Spatial distribution and determinants of measles vaccination dropout among under-five children in Ethiopia: A spatial and multilevel analysis of 2019 Ethiopian demographic and health survey

Abstract

Background: Each year, vaccine-preventable diseases cost the lives of 8.8 million under-five children. Although vaccination prevents 1-2 million childhood deaths worldwide, measles vaccination dropouts are not well studied in developing countries, particularly in Ethiopia. Therefore, this study aims to assess the spatial distribution of the measles vaccination dropout and its determinants among under-five children in Ethiopia.

Methods: Data from Ethiopian Demographic and Health Survey 2019 was used for data analysis. The study used a total of 5,753 children. Spatial autocorrelations was used to determine the spatial dependency of measles vaccination dropout. Ordinary interpolation was employed to forecast measles vaccination dropout. Factors associated with measles vaccination dropout were declared significant at p-values <0.05. The data were interpreted using the confidence interval and adjusted odds ratio. A model with the lowest deviance and highest logliklihood ratio was selected as the best-fit model.

Results: In Ethiopia, one in three under-five children had measles vaccination dropouts. Factors such as birth interval (AOR = 1.87, 95% CI: 1.30, 2.70), unmarried marital status women (AOR = 3.98, 95% CI: 1.08, 8.45), ≤1 number of under-five children (AOR = 3.86, 95% CI: 2.56, 5.81), rural place of residence (AOR = 2.43, 95% CI: 2.29, 3.11), low community-level ANC utilization (AOR = 3.20, 95% CI: 2.53, 3.56), and residing in Benishangul Gumuz (AOR = 1.80, 95% CI: 1.061, 3.06) had higher odds of measles vaccination dropout.

Conclusions: Measles vaccination dropout rates in Ethiopia among under-five children were high compared to the maximum tolerable vaccination dropout level of 10% by the WHO. Both individual and community-level variables were determinants of measles vaccination dropout. The ministry of health in Ethiopia should give attention to those mothers of under-five children who reported underutilization of ANC services and rural residences while designing policies and strategies in areas of high spatial clustering of vaccine dropout in Ethiopia.

Fig 1. Conceptual framework for factors associated with measles vaccination dropouts among under-five children in Ethiopia.

Fig 2. Measles vaccination dropout rates among under-five children in Ethiopia, Mini EDHS 2019.

Fig 3. Regional prevalence of measles vaccination dropout rates among under-five children in Ethiopia, Mini EDHS 2019.

Fig 4. Spatial autocorrelation of measles vaccination dropout in Ethiopia based on feature locations and attribute values using the Global Moran’s index statistic, Mini EDHS 2019.

Fig 5. Hotspot analysis of measles vaccination dropout in Ethiopia, Mini EDHS 2019.

Fig 6. Kriging interpolation analysis of measles vaccination dropout in Ethiopia, Mini EDHS 2019.

Fig 7. Sat scan analysis of measles vaccination dropout in Ethiopia, Mini EDHS 2019.