Peer-reviewed article
Decomposition of Wealth-Related Inequalities in Childhood Zero-Dose Vaccination: Analysis of the 2016 Ethiopian Demographic and Health Survey.
Fisseha Shiferie, Anteneh Asefa, Samson Gebremedhin, Lenka Beňová ·
Summary
Written by AI, not yet AICS's view · claude-haiku-4-5-20251001This study analyzed data from Ethiopia's 2016 Demographic and Health Survey to understand why some children do not receive any vaccinations. The researchers found that 25.7% of children aged 12-23 months had received no routine vaccines, with much higher rates among poor families. Low household wealth and lack of antenatal care were the biggest reasons for these disparities. The study recommends expanding antenatal care, targeting poor and remote populations, and improving maternal education to increase vaccination coverage.
Key points
- 25.7% of children aged 12-23 months in the 2016 survey had received no routine vaccines (zero-dose status)
- Zero-dose children were disproportionately concentrated among poorer households (concentration index -0.15, P <0.001)
- Low household wealth accounted for 36.5% of the inequality, and lack of antenatal care for 33%
- Zero-dose prevalence was highest among mothers with no education, those with no antenatal care, home deliveries, and those in rural or pastoralist areas
- Religion (22.3%), place of childbirth (10.2%), and maternal education (5.9%) also contributed to inequalities
Limitations
This is a secondary analysis of cross-sectional survey data from 2016, so it cannot establish causation or identify barriers to vaccination at the individual level. The analysis does not evaluate any intervention, only describes existing patterns and their associations.
Abstract
Vaccination prevents 3.5-5 million deaths annually, yet inequities persist within low- and middle-income countries, including Ethiopia. Zero-dose children, those who have not received any routine vaccines, are often found in the poorest and most marginalized communities. In 2019, 16.3% of Ethiopian children aged 12-35 months were zero-dose, highlighting persistent wealth-related disparities. The aim for the present study was to examine wealth-related inequalities in zero-dose status among Ethiopian children aged 12-23 months and identify key contributing factors. A secondary analysis of the 2016 Ethiopian Demographic and Health Survey was conducted, including 1,890 children aged 12-23 months. Zero-dose status was defined as not receiving the first dose of a diphtheria-, tetanus-, and pertussis-containing vaccine. Wealth-related inequality was measured using the Erreygers corrected concentration index (CnI), and contributing factors were assessed using Wagstaff decomposition analysis. Overall, 25.7% of children were zero-dose, with the highest prevalence among those whose mothers had no education, received no antenatal care (ANC), delivered at home, or lived in rural or pastoralist areas. The CnI (-0.15; P <0.001) indicated that zero-dose children were disproportionately concentrated among poorer households. Low household wealth (36.5%) and a lack of ANC (33%) were the main contributors to inequality, followed by religion (22.3%), place of childbirth (10.2%), and maternal education (5.9%). Substantial wealth-based inequalities in zero-dose vaccination persist in Ethiopia. Expanding ANC coverage, prioritizing the poorest and most underserved populations through targeted outreach, and strengthening maternal education are essential to advancing immunization equity and achieving national and global immunization goals.