Abstract
BackgroundIn Ethiopia, despite the considerable improvement in immunization coverage, the burden of defaulting from immunization among children is still high with marked variation among regions. However, the geographical variation and contextual factors of defaulting from immunization were poorly understood. Hence, this study aimed to identify the spatial pattern and associated factors of defaulting from immunization.MethodsAn in-depth analysis of the 2016 Ethiopian Demographic and Health Survey (EDHS 2016) data was used. A total of 1638 children nested in 552 enumeration areas (EAs) were included in the analysis. Global Moran’s I statistic and Bernoulli purely spatial scan statistics were employed to identify geographical patterns and detect spatial clusters of defaulting immunization, respectively. Multilevel logistic regression models were fitted to identify factors associated with defaulting immunization. A p value < 0.05 was used to identify significantly associated factors with defaulting of child immunization.ResultsA spatial heterogeneity of defaulting from immunization was observed (Global Moran’s I = 0.386379, p value < 0.001), and four significant SaTScan clusters of areas with high defaulting from immunization were detected. The most likely primary SaTScan cluster was seen in the Somali region, and secondary clusters were detected in (Afar, South Nation Nationality of people (SNNP), Oromiya, Amhara, and Gambella) regions. In the final model of the multilevel analysis, individual and community level factors accounted for 56.4% of the variance in the odds of defaulting immunization. Children from mothers who had no formal education (AOR = 4.23; 95% CI: 117, 15.78), and children living in Afar, Oromiya, Somali, SNNP, Gambella, and Harari regions had higher odds of having defaulted immunization from community level.ConclusionsA clustered pattern of areas with high default of immunization was observed in Ethiopia. Both the individual and community-level characteristics were statistically significant factors of defaulting immunization. Therefore, the Federal Ethiopian Ministry of Health should prioritize the areas with defaulting of immunization and consider the identified factors for immunization interventions.
Highlights
In Ethiopia, despite the considerable improvement in immunization coverage, the burden of defaulting from immunization among children is still high with marked variation among regions
A clustered pattern of areas with high default of immunization was observed in Ethiopia
The Federal Ethiopian Ministry of Health should prioritize the areas with defaulting of immunization and consider the identified factors for immunization interventions
Summary
In Ethiopia, despite the considerable improvement in immunization coverage, the burden of defaulting from immunization among children is still high with marked variation among regions. Besides the attainment of high coverage of vaccines, receiving complete immunization under 1 year of age is essential to reduce vaccine-preventable diseases among children. It is vital for achieving the Sustainable Development Goals, poverty reduction, and universal health coverage [3]. 19.4 million children (14%) were not fully vaccinated in 2018, and among them, 13.5 million (70%) did not receive any diphtheria, tetanus, and pertussis (DTP) doses in low-income countries, which is a principal indicator of immunization performance [4]. An estimated 5 million children died each year worldwide [5], nearly 199,000 deaths caused by Haemophilus Influenza type b (Hib), 195,000 by pertussis, 118,000 by measles, 59,000 by neonatal tetanus, 476,000 by pneumococcal disease, and 453,000 by rotavirus [6, 7]
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