Prediction of incomplete immunization among under-five children in East Africa from recent demographic and health surveys: a machine learning approach

Machine Learning


  • Miller, M. A. & Hinman, A. R. In Vaccines, 6th edn (eds Plotkin, S. A., Orenstein, W. A., & Offit, P. A.) 1413–1426 (W.B. Saunders, 2013).

  • Ozawa, S. et al. Return on investment from childhood immunization in low- and middle-income countries, 2011–20. Health Aff. (Project Hope) 35, 199–207. https://doi.org/10.1377/hlthaff.2015.1086 (2016).

    Article 

    Google Scholar 

  • Bloom, D. E. In Hot Topics in Infection and Immunity in Children VII (eds Curtis, N., Finn, A., & Pollard, A. J.) 1–8 (Springer, 2011).

  • Sim, S. Y., Watts, E., Constenla, D., Brenzel, L. & Patenaude, B. N. Return on investment from immunization against 10 pathogens in 94 low- and middle-income countries, 2011–30. Health Aff. (Project Hope) 39, 1343–1353. https://doi.org/10.1377/hlthaff.2020.00103 (2020).

    Article 

    Google Scholar 

  • Machingaidze, S., Wiysonge, C. S. & Hussey, G. D. Strengthening the expanded programme on immunization in Africa: Looking beyond 2015. PLoS Med. 10, e1001405 (2013).

    Article 
    PubMed 
    PubMed Central 

    Google Scholar 

  • Masud, T. & Navaratne, K. V. The expanded program on immunization in Pakistan: Recommendations for improving performance. (2012).

  • WHO/UNICEF. Progress and challenges with achieving universal immunization coverage. (2020).

  • WHO and UNICEF: Progress and Challenges with Achieving Universal Immunization Coverage. (WHO/UNICEF Estimates of National Immunization Coverage, J., 2019).

  • UNICEF. Under Five Mortality. https://data.unicef.org/topic/child-survival/under-five-mortality/ (2023).

  • WHO/UNICEF. Estimates of National Immunization Coverage. http://www.who.int/news-room/fact-sheets/detail/immunization-coverage (2021).

  • Debie, A., Lakew, A. M., Tamirat, K. S., Amare, G. & Tesema, G. A. Complete vaccination service utilization inequalities among children aged 12–23 months in Ethiopia: A multivariate decomposition analyses. Int. J. Equity Health 19, 65. https://doi.org/10.1186/s12939-020-01166-8 (2020).

    Article 
    PubMed 
    PubMed Central 

    Google Scholar 

  • UNICEF. (2020).

  • Faisal, S. et al. Modeling the factors associated with incomplete immunization among children. Math. Probl. Eng. 2022 (2022).

  • Negussie, A., Kassahun, W., Assegid, S. & Hagan, A. K. Factors associated with incomplete childhood immunization in Arbegona district, southern Ethiopia: A case-control study. BMC Public Health 16, 27. https://doi.org/10.1186/s12889-015-2678-1 (2016).

    Article 
    PubMed 
    PubMed Central 

    Google Scholar 

  • Nour, T. Y. et al. Predictors of immunization coverage among 12–23 month old children in Ethiopia: Systematic review and meta-analysis. BMC Public Health 20, 1803. https://doi.org/10.1186/s12889-020-09890-0 (2020).

    Article 
    PubMed 
    PubMed Central 

    Google Scholar 

  • Tesema, G. A., Tessema, Z. T., Tamirat, K. S. & Teshale, A. B. Complete basic childhood vaccination and associated factors among children aged 12–23 months in East Africa: A multilevel analysis of recent demographic and health surveys. BMC Public Health 20, 1837. https://doi.org/10.1186/s12889-020-09965-y (2020).

    Article 
    PubMed 
    PubMed Central 

    Google Scholar 

  • Skull, S. A., Ngeow, J. Y. Y., Hogg, G. & Biggs, B.-A. Incomplete immunity and missed vaccination opportunities in East African immigrants settling in Australia. J. Immigr. Minor. Health 10, 263–268. https://doi.org/10.1007/s10903-007-9071-9 (2008).

