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

Abstract

Background: Ethiopia 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.

Methods: Full 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.

Results: Full 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.

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. Targeted programmes to reach under-immunised children in these subpopulations will improve vaccination coverage and equity outcomes in Ethiopia.

Keywords: Demographic and health survey; Ethiopia; Immunisation coverage; Vaccine equity.

Fig. 1

Vaccination coverage in Ethiopia among children aged 12–23 months by socioeconomic, geographic, maternal,and child characteristics. Full vaccination coverage (1-dose BCG, 3-dose DTP3-HepB-Hib, 3-dose polio, 1-dose measles (MCV1), 3-dose PCV3, and 2-dose rotavirus vaccines) in Ethiopia among children aged 12–23 months 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.

Fig. 2

Vaccination coverage in Ethiopia among children aged 12–23 months at the regional level. Full vaccination coverage (1-dose BCG, 3-dose DTP3-HepB-Hib, 3-dose polio, 1-dose measles (MCV1), 3-dose PCV3, and 2-dose rotavirus vaccines) in Ethiopia among children aged 12–23 months in the nine regions and two chartered cities of Ethiopia.

Fig. 3

Wealth related inequity in vaccination coverage in Ethiopia. Concentration curve for full vaccination coverage (1-dose BCG, 3-dose DTP3-HepB-Hib, 3-dose polio, 1-dose measles (MCV1), 3-dose PCV3, and 2-dose rotavirus vaccines) in children aged 12–23 months by household wealth in Ethiopia.

Fig. 4

Inequities in vaccination coverage in Ethiopia associated with socioeconomic, geographic, maternal, and child characteristics. Inequities in full vaccination coverage (1-dose BCG, 3-dose DTP3-HepB-Hib, 3-dose polio, 1-dose measles (MCV1), 3-dose PCV3, and 2-dose rotavirus vaccines) among children aged 12–23 months associated with socioeconomic (household wealth), geographic (area of residence, region), maternal (maternal age at birth, maternal education, sex of household head), and child (sex of child, birth order) characteristics, based on multiple logistic regression estimates of adjusted odds ratios.