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Vaccination status and its determinants among children aged 12-23 months in Tigray, northern Ethiopia: A

Hailay Gebretnsae¹, Brhane Ayele¹, Fana Gebresilassie¹

¹Tigray Health Research Institute, Mekelle, Tigray, Ethiopia.

|July 28, 2025

Insights

In Tigray, Ethiopia, only 59.9% of children aged 12-23 months are fully vaccinated, with 40.1% under-vaccinated or zero-dose. Rebuilding immunization infrastructure and targeted interventions are crucial for improving child vaccination coverage in post-conflict settings.

Area of Science:

Public Health
Epidemiology
Pediatrics

Background:

Conflict in Tigray, Ethiopia, has severely disrupted immunization services, leading to a rise in vaccine-preventable diseases.
Limited evidence exists on the current vaccination status of children in the region.
This study addresses the critical need to understand child vaccination status and its determinants in Tigray.

Purpose of the Study:

To assess the vaccination status among children aged 12-23 months in Tigray, northern Ethiopia.
To identify the key determinants influencing vaccination status in this vulnerable population.
To provide evidence for improving immunization programs in post-conflict settings.

Main Methods:

A community-based cross-sectional study was conducted in August 2023, involving 1,620 mothers of children aged 12-23 months across 19 districts in Tigray.
A multistage cluster sampling technique and a structured questionnaire on Open Data Kit (ODK) were employed for data collection.
Zero-inflated Poisson regression analysis was used to identify factors associated with child vaccination status, with significance set at p < 0.05.

Main Results:

The overall full vaccination proportion was 59.9%, with 29.4% under-vaccinated and 10.7% zero-dose children.
Factors associated with higher vaccination uptake included maternal media exposure and availability of routine immunization services.
Maternal lack of formal education, lack of routine immunization services, and absence of postnatal care follow-up were determinants for zero-dose vaccination.

Conclusions:

A substantial proportion (40.1%) of children in Tigray remain zero-dose or under-vaccinated, highlighting a significant public health challenge.
Rebuilding immunization infrastructure, ensuring service availability, and implementing targeted media campaigns and postnatal care promotion are essential.
Post-conflict strategies must include identifying and reaching unvaccinated children through catch-up vaccination efforts to ensure universal immunization coverage.

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Abstract

Background:

In Tigray, immunization services have been severely interrupted, and cases with vaccine preventable diseases become rampant due to the conflict. However, there is limited evidence on the status of child vaccination in the region. Therefore, this study aimed to assess the vaccination status and its determinants among children aged 12-23 months in Tigray, northern Ethiopia.

Methods:

A community-based cross-sectional study was conducted in August 2023 in the Tigray region, Northern Ethiopia. Using a multistage cluster sampling technique, the study included mothers of children aged 12-23 months from 19 randomly selected districts. Data were collected through a pre-tested structured questionnaire designed on Open Data Kit (ODK). Child vaccination status (the outcome variable) was measured for 14 vaccine antigens. Data analysis was conducted using R software. A zero-inflated Poisson regression model was applied to identify factors associated with child vaccination status, with statistical significance determined at a p-value of < 0.05.

Results:

In this study a total of 1,620 mothers of children aged 12-23 months were included. The overall proportion of fully vaccination was 59.9% (95% Confidence Interval (CI): 57.7-62.3%), while 29.4% (95% CI: 27.1-31.7%) were under-vaccinated and 10.7% (95% CI: 9.1-12.2%) were zero-dose. Being with no formal education(Adjusted Incidence Relative Risk (AIRR) = 0.94, 95% CI: 0.90-0.97), availability of routine immunization services at the nearest health facility (AIRR = 1.09, 95% CI: 1.04-1.13) and having media exposure (AIRR = 1.04, 95% CI: 1.01-1.08) were the factors associated with getting more vaccines among children. Moreover, being with no formal education (Adjusted Odds Ratio (AOR) =1.83, 95% CI: 1.21-2,75), availability of routine immunization services at the nearest health facility (AOR = 0.39, 95% CI: 0.27-0.55) and having Postnatal Care (PNC) follow-up (AOR = 0.53, 95% CI: 0.29-0.99) were the determinants for zero-dose vaccination.

Conclusions:

This study revealed that a significant proportion (40.1%) of children were left as zero-dose or under-vaccinated. To improve vaccination coverage in post-conflict settings, health policymakers should prioritize re-building immunization infrastructure and ensuring the availability of vaccination services across all levels of the healthcare system through mobilizing and allocating resources. Media campaigns should be provided to encourage mothers to vaccinate their children. Healthcare professionals should also promote timely post-natal care visits to initiate vaccinations at the appropriate age. Furthermore, it is essential to identify and reach zero-dose or under-vaccinated children through targeted catch-up vaccination efforts to ensure that no child is left unvaccinated in post war settings.

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