Quality of Expanded Program on Immunization in Public Health Facilities of Debre Birhan Wereda, North Shoa zone, Amhara Region, Central Ethiopia

Abstract

Background: poor quality of health care determines the successful implementation of health programs including immunization given a priority to improve health care services. Therefore it was relevant to do quality related studies on immunization service delivery in the study area. Objective: The objective of the study was to assess the quality of Expanded Program on immunization service delivery in Debre Birhan Wereda, Amhara Region, Ethiopia. Method: A facility based cross-sectional survey was conducted from June 20 to Aug 10, 2013. Three purposively selected facilities (one hospital and two health centers) were included in the study. A sample of 362 mothers/care takers having < 1 year child for immunization, three immunization service coordinators and 73 observation sessions were enrolled in the study. Interview questionnaires, guides and observation checklists were prepared. Data were entered, cleaned, coded and analyzed using SPSS for Windows Version 16.0. Mean, median, percentages, and frequencies were used to analyze the results. Logistic regression model was used and cut-off points for the factors associated with satisfaction score was set at a significance level of p < 0.05 and CI = 0.95. Ethical clearance was obtained from the Ethical Review Committee of Jimma University and official letter was given to Zonal Health Department of study area and then permission letter to study facilities. Written and verbal consent was obtained from study participants before data collection and information collected from study participants was kept confidential. Result: Three hundred thirty nine respondents were participated in the study and the response rate was 93.6%. In the study, structural/ input assessment of the facilities found to be inadequate though basic equipments and supplies including refrigerator, vaccine carriers, log books, immunization card and tally sheets were found in majority of study facilities. In the process of immunization service, most health workers’ practices were poor and not in line with the immunization guide line standards of Ethiopia. The overall Satisfaction of clients toward immunization service in this study was satisfactory (54.3 %). Both in bivariate and multivariate logistic regression analysis, marital status (being divorced) and type of health facility (being health center) were found to be significant factors to ward clients’ satisfaction. Conclusion: the first two components of quality were found to be inadequate and poor respectively where as the outcome in terms of satisfaction was satisfactory in the study. Recommendation: all facilities in the study areas should improve their service rooms and waiting areas, stock control of AD syringe and vaccines, cold chain management and communication with clients and communities.