnel in each health center – an Extended Program on Immunization focal person, a midwife, and the medical director or head. From each health post, interviews were held with one health extension worker. Data were collected using a selfadministered questionnaire facilitated by woreda and zonal health and CORE Group staff. The outcome variable of interest, readiness, was measured using three indicator variables – high to very high levels of self-reported motivation and involvement in immunization service provision, and having received at least one immunizationrelated training in the last two years. In addition to health care workers’ background characteristics, where workers were based – in pastoral or semi-pastoral areas – were included as factors for readiness. Data were entered into EpiData and exported to STATA version 12 for analysis. Binary logistic regression was used to identify independent factors associated with readiness, and p