Abstract
BackgroundEthiopia is a priority country of Gavi, the Vaccine Alliance to improve vaccination coverage and equitable uptake. The Ethiopian National Expanded Programme on Immunisation (EPI) and the Global Vaccine Action Plan set coverage goals of 90% at national level and 80% at district level by 2020. This study analyses full vaccination coverage among children in Ethiopia and estimates the equity impact by socioeconomic, geographic, maternal and child characteristics based on the 2016 Ethiopia Demographic and Health Survey dataset. MethodsFull vaccination coverage (1-dose BCG, 3-dose DTP3-HepB-Hib, 3-dose polio, 1-dose measles (MCV1), 3-dose pneumococcal (PCV3), and 2-dose rotavirus vaccines) of 2,004 children aged 12–23 months was analysed. Mean coverage was disaggregated by socioeconomic (household wealth, religion, ethnicity), geographic (area of residence, region), maternal (maternal age at birth, maternal education, maternal marital status, sex of household head), and child (sex of child, birth order) characteristics. Concentration indices estimated wealth and education-related inequities, and multiple logistic regression assessed associations between full vaccination coverage and socioeconomic, geographic, maternal, and child characteristics. ResultsFull vaccination coverage was 33.3% [29.4–37.2] in 2016. Single vaccination coverage ranged from 49.1% [45.1–53.1] for PCV3 to 69.2% [65.5–72.8] for BCG. Wealth and maternal education related inequities were pronounced with concentration indices of 0.30 and 0.23 respectively. Children in Addis Ababa and Dire Dawa were seven times more likely to have full vaccination compared to children living in the Afar region. Children in female-headed households were 49% less likely to have full vaccination. ConclusionVaccination coverage in Ethiopia has a pro-advantaged regressive distribution with respect to both household wealth and maternal education. Children from poorer households, rural regions of Afar and Somali, no maternal education, and female-headed households had lower full vaccination coverage. Targeted programmes to reach under-immunised children in these subpopulations will improve vaccination coverage and equity outcomes in Ethiopia.
Highlights
Ethiopia had a total population of 109 million with gross national income per capita of US$ 790 in 2018 [1]
Our aim is to analyse full vaccination coverage among children in Ethiopia and to estimate the equity impact by socioeconomic, geographic, maternal, and child characteristics based on the Ethiopia Demographic and Health Survey 2016 dataset
Vaccination coverage for other single vaccines ranged from 49.1% [45.1– 53.1] for PCV3 to 69.2% [65.5–72.8] for Bacille Calmette-Guérin (BCG) vaccine
Summary
Ethiopia had a total population of 109 million with gross national income per capita of US$ 790 in 2018 [1]. Children under the age of 5 years constitute 14.9% of the total population, with an infant mortality rate of 41 per 1000 live births and under-five. At present 19.4 million children under the age of one year do not receive basic vaccines, 60% of whom live in Angola, Brazil, Congo, Ethiopia, India, Indonesia, Nigeria, Pakistan, Philippines, and Vietnam [7]. Concentration indices estimated wealth and education-related inequities, and multiple logistic regression assessed associations between full vaccination coverage and socioeconomic, geographic, maternal, and child characteristics. Conclusion: Vaccination coverage in Ethiopia has a pro-advantaged regressive distribution with respect to both household wealth and maternal education. Children from poorer households, rural regions of Afar and Somali, no maternal education, and female-headed households had lower full vaccination coverage.
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