Abstract:
Results: Among children aged 12–23 months, the prevalence of complete childhood vaccination status increased from
20.7% in rural to 49.2% in urban in 2011 and from 31.7% in rural to 66.8% in urban residences in 2016. The
decomposition analyses indicated that 72% in 2011 and 70.5% in 2016 of the overall difference in vaccination status
was due to differences in respondent characteristics. Of the changes due to the composition of respondent
characteristics, such as antenatal care and place of delivery were the major contributors to the increase in complete
childhood vaccination in 2011, while respondent characteristics such as wealth index, place of delivery and media
exposure were the major contributors to the increase in 2016. Of the changes due to differences in coefficients, those
of low wealth status in 2016 across residences significantly contributed to the differences in complete childhood
vaccination. On top of that, from 2011 to 2016, there was a significant increment in complete childhood vaccination
status and a 59.8% of the overall increment between the surveys was explained by the difference in composition of
respondents. With regard to the change in composition, the differences in composition of ANC visit, wealth status,
place of delivery, residence, maternal education and media exposure across the surveys were significant predictors for
the increase in complete child vaccination over time. On the other hand, the wealth-related inequalities in the
utilization of childhood vaccination status were the pro-rich distribution of health services with a concentration index
of CI = 0.2479 (P-value < 0.0001) in 2011 and [CI = 0.1987; P-value < 0.0001] in 2016.
Conclusion: A significant rural-urban differentials was observed in the probability of a child receiving the required
childhood vaccines. Children in urban households were specifically more likely to have completed the required
number of vaccines compared to the rural areas in both surveys. The effect of household wealth status on the
probability of a child receiving the required number of vaccines are similar in the 2011 and 2016 surveys, and the
vaccination status was high in households with high wealth status. The health policies aimed at reducing wealth
related inequalities in childhood vaccination in Ethiopia need to adjust focus and increasingly target vulnerable
children in rural areas. It is of great value to policy-makers to understand and design a compensation mechanism for
the costs incurred by poor households. Special attention should also be given to rural communities through improving
their access to the media. The findings highlight the importance of women empowerment, for example, through
education to enhance childhood vaccination services in Ethiopia.
Keywords: Complete vaccination, Inequalities, Children, Ethiopia
