Effective coverage of child immunisation service in Ethiopia

Vaccines are one of the safest and most cost-effective interventions to prevent disease and disabilities worldwide. Yet, nearly 19 million children do not receive basic vaccines and most of them are from low and middle-income countries. The Sustainable Development Goal 3 aims at eliminating preventable deaths of newborns and under-five children by 2030. However, Ethiopia has a high child mortality rate, and most of them are from preventable causes. Quality provision of immunisation could reduce vaccine-preventable morbidity and mortality. Despite this, the quality-adjusted coverage of immunisation services in Ethiopia has not been well-documented. We used the Kids' record from the 2019 Ethiopian Demographic and Survey (EDHS) and the health facility recode from the 2021-2022 Ethiopian Service Provision Assessment (ESPA). The EDHS and ESPA data were linked using administrative boundary linkage using administrative regions and city administrations. The crude coverage was weighted before linking with the ESPA dataset. Health facilities which provide child immunisation services were included. The quality of immunisation service provision was constructed from 14 indicators. The quality of immunisation was calculated as the sum of the availability of items in each domain, divided by the total number of items in the domain, and finally multiplied by 100. The effective coverage was measured as the product of contact coverage and quality of immunisation service provision. We use STATA 17 for analysis. A total of 951 respondents who have a live children aged 12-23 month were included. The national effective coverage of immunisation was 34.3% (95% Confidence interval (CI): 33.0, 35.5) with a large variation in different regions, ranged from 14.8% in Afar to 83.5% in Addis Ababa. The crude coverage of immunisation services was 39.6% (95% CI: 36.5, 42.7), ranged from 19.2% in Afar to 87.39% in Addis Ababa. The overall score for quality of immunisation service was 82% (95% CI: 80.44, 83.51). The quality ranged from 74.6% in SNNPR to 95.5% in Addis Ababa. The quality of immunisation varies with the managing authority of health facilities, private facilities had the highest quality (90% (95% CI: 85.35, 95.36)) and government facilities scored the lowest quality (82% (95% CI: 80.06, 83.22)). There was low effective coverage of immunisation services provision in Ethiopia. The effective coverage was lower in the pastoral regions (Afar and Somali). Government facilities and facilities in rural areas had lower-quality immunisation services. Facilities in SNNPR and Afar region had low-quality of immunisation service. Policymakers should focus on improving the quality of government facilities and the facilities in rural areas and pastoral regions to improve immunisation services.