Peer-reviewed article
Zero-dose childhood vaccination and associated factors in Ethiopia: A systematic review and meta-analysis
Molalign Aligaz Adisu, Abraham Dessie Gessesse, Yabibal Asfaw Derso, Tesfaye Engdaw Habtie ·
Summary
Written by AI, not yet AICS's view · claude-sonnet-5This study combined data from 14 research papers to estimate how many Ethiopian children have received no vaccinations at all, known as 'zero-dose' children. It found that about one in five children (22.29%) had not received any vaccines. Several factors were linked to higher rates of zero-dose children, including mothers with no education, single mothers, low household wealth, living in rural areas, giving birth at home, and not attending antenatal or postnatal care visits. The authors say better maternal health services and outreach vaccination programs are needed to close this gap.
Key points
- Pooled prevalence of zero-dose vaccination among Ethiopian children was 22.29% (95% CI: 16.37%–28.20%)
- Home delivery was the strongest associated factor (AOR: 3.91, 95% CI: 1.81–6.01)
- Poor maternal knowledge of vaccine-preventable diseases was linked to higher zero-dose rates (AOR: 2.79)
- Low household wealth index increased odds of zero-dose vaccination (AOR: 2.25)
- Rural residence, having a single mother, and low antenatal/postnatal care use were all significantly associated with zero-dose status
Limitations
This is an observational meta-analysis showing associations, not proof that these factors cause low vaccination; it also does not test or evaluate any specific program to fix the problem.
Abstract
Background Globally, 14 million children are zero-dose, with Ethiopia accounting for approximately 5% of that burden. This study aims to provide national estimates of the pooled prevalence and factors associated with zero-dose vaccination among Ethiopian children. Methods A systematic review and meta-analysis were conducted following PRISMA guidelines using multiple databases and grey literature. Observational studies published from 2019 to March 2026 were included. A total of 14 studies met the inclusion criteria. Quality was assessed using the Joanna Briggs Institute criteria. A random-effects model was used to pool prevalence and adjusted odds ratios (AORs) using STATA. Heterogeneity was evaluated with I 2 statistics, and publication bias was assessed using funnel plots and Egger's test. Results The pooled prevalence of zero-dose vaccination was 22.29% (95% CI: 16.37%–28.20%). Significant associated factors included: children of uneducated mothers (AOR: 1.61, 95% CI: 1.28–1.95), Single mothers (AOR: 2.19, 95% CI: 1.55–2.84), less than four ANC visits (AOR: 1.58, 95% CI: 1.22–1.94), no PNC visit (AOR: 2.04, 95% CI: 1.41–2.67), low household wealth index (AOR: 2.25, 95% CI: 1.69–2.81), rural residence (AOR: 2.02, 95% CI: 1.08–2.96), poor maternal knowledge of vaccine-preventable diseases (AOR: 2.79, 95% CI: 1.74–3.84), and home delivery (AOR: 3.91, 95% CI: 1.81–6.01). Conclusion Approximately one in five Ethiopian children is zero-dose, representing a major public health burden. Key determinants include low maternal education, marital status, limited use of Antenatal and postnatal care services, low household wealth, rural residence, home delivery, and poor maternal knowledge. Strengthening maternal health services, community-based health education, and expanding outreach and mobile vaccination programs are essential to reduce this burden.