Abstract
Background: Monitoring and addressing unnecessary and avoidable differences in child vaccination is a critical global concern. This study aimed to assess socioeconomic inequalities in basic vaccination coverage among children aged 12-23 months in Ethiopia.
Methods: Secondary analyses of cross-sectional data from the two most recent (2011 and 2016) Ethiopia Demographic and Health Surveys were performed. This analysis included 1930 mother-child pairs in 2011 and 2004 mother-child pairs in 2016. Completion of basic vaccinations was defined based on whether a child received a single dose of Bacille Calmette Guerin (BCG), three doses of diptheria, tetanus toxoids, and pertussis (DTP), three doses of polio vaccine (OPV), and one dose of measles vaccine. The concentration curve and concentration index (CCI) were used to estimate wealth related inequalities. The concentration indices were also decomposed to examine the contributing factors to socioeconomic inequalities in childhood vaccination.
Results: From 2011 to 2016, the proportion of children who received basic vaccination increased from 24.6% (95% confidence interval, CI: 21.4 to 28.0) to 38.6% (95% CI: 34.6 to 42.9). While coverage of BCG, DPT, and polio immunization increased during the study period, the uptake of measles vaccine decreased. The positive concentration index shows that basic vaccination status was favourably concentrated among children from wealthier households CCI= 0.212 in 2011 and CCI= 0.212 in 2016. The decomposition analysis shows that maternal health services such as family planning and antenatal care, socioeconomic status, exposure to media, urban-rural residence, and maternal education explain inequalities in basic vaccination coverage in Ethiopia.
Conclusions: Childhood vaccination coverage was low in Ethiopia. Vaccination was less likely in poorer than in richer households. Addressing wealth inequalities, enhancing education, and improving maternal health service coverage will reduce socioeconomic inequalities in basic vaccination uptake in Ethiopia.