    Article 
    PubMed 

    Google Scholar 

  • Adedokun, S. T., Uthman, O. A., Adekanmbi, V. T. & Wiysonge, C. S. Incomplete childhood immunization in Nigeria: A multilevel analysis of individual and contextual factors. BMC Public Health 17, 236. https://doi.org/10.1186/s12889-017-4137-7 (2017).

    Article 
    PubMed 
    PubMed Central 

    Google Scholar 

  • Russo, G. et al. Vaccine coverage and determinants of incomplete vaccination in children aged 12–23 months in Dschang, West Region, Cameroon: A cross-sectional survey during a polio outbreak. BMC Public Health 15, 630. https://doi.org/10.1186/s12889-015-2000-2 (2015).

    Article 
    PubMed 
    PubMed Central 

    Google Scholar 

  • Mohamud Hayir, T. M., Magan, M. A., Mohamed, L. M., Mohamud, M. A. & Muse, A. A. Barriers for full immunization coverage among under 5 years children in Mogadishu, Somalia. J. Fam. Med. Prim. Care 9, 2664–2669. https://doi.org/10.4103/jfmpc.jfmpc_119_20 (2020).

    Article 

    Google Scholar 

  • Kebede Kassaw, A. A. et al. Spatial distribution and machine learning prediction of sexually transmitted infections and associated factors among sexually active men and women in Ethiopia, evidence from EDHS 2016. BMC Infect. Dis. 23, 49. https://doi.org/10.1186/s12879-023-07987-6 (2023).

    Article 
    PubMed 
    PubMed Central 

    Google Scholar 

  • DHS. Data Collection. https://www.dhsprogram.com/Data/.

  • Etana, B. & Deressa, W. Factors associated with complete immunization coverage in children aged 12–23 months in Ambo Woreda, Central Ethiopia. BMC Public Health 12, 566. https://doi.org/10.1186/1471-2458-12-566 (2012).

    Article 
    PubMed 
    PubMed Central 

    Google Scholar 

  • Kassahun, M. B., Biks, G. A. & Teferra, A. S. Level of immunization coverage and associated factors among children aged 12–23 months in Lay Armachiho District, North Gondar Zone, Northwest Ethiopia: A community based cross sectional study. BMC. Res. Notes 8, 239. https://doi.org/10.1186/s13104-015-1192-y (2015).

    Article 
    PubMed 
    PubMed Central 

    Google Scholar 

  • Sheikh, N. et al. Coverage, timelines, and determinants of incomplete immunization in Bangladesh. Trop. Med. Infect. Dis. 3, 72 (2018).

    Article 
    PubMed 
    PubMed Central 

    Google Scholar 

  • Bugvi, A. S. et al. Factors associated with non-utilization of child immunization in Pakistan: Evidence from the Demographic and Health Survey 2006–07. BMC Public Health 14, 232. https://doi.org/10.1186/1471-2458-14-232 (2014).

    Article 
    PubMed 
    PubMed Central 

    Google Scholar 

  • Tadesse, H., Deribew, A. & Woldie, M. Predictors of defaulting from completion of child immunization in south Ethiopia, May 2008—A case control study. BMC Public Health 9, 150. https://doi.org/10.1186/1471-2458-9-150 (2009).

    Article 
    PubMed 
    PubMed Central 

    Google Scholar 

  • Jani, J. V., De Schacht, C., Jani, I. V. & Bjune, G. Risk factors for incomplete vaccination and missed opportunity for immunization in rural Mozambique. BMC Public Health 8, 161. https://doi.org/10.1186/1471-2458-8-161 (2008).

    Article 
    PubMed 
    PubMed Central 

    Google Scholar 

  • De, P. & Bhattacharya, B. N. Determinants of child immunization in fourless-developed states of North India. J. Child Health Care 6, 34–50 (2002).

