Spatial distribution and associated factors of zero-dose immunization among 12–23 month-old children in Ethiopia: spatial and survey regression analysis
Abstract 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 in...
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2025-07-01
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| Online Access: | https://doi.org/10.1186/s12887-025-05900-5 |
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| author | Kindie Fentahun Muchie Abebaw Gedef Azene Kassawmar Angaw Bogale Desale Bihonegn Asmamaw Wubshet Debebe Negash Tadele Biresaw Belachew Bethelihem Tigabu Tarekegn Bewuketu Terefe Getasew Mulat Bantie Habitu Birhan Eshetu Gizachew Tadesse Wassie |
| author_facet | Kindie Fentahun Muchie Abebaw Gedef Azene Kassawmar Angaw Bogale Desale Bihonegn Asmamaw Wubshet Debebe Negash Tadele Biresaw Belachew Bethelihem Tigabu Tarekegn Bewuketu Terefe Getasew Mulat Bantie Habitu Birhan Eshetu Gizachew Tadesse Wassie |
| author_sort | Kindie Fentahun Muchie |
| collection | DOAJ |
| description | Abstract 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. |
| format | Article |
| id | doaj-art-ad89d669e2244bfe955e6aa5244f55a2 |
| institution | Kabale University |
| issn | 1471-2431 |
| language | English |
| publishDate | 2025-07-01 |
| publisher | BMC |
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| series | BMC Pediatrics |
| spelling | doaj-art-ad89d669e2244bfe955e6aa5244f55a22025-08-20T03:42:10ZengBMCBMC Pediatrics1471-24312025-07-0125111110.1186/s12887-025-05900-5Spatial distribution and associated factors of zero-dose immunization among 12–23 month-old children in Ethiopia: spatial and survey regression analysisKindie Fentahun Muchie0Abebaw Gedef Azene1Kassawmar Angaw Bogale2Desale Bihonegn Asmamaw3Wubshet Debebe Negash4Tadele Biresaw Belachew5Bethelihem Tigabu Tarekegn6Bewuketu Terefe7Getasew Mulat Bantie8Habitu Birhan Eshetu9Gizachew Tadesse Wassie10Department of Epidemiology and Biostatistics, School of Public Health, College of Medicine and Health Sciences, Bahir Dar UniversityDepartment of Epidemiology and Biostatistics, School of Public Health, College of Medicine and Health Sciences, Bahir Dar UniversityDepartment of Epidemiology and Biostatistics, School of Public Health, College of Medicine and Health Sciences, Bahir Dar UniversityDepartment of Reproductive Health, Institute of Public Health, College of Medicine and Health Sciences, University of GondarDepartment of Health Systems and Policy, Institute of Public Health, College of Medicine and Health Sciences, University of GondarDepartment of Health Systems and Policy, Institute of Public Health, College of Medicine and Health Sciences, University of GondarDepartment of Pediatrics and Child Health Nursing, School of Nursing, College of Medicine and Health Sciences, University of GondarDepartment of Community Health Nursing, School of Nursing, College of Medicine and Health Sciences, University of GondarAmhara National Regional State Public Health InstituteDepartment of Health Promotion and Health Behavior, Institute of Public Health, College of Medicine and Health Sciences, University of GondarDepartment of Epidemiology and Biostatistics, School of Public Health, College of Medicine and Health Sciences, Bahir Dar UniversityAbstract 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.https://doi.org/10.1186/s12887-025-05900-5Zero-doseImmunizationPrevalenceSpatial distributionAssociated factorsSurvey regression |
| spellingShingle | Kindie Fentahun Muchie Abebaw Gedef Azene Kassawmar Angaw Bogale Desale Bihonegn Asmamaw Wubshet Debebe Negash Tadele Biresaw Belachew Bethelihem Tigabu Tarekegn Bewuketu Terefe Getasew Mulat Bantie Habitu Birhan Eshetu Gizachew Tadesse Wassie Spatial distribution and associated factors of zero-dose immunization among 12–23 month-old children in Ethiopia: spatial and survey regression analysis BMC Pediatrics Zero-dose Immunization Prevalence Spatial distribution Associated factors Survey regression |
| title | Spatial distribution and associated factors of zero-dose immunization among 12–23 month-old children in Ethiopia: spatial and survey regression analysis |
| title_full | Spatial distribution and associated factors of zero-dose immunization among 12–23 month-old children in Ethiopia: spatial and survey regression analysis |
| title_fullStr | Spatial distribution and associated factors of zero-dose immunization among 12–23 month-old children in Ethiopia: spatial and survey regression analysis |
| title_full_unstemmed | Spatial distribution and associated factors of zero-dose immunization among 12–23 month-old children in Ethiopia: spatial and survey regression analysis |
| title_short | Spatial distribution and associated factors of zero-dose immunization among 12–23 month-old children in Ethiopia: spatial and survey regression analysis |
| title_sort | spatial distribution and associated factors of zero dose immunization among 12 23 month old children in ethiopia spatial and survey regression analysis |
| topic | Zero-dose Immunization Prevalence Spatial distribution Associated factors Survey regression |
| url | https://doi.org/10.1186/s12887-025-05900-5 |
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