Spatial distribution and associated factors of zero-dose immunization among 12-23 month-old children in Ethiopia: spatial and survey regression analysis.

BACKGROUND

Immunization is one of the public health interventions, saving millions of lives. Despite this, many children, especially those living in low- and middle-income countries, continue to miss out on lifesaving vaccines, the worst of which is zero-dosage. It is crucial to identify individuals and obtain timely, reliable information on their geographic distribution and related attributes to support spatially tailored strategies and interventions. Undoubtedly, assessing zero-dose prevalence is an input to achieve the WHO's 2030 agenda, which attempts to reduce the number of zero-dose children. Hence, this study aimed to determine the prevalence, spatial distribution and associated factors of zero-dose immunization among children in Ethiopia.

METHODS

A secondary analysis of the Ethiopian mini demographic and health survey 2019 data was conducted. Our analysis focused on zero-dose immunization among children aged 12-23 months. Geographic variations in zero-dose prevalence were assessed using spatial analysis techniques, including Moran's I statistic and inverse distance weighted interpolation. Bivariable and multivariable survey logistic regression models were used to identify factors associated with zero-dose immunization.

RESULTS

A total of 1008 children aged 12 to 23 months old were retained for the final analysis. The overall weighted prevalence of zero-dose immunization status at national level in Ethiopia was 23.7% [95% CI: 18.7-28.5]. Hot spots of zero-dose immunization were observed in southwest and northeast part of Ethiopia whereas cold spots of zero-dose immunization were observed in the central and northern parts of the country. Rural resident children [AOR = 2.55; 95%CI: 1.05, 6.22], female children (AOR = 1.78; 95%CI: 1.09, 2.91), children not delivered at the health institution (AOR = 4.12; 95% CI: 2.39, 7.08), and children from a mother did not completed four or more ANC visits (AOR = 2.55; 95% CI: 1.37, 4.75) were more likely to be zero-dose as compared to their counter parts.

CONCLUSION

There is high prevalence of children being zero-dose among 12-23 months old children in Ethiopia. Interventions tailored on geographic areas, residence, sex of the child, four or more ANC visits and institutional delivery could help to reduce zero-dose children in Ethiopia.