    Article 

    Google Scholar 

  • Rahman, M. & Obaida-Nasrin, S. Factors affecting acceptance of complete immunization coverage of children under five years in rural Bangladesh. Salud pública de méxico 52, 134–140 (2010).

    Article 
    PubMed 

    Google Scholar 

  • Atnafu, A. et al. Prevalence and determinants of incomplete or not at all vaccination among children aged 12–36 months in Dabat and Gondar districts, northwest of Ethiopia: Findings from the primary health care project. BMJ Open 10, e041163. https://doi.org/10.1136/bmjopen-2020-041163 (2020).

    Article 
    PubMed 
    PubMed Central 

    Google Scholar 

  • Melaku, M. S., Nigatu, A. M. & Mewosha, W. Z. Spatial distribution of incomplete immunization among under-five children in Ethiopia: Evidence from 2005, 2011, and 2016 Ethiopian Demographic and health survey data. BMC Public Health 20, 1362. https://doi.org/10.1186/s12889-020-09461-3 (2020).

    Article 
    PubMed 
    PubMed Central 

    Google Scholar 

  • Pedregosa, F. et al. Scikit-learn: Machine learning in Python. J. Mach. Learn. Res. 12, 2825–2830 (2011).

    MathSciNet 

    Google Scholar 

  • Chen, T. & Guestrin, C. XGBoost: A Scalable Tree Boosting System. (2016).

  • Lundberg, S. M. et al. From local explanations to global understanding with explainable AI for trees. Nat. Mach. Intell. 2, 56–67. https://doi.org/10.1038/s42256-019-0138-9 (2020).

    Article 
    PubMed 
    PubMed Central 

    Google Scholar 

  • Rawat, S., Rawat, A., Kumar, D. & Sabitha, A. S. Application of machine learning and data visualization techniques for decision support in the insurance sector. Int. J. Inf. Manag. Data Insights 1, 100012 (2021).

    Google Scholar 

  • Guo, Y. The 7 steps of machine learning (2017). towardsdatascience.com (2017).

  • Brownlee, J. Data Preparation for Machine Learning: Data Cleaning, Feature Selection, and Data Transforms in Python (Machine Learning Mastery, 2020).

  • Yu, L. & Liu, H. In Proceedings of the 20th International Conference on Machine Learning (ICML-03). 856–863.

  • Bekele, W. T. Machine learning algorithms for predicting low birth weight in Ethiopia. BMC Med. Inform. Decis. Mak. 22, 232. https://doi.org/10.1186/s12911-022-01981-9 (2022).

    Article 
    PubMed 
    PubMed Central 

    Google Scholar 

  • Bitew, F. H., Sparks, C. S. & Nyarko, S. H. Machine learning algorithms for predicting undernutrition among under-five children in Ethiopia. Public Health Nutr. 1–12 (2021).

  • Chilyabanyama, O. N. et al. Performance of machine learning classifiers in classifying stunting among under-five children in Zambia. Children (Basel, Switzerland). https://doi.org/10.3390/children9071082 (2022).

    Article 
    PubMed 
    PubMed Central 

    Google Scholar 

  • Emmanuel, M. Application of Machine Learning Methods in Analysis of Infant Mortality in Rwanda: Analysis of Rwanda Demographic Health Survey 2014–15 Dataset (University of Rwanda, 2021).

  • Fenta, H. M., Zewotir, T. & Muluneh, E. K. A machine learning classifier approach for identifying the determinants of under-five child undernutrition in Ethiopian administrative zones. BMC Med. Inform. Decis. Mak. 21, 1–12 (2021).

    Article 

    Google Scholar 

  • Kananura, R. M. Machine learning predictive modelling for identification of predictors of acute respiratory infection and diarrhoea in Uganda’s rural and urban settings. PLoS Glob. Public Health 2, e0000430. https://doi.org/10.1371/journal.pgph.0000430 (2022).

