Agimas Muluken Chanie, Asmamaw Meron, Hailu Melese Kebede, Kidie Tigabu, Abuhay Habtamu Wagnew, Yismaw Getaneh Awoke, Derseh Nebiyu Mekonnen
Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Science, University of Gondar, Gondar, Ethiopia.
Department of Emergency and Critical Care Nursing, College of Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia.
PLoS One. 2024 Dec 31;19(12):e0312610. doi: 10.1371/journal.pone.0312610. eCollection 2024.
Zero-dose vaccine status refers to a child who has not yet received any childhood vaccines. Globally, zero-dose vaccination status is the major public health problem. In sub-Saharan African countries, among five children, one child did not access the vaccines. The efforts to identify the factors contributing to the zero-dose vaccine have not yet been addressed in Ethiopia.
To assess the distribution and determinants of zero dose vaccination status hot spots among children in Ethiopia using Ethiopian demographic health survey 2019.
A secondary analysis of a cross-sectional study was used among a total of 3208 participants. Stata-14, Arc geographic information system-10.3, and Sat Scan software were used to analyze the data. Moran's I statistic was used to assess the non-random distribution of zero-dose vaccination status. Spatial and geographically weighted regression was used to map the distribution and determinants of zero-dose vaccination status in Ethiopia. The Getis-Ord-statistics and Sat Scan analysis were also used to identify the hot spot area and significant clusters respectively. To identify significant factors, a p-value <0.05 was used.
The prevalence of zero-dose vaccination status among children aged 12-35 months old was 16.3% (95%CI, 15%-17.6%). The distribution of zero-dose vaccination status in Ethiopia was not randomly distributed across the area (Moran's I value = 0.4, p<0.001). The hotspot area of zero-dose vaccination status in Ethiopia was located in Afar, Somalia, and the south nations region. The primary cluster was located at 5.479641 N and 42.196835 E within a 405.96 km radius in the Somali region. The highest effect (β, 0.23-0.24) of give birth at home on zero-dose vaccination status was observed in Afar, Somalia, and Tigray, whereas the lowest effect of home delivery (β, 0.21-0.22) was observed in south nations, Gambela, and the western part of Benishangul Gumuz. Additionally, the poor wealth index had the highest effect on zero-dose vaccination status (β, 0.06-0.07) in south nations, Benishangul Gumuz, and the Gambela region, and the lowest effect of the poor wealth index (β, 0.03-0.04) was observed in Somalia and the Afar region.
The zero dose child in Ethiopia was low. Geographically, the highest proportion of zero-dose vaccination status among children was in the Somali and Afar regions. Home delivery had the highest and most positive effect on zero-dose vaccination status in Afar, Somalia, and the Tigray region. Additionally, the poor wealth index had the highest and most positive effect in Somalia and the Afar region. Expanding delivery at the health facility and economic empowerment of women are recommended to improve vaccination in Ethiopia.
零剂次疫苗接种状态是指儿童尚未接种任何儿童疫苗。在全球范围内，零剂次疫苗接种状态是主要的公共卫生问题。在撒哈拉以南非洲国家，每五个儿童中就有一个无法接种疫苗。埃塞俄比亚尚未对导致零剂次疫苗接种的因素进行研究。
利用2019年埃塞俄比亚人口与健康调查评估埃塞俄比亚儿童零剂次疫苗接种状态热点地区的分布及决定因素。
对一项横断面研究的3208名参与者进行二次分析。使用Stata-14、Arc地理信息系统-10.3和Sat Scan软件分析数据。使用莫兰指数（Moran's I）统计量评估零剂次疫苗接种状态的非随机分布。采用空间和地理加权回归绘制埃塞俄比亚零剂次疫苗接种状态的分布及决定因素。Getis-Ord统计量和Sat Scan分析分别用于识别热点地区和显著聚集区。为确定显著因素，采用p值<0.05。
12至35个月大儿童的零剂次疫苗接种状态患病率为16.3%（95%置信区间，15%-17.6%）。埃塞俄比亚零剂次疫苗接种状态在该地区并非随机分布（莫兰指数值=0.4，p<0.001）。埃塞俄比亚零剂次疫苗接种状态的热点地区位于阿法尔州、索马里州和南方各族州。主要聚集区位于索马里州北纬5.479641度、东经42.196835度，半径405.96公里范围内。在家分娩对零剂次疫苗接种状态的影响最大（β，0.23 - 0.24），在阿法尔州、索马里州和提格雷州观察到，而在家分娩影响最小（β，0.21 - 0.22）的是在南方各族州、甘贝拉州和本尚古勒-古穆兹州西部。此外，贫困财富指数对南方各族州、本尚古勒-古穆兹州和甘贝拉地区的零剂次疫苗接种状态影响最大（β，0.06 - 0.07），而在索马里州和阿法尔州贫困财富指数的影响最小（β，0.03 - 0.04）。
埃塞俄比亚的零剂次疫苗接种儿童比例较低。从地理上看，儿童零剂次疫苗接种状态比例最高的是索马里州和阿法尔州。在家分娩对阿法尔州、索马里州和提格雷州的零剂次疫苗接种状态有最高且最显著的影响。此外，贫困财富指数在索马里州和阿法尔州有最高且最显著的影响。建议在埃塞俄比亚扩大医疗机构分娩服务并增强妇女经济权能以改善疫苗接种情况。
