Alemu Samrawit Birhanu, Belay Daniel Gashaneh, Belay Aynalem, Alemu Melaku Birhanu
Public Health, Debre Markos University, Debre Markos, Ethiopia.
Department of Epidemiology and Biostatistics, University of Gondar, Gondar, Ethiopia.
BMJ Public Health. 2025 May 26;3(1):e002255. doi: 10.1136/bmjph-2024-002255. eCollection 2025.
Child immunisation is a cost-effective strategy to reduce vaccine-preventable diseases. While effective coverage is key to ensuring quality immunisation, little is known about its geographical distribution in Ethiopia. This study aims to assess the spatial distribution of effective coverage of child immunisation and identify areas with low coverage to inform targeted interventions.
We used the 2019 Ethiopia Mini Demographic and Health Survey and Ethiopia Service Provision Assessment datasets. After calculating the effective coverage of immunisation, Bayesian model-based geostatistics were employed to assess the spatial distribution of effective immunisation coverage in Ethiopia, using relevant covariates to estimate coverage rates across regions.
The national effective coverage of immunisation was 34% (95% CI: 31.9% to 36.5%), with significant regional variation. Addis Ababa, western Benishangul-Gumuz, Dire Dawa city administrative, the northern part of South West Ethiopia and the northwest part of Amhara had hotspots for high level of effective coverage of child immunisation. On the other hand, central Amhara, northern Gambela, central Oromia, Sidama, northern Southern Nations, Nationalities and Peoples regions (SNNPR) and Somali had low effective coverage of child immunisation. Travel time to the nearest city (-0.292: 95% CI:-0.533 to -0.052) was found to be negative predictor of spatial distribution.
There were significant geographical variations in the effective coverage of immunisation services in Ethiopia. Travel time to nearest city was a significant predictor of spatial distribution. Policymakers are advised to prioritise underserved areas and improve spatial predictors to have a safe, effective and life-saving vaccination program in Ethiopia.
儿童免疫接种是减少疫苗可预防疾病的一项具有成本效益的策略。虽然有效覆盖率是确保高质量免疫接种的关键，但对于其在埃塞俄比亚的地理分布却知之甚少。本研究旨在评估儿童免疫接种有效覆盖率的空间分布，并确定覆盖率较低的地区，以为有针对性的干预措施提供依据。
我们使用了2019年埃塞俄比亚微型人口与健康调查以及埃塞俄比亚服务提供评估数据集。在计算免疫接种的有效覆盖率后，采用基于贝叶斯模型的地统计学方法来评估埃塞俄比亚免疫接种有效覆盖率的空间分布，并使用相关协变量来估计各地区的覆盖率。
全国免疫接种有效覆盖率为34%（95%置信区间：31.9%至36.5%），存在显著的地区差异。亚的斯亚贝巴、西部的本尚古勒-古穆兹、迪雷达瓦市行政区、埃塞俄比亚西南部北部以及阿姆哈拉西北部是儿童免疫接种有效覆盖率较高的热点地区。另一方面，阿姆哈拉中部地区、北部的甘贝拉、奥罗米亚中部、锡达马、南部各族州北部地区以及索马里的儿童免疫接种有效覆盖率较低。到最近城市的出行时间（-0.292：95%置信区间：-0.533至-0.052）被发现是空间分布的负预测因子。
埃塞俄比亚免疫接种服务的有效覆盖率存在显著的地理差异。到最近城市的出行时间是空间分布的一个重要预测因子。建议政策制定者优先考虑服务不足的地区，并改善空间预测因子，以便在埃塞俄比亚实施安全、有效且能挽救生命的疫苗接种计划。
