Geospatial and multilevel analysis of incomplete rotavirus vaccination (second-dose non-completion) among children in Ethiopia

Abstract Background Rotavirus remains a leading cause of severe diarrheal morbidity and mortality among children under five years of age in low- and middle-income countries. Although Ethiopia introduced the rotavirus vaccine into its national immunization program, incomplete vaccination, particularly failure to complete the second dose continues to undermine its public health impact. Evidence on the multilevel and spatial determinants of rotavirus vaccine non-completion remains limited. This study aimed to assess the magnitude, spatial distribution, and individual- and community-level factors of incomplete rotavirus vaccination in Ethiopia. Methods A secondary analysis of data from the 2019 Mini Ethiopian Demographic and Health Survey was conducted among 1,376 weighted children aged 12–35 months. Spatial analyses, including Global Moran’s I and Getis-Ord Gi* statistics, were used to assess spatial clustering of rotavirus vaccine second-dose non-completion. Multilevel logistic regression models were fitted to identify associated individual- and community-level factors. Adjusted Odds Ratios (AORs) with 95% confidence intervals (CIs) and p-values < 0.05 were used to determine statistical significance. Results The prevalence of incomplete rotavirus vaccination (second-dose non-completion) was 8.8% (95% CI: 6.7–11.4%) and showed significant spatial clustering (Moran’s I = 0.108; p = 0.01), with hotspots observed in Afar, Somali, and Harari regions. Factors associated with incomplete vaccination included home delivery (AOR = 1.85; 95% CI: 1.30–2.72; p < 0.001), female sex of the child (AOR = 1.60; 95% CI: 1.16–2.16; p < 0.001), maternal age 20–34 years (compared with 35–49 years) (AOR = 3.01; 95% CI: 1.31–7.01; p < 0.01), residence in small peripheral regions (AOR = 2.18; 95% CI: 1.01–4.71; p < 0.05), and lack of a child health card (AOR = 2.66; 95% CI: 1.55–4.55; p < 0.001). Conclusion Incomplete rotavirus vaccination remains a significant public health concern in Ethiopia and exhibits marked geographic clustering. Interventions should prioritize hotspot regions, promote institutional delivery, strengthen health card utilization, and address gender-related and maternal age–related barriers to improve vaccine completion.