Peer-reviewed article
Childhood vaccination coverage and equity impact in Ethiopia by socioeconomic, geographic, maternal, and child characteristics
Anne Geweniger, Kaja Abbas ·
Summary
Written by AI, not yet AICS's view · claude-haiku-4-5-20251001This study examined childhood vaccination coverage in Ethiopia using data from 2,016 children aged 12-23 months. Full vaccination coverage was only 33.3%, with major gaps between wealthy and poor households, educated and uneducated mothers, and urban and rural regions. Children in poorer households, remote regions like Afar and Somali, and female-headed households were significantly less likely to be fully vaccinated. The findings show that vaccination inequity in Ethiopia strongly favours advantaged groups and suggests targeted programmes are needed to reach underimmunised populations.
Key points
- Full vaccination coverage was 33.3%, falling short of the national 90% target set by the Global Vaccine Action Plan
- Concentration indices of 0.30 for wealth and 0.23 for maternal education indicate strong pro-advantaged inequities
- Children in Addis Ababa and Dire Dawa were seven times more likely to be fully vaccinated than those in Afar region
- Children in female-headed households were 49% less likely to be fully vaccinated
- Single vaccine coverage ranged from 49.1% for PCV3 to 69.2% for BCG
Limitations
The study is cross-sectional based on 2016 survey data and cannot determine causation or track changes over time. It does not evaluate interventions or test solutions to address the identified inequities.
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.