    Article 
    PubMed 
    PubMed Central 

    Google Scholar 

  • Saroj, R. K., Yadav, P. K., Singh, R. & Chilyabanyama, O. N. Machine learning algorithms for understanding the determinants of under-five mortality. BioData Min. 15, 20. https://doi.org/10.1186/s13040-022-00308-8 (2022).

    Article 
    PubMed 
    PubMed Central 

    Google Scholar 

  • Tesfaye, B., Atique, S., Azim, T. & Kebede, M. M. Predicting skilled delivery service use in Ethiopia: Dual application of logistic regression and machine learning algorithms. BMC Med. Inform. Decis. Mak. 19, 209. https://doi.org/10.1186/s12911-019-0942-5 (2019).

    Article 
    PubMed 
    PubMed Central 

    Google Scholar 

  • Bekkar, M., Djemaa, H. K. & Alitouche, T. A. Evaluation measures for models assessment over imbalanced data sets. J. Inf. Eng. Appl. 3, 15–33 (2013).

    Google Scholar 

  • Yang, L. & Shami, A. On hyperparameter optimization of machine learning algorithms: Theory and practice. Neurocomputing 415, 295–316. https://doi.org/10.1016/j.neucom.2020.07.061 (2020).

    Article 

    Google Scholar 

  • Kebede, S. D. et al. Prediction of contraceptive discontinuation among reproductive-age women in Ethiopia using Ethiopian Demographic and Health Survey 2016 Dataset: A machine learning approach. BMC Med. Inform. Decis. Mak. 23, 9. https://doi.org/10.1186/s12911-023-02102-w (2023).

    Article 
    PubMed 
    PubMed Central 

    Google Scholar 

  • Wang, K. et al. Interpretable prediction of 3-year all-cause mortality in patients with heart failure caused by coronary heart disease based on machine learning and SHAP. Comput. Biol. Med. 137, 104813. https://doi.org/10.1016/j.compbiomed.2021.104813 (2021).

    Article 
    PubMed 

    Google Scholar 

  • Lundberg, S. M. & Lee, S.-I. A unified approach to interpreting model predictions. Adv. Neural Inf. Process. Syst. 30 (2017).

  • Li, Q., Zhang, Y., Kang, H., Xin, Y. & Shi, C. Mining association rules between stroke risk factors based on the Apriori algorithm. Technol. Health Care. 25, 197–205. https://doi.org/10.3233/thc-171322 (2017).

    Article 
    PubMed 

    Google Scholar 

  • Chandir, S. et al. Using predictive analytics to identify children at high risk of defaulting from a routine immunization program: Feasibility study. JMIR Public Health Surveill. 4, e9681 (2018).

    Article 

    Google Scholar 

  • Mutua, M. K., Kimani-Murage, E. & Ettarh, R. R. Childhood vaccination in informal urban settlements in Nairobi, Kenya: Who gets vaccinated?. BMC Public Health 11, 6. https://doi.org/10.1186/1471-2458-11-6 (2011).

    Article 
    PubMed 
    PubMed Central 

    Google Scholar 

  • Landoh, D. E. et al. Predictors of incomplete immunization coverage among one to five years old children in Togo. BMC Public Health 16, 968. https://doi.org/10.1186/s12889-016-3625-5 (2016).

    Article 
    PubMed 
    PubMed Central 

    Google Scholar 

  • Pavlopoulou, I. D., Michail, K. A., Samoli, E., Tsiftis, G. & Tsoumakas, K. Immunization coverage and predictive factors for complete and age-appropriate vaccination among preschoolers in Athens, Greece: A cross- sectional study. BMC Public Health 13, 908. https://doi.org/10.1186/1471-2458-13-908 (2013).

    Article 
    PubMed 
    PubMed Central 

    Google Scholar 

  • Zewdie, A., Letebo, M. & Mekonnen, T. Reasons for defaulting from childhood immunization program: A qualitative study from Hadiya zone, Southern Ethiopia. BMC Public Health 16, 1240. https://doi.org/10.1186/s12889-016-3904-1 (2016).

