Low uptake and readiness of child health services in Postwar Tigray, Ethiopia: awaiting for a response

Following the armed conflict in Tigray, the health system collapsed and routine health services were interrupted. However, after the Pretoria peace agreement, various health -related interventions aimed at recovery were implemented. Despite these efforts, little is known about the current status of child health services, including immunization and healthcare seeking for childhood illnesses. Therefore, this study aimed to evaluate child health services in post-war Tigray. A community and facility-based cross-sectional study was conducted from January to February 2024 to assess the uptake of child health services and service readiness among mothers of children aged 0–59 months (N = 2340). A multistage sampling technique was used, with a random selection of 24 districts and 78 sub-districts, and 30 households were considered per Tabia based on the assumption of Ethiopian Demographic Health Survey, 2019. A representative sample of health facilities (30%) including primary hospitals, health centers and health posts, was also considered. Data were collected using Open Data Kit (ODK), which was pretested, modified, and translated into the local language. The collected data were cleaned, coded, and analyzed using SPSS version 25. The response rate of this study was 99.9%. The proportion of children who received full vaccination was 58.8%, with a significant disparity between urban and rural areas. A significant difference was noted in the full vaccine uptake among contraceptive users (65.7%) (p-value < 0.007) and by residence urban (66.8%) versus rural (56.3%) (p-value < 0.006). Cough was the leading cause of childhood illnesses, followed by fever in the rural settings accompanied by the healthcare seeking of 58.6%, 48.4%, 59.3% for diarrhea, cough and fever respectively. The overall readiness score for child health and specific EPI service were 46.4% and 37.4% respectively. In the post- war period, immunization coverage in Tigray was relatively low, with a notable urban–rural disparity. Utilization of healthcare for childhood illness was also low in rural communities despite the high burden of diseases. Overall, readiness score for child health and immunization services were low. Concerted efforts are needed to improve the uptake of childhood vaccines and the readiness score for child health services.