OBJECTIVES

Vaccine preventable diseases significantly lead to high under 5 mortality in sub-Saharan Africa. Much attention is given to immunization coverage, but little is known about the population of never-vaccinated children (those that have not received any dose of the WHO recommended immunizations) in Ethiopia. This study aims to (i) Describe the prevalence of never-vaccinated children in Ethiopia and (ii) Examine the effects of individual and contextual factors on non-vaccination of Ethiopian children.

METHODS

We conducted a secondary analysis using pooled cross-sectional data from 2000-2016 Ethiopia Demographic Health Survey. Analyses were restricted to children aged 12–59 months. A two-level multilevel regression analysis model was built with individuals (level 1) nested within communities (level 2).

RESULTS

A total of 20,212 children aged 12–59 months nested within 520 clusters were included in the analysis. Approximately 19% (n=3,943) of the study sample had never been vaccinated. Prevalence of non-vaccination was higher among mothers who delivered at home (86%), with no formal education (62%). In the fully adjusted model, the odds of not being vaccinated reduced for children whose mothers attended high school (adjusted odds ratio [aOR] = 0.35; 95% confidence interval [CI]=0.14-0.84), had employment (aOR, 0.74; 95% CI, 0.59-0.92) and delivered in the hospital (aOR, 0.68; 95% CI, 0.52-0.91). As wealth index increases, the odds of a child not being vaccinated decreased (aOR, 0.63; 95%CI, 0.42-0.93). The odds of being unvaccinated were higher among children whose mother lived in rural area (aOR, 1.76; 95% CI, 1.07-2.89), Somali region (aOR, 13.16; 95% CI, 7.68-22.57) and Affar region (aOR, 8.28; 95% CI, 5.04-13.61) compare to those who lived in urban area or Addis Ababa.

CONCLUSIONS

Both individual and contextual factors contributed to non-vaccination of children in Ethiopia. Interventions to improve childhood vaccination could benefit from putting these factors responsible for non-vaccination of under 5 children into consideration.