Spatial Distribution of Rotavirus Immunization Coverage in Ethiopia

Abstract Introduction: Rotavirus immunization prevents severe diarrheal diseases in children, but vaccination coverage is still far from desired targets in many African countries including Ethiopia. Measuring rotavirus immunization coverage at a lower geographic area can provide information for designing and implementing a targeted immunization campaign. This study aimed to investigate the spatial distributions of rotavirus immunizations coverage in Ethiopia. Methods Rotavirus immunization coverage data were obtained from the Ethiopian Demographic and Health Survey (EDHS) 2019. Covariate data were assembled from different publicly available sources. A Bayesian geostatistic model was used to estimate the national rotavirus immunization coverage at a pixel level and to identify factors associated with the spatial clustering of immunization coverages. Result The national rotavirus immunization coverage in Ethiopia was 52.3% (95% CI: 50.3, 54.3). The immunization coverage varied substantially at the sub-national level with spatial clustering of low immunization coverage observed in the Eastern, Southeastern, and Northeastern parts of Ethiopia. The spatial clustering of the rotavirus immunization coverage was positively associated with altitude of the area (mean regression coefficient ( β ): 0.38; 95% credible interval (95% CrI): 0.18, 0.58) and negatively associated with travel time to the nearest cities in minutes (mean regression coefficient ( β ): -0.45; 95% credible interval (95% CrI): (-0.73, -0.18) and distance to the nearest health facilities (mean regression coefficient ( β ): -0.72; 95% credible interval (95% CrI): (-1.07, -0.37). Conclusions This study found that the rotavirus immunization coverage varied substantially at sub-national and local levels in Ethiopia. The spatial clustering of rotavirus immunization coverage was associated with geographic and healthcare access factors such as altitude, distance to health facilities, and travel time to the nearest cities. The immunization program should be strengthened in Ethiopia, especially in the Eastern, Southeastern, and Northeastern parts of the Country. Outreach immunizations services should be also implemented in areas with low coverage.