Immunization status of children aged 12-23 months in Jonglei State, South Sudan: a cross-sectional epidemiologic study.

Introduction: the immunization program focuses on reducing the morbidity and mortality associated with vaccine-preventable diseases. The purpose of the study was to determine the state of immunization coverage of children aged 12-23 months in Jonglei State, South Sudan, and to identify the factors that contribute to the low immunization coverage. Methods: a cross-sectional epidemiologic study was carried out between June and September 2020 using a predefined questionnaire based on the standard World Health Organization (WHO) Expanded Program on Immunization (EPI) protocol. A total of 385 women, 35 from 11 counties each of the Jonglei state who resided in the area for a minimum of 12 months, were randomly selected and individually interviewed. The immunization status of the child was verified either by health card or health card plus history recalls. Obtained data were subjected to statistical analysis. Results: only 17.7% and 27.5% of children were fully immunized as validated by health card and health card plus recall history, respectively. The most common reason for no immunization and partial immunization was a far distance of the health facility (24.9%) followed by lack of knowledge (23.1%). Based on the multivariate regression analysis of data verified by health card plus history recalls, age group of 25-29 years (OR=4.467 95% CI=1.112-1.795, p=0.000) and no knowledge of immunization (OR=1.578, 95% CI=1.438-4.579, p=0.000) significantly increased the odds of children being fully immunized, while Murle ethnic group(OR=0.083, 95% CI=0.008-0.849, p=0.036), delivery assistance by skilled birth attendance (OR=0.001, 95% CI=0.000-0.006, p=0.000) significantly decreased the odds of children being fully immunized. Conclusion: effective health education and easy access to health facilities and their utilization may significantly improve immunization in Jonglei, South Sudan.