<p>We conducted unmatched 1:2 case control study of 60 cases and 120 controls in chena district from October to December 2023. Cases were selected from line lists and controls from their neighbors’ structured questioner was used to interview participants discussion were held with key informants about cold chain management and vaccination coverage. Micro soft office Excel, Epi Info 7.2.1.0 for and SPSS were used for Bivariate and Multivariate analysis&nbsp;</p>