Understanding Socioeconomic Inequalities in Zero-Dose Children for Vaccination in Underserved Settings of Ethiopia: Decomposition Analysis Approach.

Despite considerable global efforts to enhance vaccine distribution in low-income countries, a significant number of children remain unvaccinated, particularly in Ethiopia. The underlying socioeconomic challenges in these regions are recognized as primary contributors to the low vaccination rates. However, the reasons for this persistent disparity in Ethiopia's remote and underserved regions need further analysis. The study employed a cross-sectional design and was conducted as part of the Project HOPE Zero-Dose Evaluation from 1 February to 31 July 2022. Concentration indices were utilized to quantify the extent of inequality, with further decomposition aimed at identifying contributing factors to this disparity. The findings underscored that populations with lower socioeconomic status encounter high numbers of children receiving no vaccinations. Key factors influencing the number of zero-dose children included distance from healthcare facilities (61.03%), economic status of the household (38.93%), absence of skilled birth assistance (20.36%), underutilization of antenatal care services (<four visits; 8.66%), lack of postnatal care (8.62%), and rural residency (7.69%). To reduce the number of zero-dose children in Ethiopia, it is essential to implement context-specific strategies that address socioeconomic barriers and integrate innovative approaches with community engagement. This approach will help to ensure equitable access to vaccines for children across all socioeconomic statuses.