Bogale Biruk, Tiruneh Gizachew Tadele, Belete Netsanet, Hunegnaw Bezawit Mesfin, Fesseha Nebreed, Zergaw Tsegaye Shewangzaw, Tadesse Hillina, Yeshiwas Takele, Meseret Hana, Emaway Dessalew
JSI, Addis Ababa, Ethiopia.
BMC Public Health. 2025 May 7;25(1):1693. doi: 10.1186/s12889-025-22837-7.
Despite the proven effectiveness of vaccination in improving child health and well-being, millions of children remain unvaccinated globally. Ethiopia has increased child vaccination coverage by threefold in the last decades. However, it is one of the top contributors to zero-dose and unimmunized children in Africa. Thus, we examined risk factors associated with zero-dose, under-immunization, and the number of vaccination doses received by children in Ethiopia.
A cross-sectional household survey was conducted as part of the formative assessment for the Strengthening Service Delivery (SSD) project from July to August 2024. A stratified two-stage sampling was employed to recruit 1,368 mothers of children aged 12-23 months from agrarian and pastoral regions of Ethiopia. A multilevel negative binomial model was then fitted to estimate associations between individual- and community-level independent variables and the number of vaccine doses received. Adjusted incidence rate ratios (AIRR) with 95% CI were reported to declare the associations.
About 14% of children did not receive any vaccinations, and 62% were under-immunized, with significant regional disparities: 9% of children in agrarian regions versus 69% in the pastoral areas received no vaccinations, while 60% of children in agrarian regions were under-immunized compared to 92% in the pastoral areas. Mothers attended higher education (AIRR = 1.20; 95% CI [1.01-1.42]), household wealth status of rich (AIRR = 1.39; 95% CI: [1.16-1.67]) and middle class (AIRR = 1.32; 95% CI: [1.09-1.61]), previous history of facility delivery (AIRR = 1.57; 95% CI: [1.35-1.83]) and home visit by community health workers (CHW) during pregnancy (AIRR = 1.32; 95% CI: [1.15-1.52]) and having any under 5 children with vaccination card (AIRR = 2.45; 95% CI: [2.08-2.90]) increased the likelihood of receiving vaccinations. However, children from the pastoral region (AIRR = 0.40; 95% CI: [0.29-0.54]) were less likely to receive higher vaccination doses.
Our study highlighted individual and community-level factors associated with the number of vaccination doses children received in Ethiopia. To address zero-dose and under-immunized children in Ethiopia, contextualized intervention focusing on the pastoral and vulnerable population is needed. Moreover, strengthening the health system and expanding healthcare access in the underserved population could help improve child vaccination.
尽管疫苗接种在改善儿童健康和福祉方面已被证明有效，但全球仍有数百万儿童未接种疫苗。埃塞俄比亚在过去几十年中将儿童疫苗接种覆盖率提高了两倍。然而，该国是非洲未接种首剂疫苗和未免疫儿童的主要来源国之一。因此，我们研究了与埃塞俄比亚儿童零剂次接种、免疫不足以及接种疫苗剂量数量相关的风险因素。
作为2024年7月至8月加强服务提供（SSD）项目形成性评估的一部分，开展了一项横断面家庭调查。采用分层两阶段抽样方法，从埃塞俄比亚农业和牧区招募了1368名12至23个月大儿童的母亲。然后拟合一个多级负二项式模型，以估计个体和社区层面的自变量与接种疫苗剂量数量之间的关联。报告了具有95%置信区间的调整发病率比（AIRR）以说明这些关联。
约14%的儿童未接种任何疫苗，62%的儿童免疫不足，存在显著的地区差异：农业地区9%的儿童未接种疫苗，而牧区这一比例为69%；农业地区60%的儿童免疫不足，而牧区为92%。母亲接受过高等教育（AIRR = 1.20；95%置信区间[1.01 - 1.42]）、家庭富裕（AIRR = 1.39；95%置信区间：[1.16 - 1.67]）和中等收入阶层（AIRR = 1.32；95%置信区间：[1.09 - 1.61]）、既往有在医疗机构分娩史（AIRR = 1.57；95%置信区间：[1.35 - 1.83]）以及孕期社区卫生工作者（CHW）进行家访（AIRR = 1.32；95%置信区间：[1.15 - 1.52]）和家中有任何5岁以下儿童持有疫苗接种卡（AIRR = 2.45；95%置信区间：[2.08 - 2.90]）会增加接种疫苗的可能性。然而，牧区的儿童（AIRR = 0.40；95%置信区间：[0.29 - 0.54]）接种更高剂量疫苗的可能性较小。
我们的研究强调了与埃塞俄比亚儿童接种疫苗剂量数量相关的个体和社区层面因素。为了解决埃塞俄比亚的零剂次接种和免疫不足儿童问题，需要针对牧区和弱势群体进行因地制宜的干预。此外，加强卫生系统并扩大服务不足人群的医疗保健可及性有助于改善儿童疫苗接种情况。
