Peer-reviewed article
Urban-rural disparities in immunization coverage among children aged 12–23 months in Ethiopia: multivariate decomposition analysis
Melash Belachew Asresie, Gedefaw Abeje Fekadu, Gizachew Worku Dagnew ·
Summary
Written by AI, not yet AICS's view · claude-haiku-4-5-20251001This study analyzed data from Ethiopia's 2019 demographic and health survey to understand why immunization coverage differs between urban and rural areas among children aged 12-23 months. Urban children had much higher full immunization coverage (65%) compared to rural children (37%). The disparity was driven by differences in how maternal healthcare use, household wealth, family size, and access to immunization records affected immunization outcomes across urban and rural settings.
Key points
- Full immunization coverage was 64.59% in urban areas versus 36.84% in rural areas
- Antenatal care visits, facility delivery, and having vaccination cards significantly widened the urban-rural gap
- High household wealth status, postnatal care, and having four or more children significantly narrowed the disparity
- The disparity was mainly driven by differences in how population characteristics affected immunization outcomes, not by differences in who lived in each area
- Strengthening maternal health services, maintaining immunization records, and reducing economic inequality are key to narrowing the gap
Limitations
The study used cross-sectional data from a single time point (2019), which cannot establish causality or track changes over time. The analysis does not explore other potential barriers such as vaccine supply, healthcare worker availability, or cultural factors that may differ between urban and rural areas.
Abstract
BACKGROUND: Immunization is one of the most cost-effective public health interventions for improving children's health and survival. In Ethiopia, low immunization coverage and disparity across residences are major public health problems. However, the factors that contributed to the urban-rural disparity have not been thoroughly investigated. Therefore, the objective of this study was to examine the change and contributing factors in full immunization coverage across geographic locations (urban-rural) in Ethiopia. METHODS: We analyzed data on children aged 12 to 23 months obtained from the 2019 mini-Ethiopian demographic and health survey. A total of 996 weighted samples (299 in urban and 697 in rural areas) were included in the analysis. A multivariate decomposition analysis technique was used to determine the disparity and identify factors that contribute to the disparity across geographical locations. Statistical significance was defined at a 95% confidence interval with a p-value of less than 0.05. RESULTS: The percentage of children aged 12-23 months who received full immunization increased from 36.84% (95% CI:31.59, 42.41) in rural areas to 64.59% (95% CI:47.10, 78.89) in urban areas. The decomposition analysis showed that the observed urban-rural disparity was attributed to a change in the effect of population characteristics (coefficient) across residences. Specifically, receiving 1-3 (β = 0.0895, 95% CI: 0.0241, 0.1550) and 4 or more (β = 0.1212, 95% CI: 0.0224, 0.2199) antenatal care visits, delivering at a health facility (β = 0.1350, 95% CI: 0.0227, 0.2472), and the source of information about immunization status from vaccination cards (β = 0.2666, 95% CI:0.1763, 0.3569) significantly contributed to the widening urban-rural disparity. On the other hand, being of high wealth status (β=-0.141, 95% CI: -0.1945, -0.0876), receiving postnatal care (β=-0.0697, 95% CI: -0.1344, -0.0051), and having four or more living children (β=-0.1774, 95% CI: -0.2971, -0.0577) significantly contributed to narrowing the urban-rural disparity. CONCLUSIONS: There was a significant urban-rural disparity in immunization coverage in Ethiopia, with urban children more likely to complete immunization. The change in the composition of population characteristics was not significant for the observed disparity. The observed disparity in full immunization coverage was mainly driven by the coefficients related to maternal healthcare utilization, household wealth status, the number of living children, and the source of immunization information. Therefore, strengthening maternal health services utilization, encouraging mothers to maintain their children's immunization records, and addressing economic inequality, particularly in rural areas, may narrow the urban-rural disparity and enhance immunization coverage nationwide.