Spatial distribution of complete basic childhood vaccination and associated factors among children aged 12–23 months in Ethiopia. A spatial and multilevel analysis

BACKGROUND: Complete childhood vaccination considerably aids in the reduction of morbidity and mortality from vaccine-preventable childhood diseases. Understanding the geographical disparity of complete basic childhood vaccination and Identifying associated factors is vital to designing appropriate interventions. This study aimed to assess the spatial distribution and associated factors of complete basic childhood vaccination among children aged 12–23 months in Ethiopia. METHODS: A two-stage stratified sampling technique was used based on the 2019 Ethiopian mini demographic and health survey data. A total weighted sample of 1,028 children was included in the analysis. ArcGIS version 10.8 software was used to visualize the spatial distribution of complete basic childhood vaccination. The Bernoulli-based model was used to detect significant clusters of areas using SaTScan version 9.6 software. To identify associated factors, multilevel logistic regression analyses were used, and all variables with a p-value less than 0.05 were reported as statistically significant predictors. RESULTS: Complete basic childhood vaccination among children aged 12–23 months had a significant variation in Ethiopia (Moran’s I = 0.276, p<0.001). The spatial scan analysis identified the most likely significant primary clusters with low complete basic childhood vaccination coverage in the Somali region’s Afder, Liben, Shabelle, and Nogobe zones; the Southern Nation Nationality and Peoples Region’s (SNNPR) Gedeo and Sidama zones; and the Oromia region’s Bale and Guji zones. The second significant cluster was found in the Afar region’s zones 1, 4, and 5, as well as the northern Somali region’s Siti zone. In the multivariable multilevel analysis, maternal age 20–24, 25–29, 35–39, and 40–44 years, delivery at a health facility, four or more antenatal care (ANC) visits, orthodox religion fellowship, maternal primary education, Muslim religion fellowship, living in the Afar, Somalia, and Oromia regions, and living in rural areas were all found to be significantly associated with complete basic childhood vaccination. CONCLUSION: A geographically significant variation of complete basic childhood vaccination was observed. Maternal age, maternal education, religion, place of delivery, ANC visit, region, and residence were significantly associated with complete basic childhood vaccination. Developing immunization campaigns targeting areas that had low basic vaccination coverage and designing healthcare programs that can motivate facility-based delivery and ANC follow-up is recommended.