Department of Reproductive Health and Population Studies, School of Public Health, College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia.
BMC Health Serv Res. 2023 Sep 7;23(1):969. doi: 10.1186/s12913-023-09940-4.
Immunization is one of the most cost-effective public health interventions for improving children's health and survival. In Ethiopia, low immunization coverage and disparity across residences are major public health problems. However, the factors that contributed to the urban-rural disparity have not been thoroughly investigated. Therefore, the objective of this study was to examine the change and contributing factors in full immunization coverage across geographic locations (urban-rural) in Ethiopia.
We analyzed data on children aged 12 to 23 months obtained from the 2019 mini-Ethiopian demographic and health survey. A total of 996 weighted samples (299 in urban and 697 in rural areas) were included in the analysis. A multivariate decomposition analysis technique was used to determine the disparity and identify factors that contribute to the disparity across geographical locations. Statistical significance was defined at a 95% confidence interval with a p-value of less than 0.05.
The percentage of children aged 12-23 months who received full immunization increased from 36.84% (95% CI:31.59, 42.41) in rural areas to 64.59% (95% CI:47.10, 78.89) in urban areas. The decomposition analysis showed that the observed urban-rural disparity was attributed to a change in the effect of population characteristics (coefficient) across residences. Specifically, receiving 1-3 (β = 0.0895, 95% CI: 0.0241, 0.1550) and 4 or more (β = 0.1212, 95% CI: 0.0224, 0.2199) antenatal care visits, delivering at a health facility (β = 0.1350, 95% CI: 0.0227, 0.2472), and the source of information about immunization status from vaccination cards (β = 0.2666, 95% CI:0.1763, 0.3569) significantly contributed to the widening urban-rural disparity. On the other hand, being of high wealth status (β=-0.141, 95% CI: -0.1945, -0.0876), receiving postnatal care (β=-0.0697, 95% CI: -0.1344, -0.0051), and having four or more living children (β=-0.1774, 95% CI: -0.2971, -0.0577) significantly contributed to narrowing the urban-rural disparity.
There was a significant urban-rural disparity in immunization coverage in Ethiopia, with urban children more likely to complete immunization. The change in the composition of population characteristics was not significant for the observed disparity. The observed disparity in full immunization coverage was mainly driven by the coefficients related to maternal healthcare utilization, household wealth status, the number of living children, and the source of immunization information. Therefore, strengthening maternal health services utilization, encouraging mothers to maintain their children's immunization records, and addressing economic inequality, particularly in rural areas, may narrow the urban-rural disparity and enhance immunization coverage nationwide.
免疫接种是改善儿童健康和生存的最具成本效益的公共卫生干预措施之一。在埃塞俄比亚，免疫接种率低且城乡之间存在差异是主要的公共卫生问题。然而，导致城乡差异的因素尚未得到彻底调查。因此，本研究旨在检验埃塞俄比亚在地理位置（城乡）方面全免疫接种覆盖率的变化及其促成因素。
我们分析了 2019 年微型埃塞俄比亚人口与健康调查中获得的 12 至 23 个月大儿童的数据。共有 996 个加权样本（城市 299 个，农村 697 个）纳入分析。使用多元分解分析技术来确定城乡之间的差异，并确定导致地理差异的因素。统计显著性定义为 95%置信区间的置信水平，p 值小于 0.05。
12-23 个月大的儿童中，接受完全免疫接种的比例从农村地区的 36.84%（95%CI：31.59，42.41）上升到城市地区的 64.59%（95%CI：47.10，78.89）。分解分析表明，观察到的城乡差异归因于居住人口特征（系数）变化的影响。具体而言，接受 1-3 次（β=0.0895，95%CI：0.0241，0.1550）和 4 次或更多次（β=0.1212，95%CI：0.0224，0.2199）产前保健访问、在保健设施分娩（β=0.1350，95%CI：0.0227，0.2472）以及从疫苗接种卡获取免疫状况信息（β=0.2666，95%CI：0.1763，0.3569）显著促进了城乡差异的扩大。另一方面，高财富状况（β=-0.141，95%CI：-0.1945，-0.0876）、接受产后保健（β=-0.0697，95%CI：-0.1344，-0.0051）和有四个或更多活产子女（β=-0.1774，95%CI：-0.2971，-0.0577）显著有助于缩小城乡差异。
埃塞俄比亚在免疫接种覆盖率方面存在显著的城乡差异，城市儿童更有可能完成免疫接种。人口特征构成的变化对观察到的差异没有显著影响。全免疫接种覆盖率的观察到的差异主要由与孕产妇保健利用、家庭财富状况、活产子女数量以及免疫信息来源相关的系数驱动。因此，加强孕产妇保健服务的利用，鼓励母亲保持其子女的免疫接种记录，并解决经济不平等问题，特别是在农村地区，可能会缩小城乡差距，提高全国的免疫接种覆盖率。
