Peer-reviewed article
Inequities and trends of polio immunisation among children aged 12–23 months in Ethiopia: a multilevel analysis of Ethiopian demographic and health survey
Hailu Fekadu Demissie, Wubegzier Mekonnen, Aynalem Adugna, Helmut Kloos, Damen Haile Mariam ·
Summary
Written by AI, not yet AICS's view · claude-haiku-4-5-20251001This study analysed polio immunisation coverage among Ethiopian children aged 12-23 months across five surveys between 2000 and 2019. While coverage increased from 35% to 60% over 19 years, significant inequities persisted based on wealth, maternal education, urban-rural residence, and region. Even in 2019, 40% of children remained unvaccinated, with the richest families 20 percentage points more likely to vaccinate than the poorest across most years.
Key points
- Polio immunisation coverage in Ethiopia increased from 34.5% in 2000 to 60.0% in 2019
- A persistent 20 percentage point gap in coverage existed between the wealthiest and poorest quintiles across most survey years
- The regional gap between Addis Ababa and Afar Region decreased from 74 percentage points (2000) to 60 percentage points (2019)
- If wealth-driven inequity had been eliminated in 2011, national coverage could have improved by 36 percentage points
- Individual factors including wealth index, maternal education, antenatal care and place of delivery were significant determinants of immunisation status
Limitations
This is a secondary analysis of survey data and cannot explain the underlying causes of inequities or test interventions to reduce them. The cross-sectional nature of the data means causality cannot be established.
Abstract
INTRODUCTION: Despite Ethiopia's policy intention to provide recommended vaccination services to underprivileged populations, inequity in polio immunisation persists. OBJECTIVE: This study examined inequity and trends in polio immunisation and determinant factors among children aged 12-23 months in Ethiopia between 2000 and 2019. METHODS: Cross-sectional data from 2000, 2005, 2011, 2016 and 2019 Ethiopian demographic and health surveys were analysed with the updated version of the WHO's Health Equity Assessment Toolkit software. Six standard equity measures: equity gaps, equity ratios, population attributable risk, population attributable fraction, slope index of inequality and relative index of inequality were used. Datasets were analysed and disaggregated by the five equality stratifiers: economic status, education, place of residence, sex of the child and regions. Multilevel logistic regression analysis was used to identify determinant factors. RESULTS: Polio immunisation coverage was increased from 34.5% (2000) to 60.0% (2019). The wealth index-related inequity, in coverage of polio immunisation between quintiles 5 and 1, was 20 percentage points for most surveys. The population attributable risk and population attributable fraction measure in 2011 indicate that the national polio immunisation coverage in that year could have been improved by nearly 36 and 81 percentage points, respectively, if absolute and relative wealth-driven inequity, respectively, had been avoided. The absolute difference between Addis Ababa and Afar Region was 74 percentage points in 2000 and 60 percentage points in 2019. In multilevel analysis result, individual-level factors like wealth index, maternal education antenatal care and place of delivery showed statistical significance. CONCLUSION: Although polio immunisation coverage gradually increased over time, in the 20-year survey periods, still 40% of children remained unvaccinated. Inequities in coverage by wealth, educational status, urban-rural residence and administrative regions persisted. Increasing service coverage and improving equitable access to immunisations services may narrow the existing inequity gaps.