Geospatial mapping to assess the distribution and determinants of zero dose vaccination status hot spots among children in Ethiopia using EDHS 2019: Spatial and geographical weighted regression

Abstract

INTRODUCTION: Zero-dose vaccine status refers to a child who has not yet received any childhood vaccines. Globally, zero-dose vaccination status is the major public health problem. In sub-Saharan African countries, among five children, one child did not access the vaccines. The efforts to identify the factors contributing to the zero-dose vaccine have not yet been addressed in Ethiopia. OBJECTIVES: To assess the distribution and determinants of zero dose vaccination status hot spots among children in Ethiopia using Ethiopian demographic health survey 2019. METHODS: A secondary analysis of a cross-sectional study was used among a total of 3208 participants. Stata-14, Arc geographic information system-10.3, and Sat Scan software were used to analyze the data. Moran's I statistic was used to assess the non-random distribution of zero-dose vaccination status. Spatial and geographically weighted regression was used to map the distribution and determinants of zero-dose vaccination status in Ethiopia. The Getis-Ord-statistics and Sat Scan analysis were also used to identify the hot spot area and significant clusters respectively. To identify significant factors, a p-value <0.05 was used. RESULTS: The prevalence of zero-dose vaccination status among children aged 12-35 months old was 16.3% (95%CI, 15%-17.6%). The distribution of zero-dose vaccination status in Ethiopia was not randomly distributed across the area (Moran's I value = 0.4, p<0.001). The hotspot area of zero-dose vaccination status in Ethiopia was located in Afar, Somalia, and the south nations region. The primary cluster was located at 5.479641 N and 42.196835 E within a 405.96 km radius in the Somali region. The highest effect (β, 0.23-0.24) of give birth at home on zero-dose vaccination status was observed in Afar, Somalia, and Tigray, whereas the lowest effect of home delivery (β, 0.21-0.22) was observed in south nations, Gambela, and the western part of Benishangul Gumuz. Additionally, the poor wealth index had the highest effect on zero-dose vaccination status (β, 0.06-0.07) in south nations, Benishangul Gumuz, and the Gambela region, and the lowest effect of the poor wealth index (β, 0.03-0.04) was observed in Somalia and the Afar region. CONCLUSION: The zero dose child in Ethiopia was low. Geographically, the highest proportion of zero-dose vaccination status among children was in the Somali and Afar regions. Home delivery had the highest and most positive effect on zero-dose vaccination status in Afar, Somalia, and the Tigray region. Additionally, the poor wealth index had the highest and most positive effect in Somalia and the Afar region. Expanding delivery at the health facility and economic empowerment of women are recommended to improve vaccination in Ethiopia.