Muchie Kindie Fentahun, Azene Abebaw Gedef, Bogale Kassawmar Angaw, Asmamaw Desale Bihonegn, Negash Wubshet Debebe, Belachew Tadele Biresaw, Tarekegn Bethelihem Tigabu, Terefe Bewuketu, Bantie Getasew Mulat, Eshetu Habitu Birhan, Wassie Gizachew Tadesse
Department of Epidemiology and Biostatistics, School of Public Health, College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia.
Department of Infectious Disease and Tropical Medicine, Heidelberg University Hospital, Heidelberg, Germany.
BMC Pediatr. 2025 Jul 14;25(1):552. doi: 10.1186/s12887-025-05900-5.
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.
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.
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.
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.
免疫接种是公共卫生干预措施之一，挽救了数百万人的生命。尽管如此，许多儿童，尤其是生活在低收入和中等收入国家的儿童，仍然无法获得挽救生命的疫苗，其中最严重的情况是零剂次接种。识别个体并及时获取有关其地理分布和相关属性的可靠信息，对于支持因地制宜的策略和干预措施至关重要。毫无疑问，评估零剂次接种率是实现世界卫生组织2030年议程的一项投入，该议程旨在减少零剂次儿童的数量。因此，本研究旨在确定埃塞俄比亚儿童零剂次免疫接种的患病率、空间分布及相关因素。
对2019年埃塞俄比亚小型人口与健康调查数据进行二次分析。我们的分析重点是12至23个月大儿童的零剂次免疫接种情况。使用空间分析技术评估零剂次接种率的地理差异，包括莫兰指数（Moran's I statistic）和反距离加权插值法。采用双变量和多变量调查逻辑回归模型来识别与零剂次免疫接种相关的因素。
最终分析共纳入1008名12至23个月大的儿童。埃塞俄比亚全国范围内零剂次免疫接种状态的总体加权患病率为23.7%[95%置信区间：18.7 - 28.5]。在埃塞俄比亚西南部和东北部观察到零剂次免疫接种的热点地区，而在该国中部和北部观察到零剂次免疫接种的冷点地区。农村常住儿童（调整后比值比[AOR]=2.55；95%置信区间：1.05, 6.22）、女童（AOR = 1.78；95%置信区间：1.09, 2.91）、未在医疗机构出生的儿童（AOR = 4.12；95%置信区间：2.39, 7.08）以及母亲产前检查次数未达到四次或更多次的儿童（AOR = 2.55；95%置信区间：1.37, 4.75）相比其对应人群更有可能为零剂次接种。
埃塞俄比亚12至23个月大儿童中零剂次接种的患病率较高。针对地理区域、居住地、儿童性别、四次或更多次产前检查以及机构分娩情况制定的干预措施，可能有助于减少埃塞俄比亚的零剂次儿童数量。
