Inequalities in measles immunization coverage in Ethiopia: a cross-sectional analysis of demographic and health surveys 2000–2016

Abstract

Background: Ethiopia has low measles immunization coverage and little is known about the disparities surrounding what coverage is provided. This study assessed disparities in measles immunization and its change over time using the four Ethiopia Demographic and Health Surveys conducted between 2000 and 2016. Methods: This is a cross-sectional analysis of data using Ethiopia Demographic and Health Surveys (EDHS) conducted between 2000 and 2016. We used the World Health Organization's (WHO) Health Equity Assessment Toolkit (HEAT) to present the inequalities. Four measures of inequality were calculated: Difference (D), Ratio (R), Population Attributable Fraction (PAF) and Population Attributable Risk (PAR). The results were disaggregated by wealth, education, residence, sex and sub-national regions and 95% Uncertainty Intervals (UIs) were computed for each point estimate to boost confidence of the findings. Results: Measles immunization coverage was higher among the richest and secondary and above schools' subgroup by nearly 30 to 31 percentage points based on point estimates (D = 31%; 95% CI; 19.48, 42.66) and 29.8 percentage points (D = 29.8%; 95% CI; 16.57, 43.06) as compared to the poorest and no education subgroup respectively in the 2016 survey. Still, in the 2016 survey, substantial economic status (

Child Vaccination Coverage, Trends and Predictors in Eastern Ethiopia: Implication for Sustainable Development Goals

“…Women from the poor family probability has less empowerment to give decision, inability to pay costs and spend more time to earn the means of livelihood. 13 , 41 , 53 …”

“…The result was in line with previous reports. 13 , 59 , 60 Maternal and child health care are interrelated. The more women adhere to maternal and child care, the more women know benefit, understand the appointment and improved communication with care providers.…”

“…Women from the poor family probability has less empowerment to give decision, inability to pay costs and spend more time to earn the means of livelihood. 13,41,53 Not utilizing maternal health service was negatively associated with vaccination uptake of the children included in this study. The chance of partially immunized or not immunized was higher among children whose mother had no antenatal care and did not access institutional delivery.…”

“…12 The Ethiopian Demographic Health Survey (EDHS) 2016 report showed that nearly two out of five children aged 12-23 months (39%) received all basic vaccinations at some time, and 22% were vaccinated by the appropriate age. 12 Improving vaccination coverage has been challenged due to factors such as quality of services, local and regional inequalities, 13,14 competing health priorities, inadequate monitoring and evaluation, resource limitations, and sociobehavioral variables. [13][14][15][16] Socio-demographic factors, 17 maternal health services utilizations during antenatal, delivery and postnatal period, 18 were found to be predictors for child vaccination.…”

“…12 Improving vaccination coverage has been challenged due to factors such as quality of services, local and regional inequalities, 13,14 competing health priorities, inadequate monitoring and evaluation, resource limitations, and sociobehavioral variables. [13][14][15][16] Socio-demographic factors, 17 maternal health services utilizations during antenatal, delivery and postnatal period, 18 were found to be predictors for child vaccination. 19 Poor perception toward vaccination and lack of awareness were deterring caregivers from seeking vaccination for their children.…”