Zero-Dose Vaccination Among Children Aged 12-35 Months in Ethiopia

Immunization is one of the most successful and cost-effective public health interventions worldwide. Approximately 62% of zero-dose children live in just 10 countries, including Ethiopia. In West Arsi Zone, findings from the rapid convenient survey (RCS) were inconsistent with DHIS-2 reports.

The objective was to determine the proportion of zero-dose vaccination and identify associated factors among children aged 12-35 months in West Arsi Zone, June-August 2023.

We conducted a community-based cross-sectional study on 1456 children selected using multistage stratified random sampling. Data were collected through face-to-face interviews with mothers/caretakers and record reviews using an ODK questionnaire. Data were cleaned and analyzed in Stata 16. Binary logistic regression identified factors associated with zero-dose vaccination. Variables with p < 0.25 and practical significance were included in multivariable regression; statistical significance was set at p < 0.05.

The proportion of zero-dose vaccination was 9.62% (8.10-11.13). The main reasons included unawareness of the need for vaccination (29.57%) and unavailability of the vaccines/vaccinators (15.59%). Factors associated with higher odds of zero-dose vaccination were as follows: living in kebeles where health posts lacked refrigerators (AOR = 2.08, 95% CI: 1.25-3.45), communities without social mobilization for immunization (AOR = 2.63, 95% CI: 1.44-4.80), caregiver unawareness of HEWs (AOR = 1.77, 95% CI: 1.02-3.07), poor immunization knowledge (AOR = 3.08, 95% CI: 1.83-5.21), negative (AOR = 4.24, 95% CI: 2.25-7.97), or neutral attitude (AOR = 4.21, 95% CI: 2.36-7.52) toward immunization, waiting times > 30 min (AOR = 2.83, 95% CI: 1.67-4.97), lack of health education at the facility (AOR = 2.48, 95% CI: 1.44-4.27), mothers with no ANC (AOR = 4.08, 95% CI: 2.32-7.16), home delivery (AOR = 4.07, 95% CI: 2.30-7.20), and female children (AOR = 1.75, 95% CI: 1.10-2.78).

Zero-dose vaccination is consistent with RCS findings and is unacceptably high compared to the national targets (100% Pentavalent 1 coverage nationally; 98% per district). Interventions should focus on increasing community awareness, ensuring vaccines and vaccinator availability, and promoting equal care for male and female children.