    Article 
    PubMed 
    PubMed Central 

    Google Scholar 

  • Tauil, M. D. C., Sato, A. P. S. & Waldman, E. A. Factors associated with incomplete or delayed vaccination across countries: A systematic review. Vaccine 34, 2635–2643. https://doi.org/10.1016/j.vaccine.2016.04.016 (2016).

    Article 
    PubMed 

    Google Scholar 

  • Shrestha, S., Shrestha, M., Wagle, R. R. & Bhandari, G. Predictors of incompletion of immunization among children residing in the slums of Kathmandu valley, Nepal: A case-control study. BMC Public Health 16, 970. https://doi.org/10.1186/s12889-016-3651-3 (2016).

    Article 
    PubMed 
    PubMed Central 

    Google Scholar 

  • Chhabra, P., Nair, P., Gupta, A., Sandhir, M. & Kannan, A. T. Immunization in urbanized villages of Delhi. Indian J. Pediatr. 74, 131–134. https://doi.org/10.1007/s12098-007-0004-3 (2007).

    Article 
    PubMed 

    Google Scholar 

  • Aregawi, H. G., Gebrehiwot, T. G., Abebe, Y. G., Meles, K. G. & Wuneh, A. D. Determinants of defaulting from completion of child immunization in Laelay Adiabo District, Tigray Region, Northern Ethiopia: A case-control study. PLoS One 12, e0185533. https://doi.org/10.1371/journal.pone.0185533 (2017).

    Article 
    CAS 
    PubMed 
    PubMed Central 

    Google Scholar 

  • Verrier, F. et al. Vaccination coverage and risk factors associated with incomplete vaccination among children in Cambodia, Madagascar, and Senegal. Open Forum Infect. Dis. 10, ofad136. https://doi.org/10.1093/ofid/ofad136 (2023).

    Article 
    PubMed 
    PubMed Central 

    Google Scholar 

  • Tesfaye, F., Tamiso, A., Birhan, Y. & Tadele, T. Predictors of immunization defaulting among children age 12–23 months in Hawassa Zuria District of southern Ethiopia: Community based unmatched case control study. Int. J. Public Health 3 (2014).

  • Atnafu Gebeyehu, N. et al. Incomplete immunization and its determinants among children in Africa: Systematic review and meta-analysis. Hum. Vaccines Immunother. https://doi.org/10.1080/21645515.2023.2202125 (2023).

  • Desalew, A., Semahegn, A., Birhanu, S. & Tesfaye, G. Incomplete vaccination and its predictors among children in Ethiopia: A systematic review and meta-analysis. Glob. Pediatr. Health 7, 2333794×20968681. https://doi.org/10.1177/2333794×20968681 (2020).

  • Mrisho, M. et al. The use of antenatal and postnatal care: perspectives and experiences of women and health care providers in rural southern Tanzania. BMC Pregnancy Childbirth 9, 10. https://doi.org/10.1186/1471-2393-9-10 (2009).

    Article 
    PubMed 
    PubMed Central 

    Google Scholar 

  • Mbengue, M. A. S. et al. Determinants of complete immunization among senegalese children aged 12–23 months: Evidence from the demographic and health survey. BMC Public Health 17, 630. https://doi.org/10.1186/s12889-017-4493-3 (2017).

    Article 
    PubMed 
    PubMed Central 

    Google Scholar 

  • Sarker, A. R., Akram, R., Ali, N., Chowdhury, Z. I. & Sultana, M. Coverage and determinants of full immunization: Vaccination coverage among senegalese children. Medicina (Kaunas, Lithuania). https://doi.org/10.3390/medicina55080480 (2019).

    Article 
    PubMed 
    PubMed Central 

    Google Scholar 



  • Source link

    Leave a Reply

    Your email address will not be published. Required fields are marked *