Multilevel and geographically weighted regression analysis of factors associated with full immunization among children aged 12–23 months in Ethiopia

• Published in: Scientific reports 2024-09, Vol.14 (1), p.22743-17, Article 22743
• Main Authors: Diress, Fasika, Negesse, Yilkal, Worede, Daniel Tarekegn, Bekele Ketema, Daniel, Geitaneh, Wodaje, Temesgen, Habtamu
• Format: Article
• Language: English
• Subjects: 692/699; 692/700; Adolescent; Adult; Age; Breast feeding; Breastfeeding & lactation; Children; Children aged 12–23 months; Disease resistance; Ethiopia; Ethiopian demographic health survey; Families & family life; Family size; Female; Fully immunization; Geographical variations; Geographically weighted regression; Humanities and Social Sciences; Humans; Immunization; Immunization - statistics & numerical data; Immunization Programs; Infant; Infectious diseases; Male; Morbidity; multidisciplinary; Multilevel Analysis; Regression analysis; Rural areas; Rural Population - statistics & numerical data; Rural populations; Science; Science (multidisciplinary); Spatial analysis; Spatial distribution; Spatial Regression; Spatial variations; Statistical analysis; Vaccination - statistics & numerical data; Vaccination Coverage - statistics & numerical data; Vaccines; Womens health; Young Adult
• ISSN: 2045-2322; 2045-2322
• DOI: 10.1038/s41598-024-74189-8

Immunization is the process of building immunity or resistance to an infectious disease, typically through administering a vaccine. It is one of the most effective strategies for lowering child morbidity and death. It protects against more than 20 potentially fatal diseases, increasing longevity and health. Despite progress, Ethiopia failed to meet its vaccination coverage target. The magnitude of full immunization is different across areas. Therefore, conducting geographically weighted regression to identify the local factors and multilevel analysis to investigate and identify factors associated with full immunization coverage among children aged 12–23 months is necessary. The study was conducted using the 2019 Ethiopian Mini Demographic Health Survey dataset. A sample of 1028 weighted children aged 12–23 months were included in the analysis. Descriptive statistics were used to describe variables. For the spatial analysis, Arc-GIS version 10.8 statistical software was used. Spatial regression (geographically weighted regression) was done to identify factors associated with the proportion of full immunization, and model comparison was based on adjusted R2 and Akaike Information Criteria (AICc). Multilevel mixed-effect binary logistic regression models were fitted to identify factors associated with full immunization. The fitted models were compared based on log-likelihood, deviance, median odds ratio, and Proportional Change in Variance. Finally, statistically significant factors were reported using an adjusted odd ratio (AOR) with a 95% Confidence Interval for fixed effect. All variables with a p-value less than 0.05 in the final model were considered statistically significant factors. In Ethiopia, the overall full immunization coverage among children aged 12–23 months was 40.58%, with spatial variation across regions in Ethiopia. The significant spatial distribution of full immunization coverage among children aged 12–23 months was detected in northern Tigray, Addis Ababa, central Oromia, and southeastern Amhara regions. The proportion of rural residents,the proportion of women aged 35–44 years,  the proportion of women who had ANC 4 and above andthe proportion of women who had PNC were local factors associated with the proportion of full immunization among children aged 12–23 months. Rural residence [AOR 0.27 (95% CI 0.10, 0.70)], family size 4 and above[AOR 0.41 (95% CI 0.17, 0.96)], never breastfeed [AOR 0.026(95% CI 0.003, 0.21)], 1–3 times ANC visit