Abstract:
Background: Vaccination is the most important mechanism to improve childhood survival. However,
immunization coverage is very low and unevenly distributed throughout the country. Therefore, this
study was aimed to investigate the spatiotemporal distribution of immunization coverage in Ethiopia.
Method: Immunization coverage data and geospatial covariates data were obtained from EDHS 2000 to
2019 and different publicly available sources. A Bayesian geostatistic model was used to estimate the
national immunization coverage at a pixel level and to identify factors associated with the spatial clustering
of immunization coverages.
Result: The overall immunization coverage in Ethiopia was 38.7%, 36.55%, 51.8%, 67.1% and 66.9% for
2000, 2005, 2011, 2016 and 2019 respectively. Spatial clustering of low immunization coverage was
observed in Eastern, Southern, Southwestern, Southeastern and Northeastern parts of Ethiopia in
EDHSs. The altitude of the area was positively associated with immunization coverage in 2000, 2005
and 2019 EDHS. The population density was positively associated with immunization coverage in
2000, 2005, 2011 and 2016. Precipitation is also positively associated with immunization coverage in
2016. Moreover, mean annual temperature was positively associated with immunization coverage in
2000, 2005 and 2019 EDHSs.
Travel time to the nearest city is negatively associated with immunization coverage in 2000, 2005,
2011 and 2016. Likewise, distance to health facilities was negatively associated with immunization coverage
in all the five EDHSs.
Conclusion: This study found that immunization coverage in Ethiopia substantially varied across the subnational
and local levels. Spatial clustering of low immunization coverage was observed in Southern,
Southeastern, Southwestern, Northeastern, and Eastern parts of the country. Altitude, population density,
precipitation, temperature, travel time to the nearest city in minutes, and distance to the health facilities
were factors that affect the spatial clustering of immunizations coverage. These findings can guide policymakers
in Ethiopia to design geographically targeted interventions to increase programs to achieve
maximum immunization coverage.
2022 The Authors. Published by Elsevier Ltd. This is an open access article under the CC BY license
