Childhood vaccination coverage and equity impact in Ethiopia by socioeconomic, geographic, maternal and child characteristics

Abstract

AbstractBackgroundEthiopia 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 aims to analyse basic vaccination coverage among children in Ethiopia and to estimate the equity impact by socioeconomic, geographic, maternal and child characteristics based on data from the Ethiopia Demographic and Health Survey 2016.MethodsBasic vaccination coverage (1-dose BCG, 3-doses DPT-HepB-Hib, 3-doses polio, 1-dose measles vaccine) 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 assessed wealth and education-related inequalities. Multiple logistic regression estimated associations between basic vaccination coverage and socioeconomic, maternal and child characteristics.ResultsNational coverage for basic vaccinations was 39.7% in 2016. Single vaccination coverage ranged between between 53.2% (DTP3) and 69.2% (BCG). Wealth and maternal education related inequities were present for all vaccines. Children from richer households, urban regions, primary maternal education and male headed households were associated with higher vaccination coverage. The Ethiopia Mini Demographic and Health Survey 2019 reports national coverage for basic vaccinations at 43.3% with single vaccination coverage ranging between 57.8% (measles) and 74.2% (BCG).ConclusionsVaccination coverage has improved from 2016 to 2019, but remains below the coverage goals of the EPI. Low vaccination coverage is associated with poorer households, rural regions of Afar and Somali, no maternal education and female headed households. Targeted approaches are necessary to improve vaccination coverage among these population subgroups and equitable uptake of vaccines in Ethiopia.