Spatial distribution and associated factors of measles vaccination among children aged 12–23 months in Ethiopia. A spatial and multilevel analysis

Figures & data

Table 1. Background characteristics of study participants and MCV1 coverage by various background characteristics among children aged 12–23 months in Ethiopia

Variables	Weighted frequency (%)	Received MCV1
		No	Yes
		N (%)	N (%)
Age of a child in months 12–15 16–19 20–23	399 (38.8) 334 (32.5) 295 (28.7)	169 (42.4) 150 (45.0) 107 (36.2)	230 (57.6) 184 (55.0) 188 (63.8)
Birth order First Second to fifth ≥six	242 (23.5) 598 (58.2) 188 (18.3)	84 (34.5) 240 (40.2) 102 (54.4)	158 (65.5) 358 (59.8) 86 (45.6)
Sex of child Male Female	495 (48.2) 533 (51.8)	210 (42.4) 217 (40.6)	286 (57.6) 316 (59.4)
Ever had a health card* No Yes	565 (54.9) 463 (45.1)	277 (49.1) 287 (32.1)	149 (50.9) 315 (67.9)
Maternal age 15–19 20–24 25–29 30–34 35–39 40–44 45–49	73 (7.1) 237 (23.0) 359 (34.9) 160 (15.6) 134 (13.0) 53 (5.2) 13 (1.3)	39 (53.3) 89 (37.5) 155 (43.3) 67 (43.0) 44 (32.6) 23 (43.4) 10 (74.5)	34 (46.7) 148 (62.5) 204 (56.6) 93 (57.0) 90 (67.4) 30 (56.7) 3 (25.5)
Maternal education No formal education Primary Secondary & above	464 (45.2) 418 (40.6) 146 (14.2)	261 (56.3) 146 (34.9) 19 (13.0)	203 (43.7) 272 (65.1) 127 (87.0)
Religion Orthodox Protestant Muslim Other & traditional	383 (37.3) 265 (25.8) 350 (34.1) 29 (2.8)	102 (26.5) 145 (54.6) 159 (45.4) 21 (71.8)	281 (73.5) 120 (45.4) 191 (54.6) 8 (28.2)
Wealth status Poor Middle Rich	431 (41.9) 178 (17.4) 419 (40.7)	224 (52.1) 96 (53.9) 106 (25.3)	207 (47.9) 82 (46.1) 313 (74.7)
No_ of living children 1 2–5 ≥6	238 (23.2) 628 (61.1) 162 (15.7)	86 (36.1) 248 (39.5) 92 (60.0)	152 (63.9) 380 (60.5) 70 (40.0)
ANC follow-up No follow-up 1–3 ≥4 visits	283 (27.6) 306 (29.8) 439 (42.7)	176 (62.2) 139 (45.5) 111 (25.2)	107 (37.8) 167 (54.5) 328 (74.8)
Place of delivery Home Health facility	477 (46.4) 551 (53.6)	286 (60.1) 140 (25.4)	190 (39.9) 411 (74.6)
Sex of household head Male Female	887 (86.2) 141 (13.8)	363 (40.9) 64 (45.1)	524 (59.1) 78 (54.9)
Residence Urban Rural	313 (30.5) 715 (69.5)	69 (21.9) 358 (50.0)	245 (78.1) 357 (50.0)

Health card: vaccination card, booklet, or other home-based records

Figure 1. MCV1 vaccination rate among children aged 12–23 months across regions of Ethiopia, EMDHS 2019.

Figure 2. The spatial distribution of MCV1 vaccination rate across regions of Ethiopia, 2019 EMDHS.

Figure 3. Spatial autocorrelation of MCV1 among children aged 12–23 months across regions of Ethiopia, EMDHS 2019.

Figure 4. Spatial pattern of hotspots and cold spots of MCV1 rate across regions in Ethiopia, EMDHS 2019.

Table 2. SaTScan analysis of measles vaccination among children aged 12–23 months in Ethiopia

Type of cluster	Significant clusters/EAs Identified	Coordinates/radius	Population	No_ of cases	RR	LLR	p-value
1	141, 125, 143, 142, 144, 136, 114, 138, 111, 137, 123, 134, 110, 117,113, 183, 89, 103, 186, 133, 181, 182, 188, 185, 135, 172, 115, 187, 102, 131	4.996240 N, 41.440734 E/403.92 km	119	94	2.07	36.56	.001
2	31, 26, 32, 30, 33, 34, 47, 45, 48, 44, 49, 29, 46, 50	(11.561794 N, 41.244868 E)/159.37 km	57	43	1.84	13.16	.002
3	220, 218, 229, 230, 219	(8.356129 N, 33.766046 E)/70.96 km	26	22	2.02	9.92	.021
4	107, 254, 255	(9.312848 N, 42.343386 E)/15.59 km	16	15	2.22	9.63	.023
5	42, 40, 41	(9.548779 N, 40.084216 E)/53.09 km	11	11	2.36	9.38	.027

Figure 5. SaTScan analysis of measles vaccination among children aged 12–23 months across zones in Ethiopia, 2019 EMDHS.

Table 3. Model comparison and random effect analysis result

Parameters	Model I	Model II	Model III	Model IV
Community level variance (SE)	2.236 (0.493)	0.818 (0.273)	0.923 (0.280)	0.551 (0.234)
ICC	40.46%	19.90%	21.92%	14.33%
MOR	4.164	2.37	2.500	2.03
Log likelihood	−638.69085	−548.52957	−580.58071	−530.57883
LR test	X^2 = 99.93, p < .001	X^2 = 20.82, p < .001	X^2 = 28.57, p < .001	X^2 = 10.41, p < .001
Deviance	1,277.3817	1,097.05914	1,161.16142	1,061.15766

Table 4. Multivariable multilevel logistic regression analysis of individual and community-level factors associated with measles vaccination among children aged 12–23 months in Ethiopia

Variables	Model I	Model II AOR (95% CI)	Model III AOR (95% CI)	Model IV AOR (95% CI)
Maternal age 15–19 20–24 25–29 30-34 35–39 40–44 45–49		1.00 1.33 (0.49–3.63) 1.16 (0.40–3.39) 1.27 (0.37–4.37) 2.81 (0.70–11.39) 2.54 (0.52–12.36) 0.25 (0.029–2.075)		1.00 1.40 (.50–3.87) 1.09 (.36–3.28) 1.16 (.33–4.13) 2.49 (.59–10.39) 2.30 (.46–11.50) 0.31 (.04–2.54)
Maternal education No education Primary Secondary & above		1.00 2.65 (1.59–4.43) 4.93 (2.10–11.56)		1.00 2.73 (1.64–4.57)* 4.99 (2.22–11.21)*
Religion Protestant Orthodox Muslim Other & traditional		1.00 4.01 (2.10–7.67) 1.85 (0.95–3.60) 0.65 (0.27–1.56)		1.00 3.07 (1.53–6.17)* 2.59 (1.25–5.38)* 0.74 (.28–1.93)
Wealth status Poor Middle Rich		1.00 0.70 (0.35–1.40) 1.26 (0.65–2.44)		1.00 0.71 (.35–1.42) 0.86 (.46–1.61)
ANC follow-up No 1–3 ≥4 visits		1.00 1.09 (0.60–1.99) 1.87 (0.92–3.78)		1.00 0.97 (.54–1.76) 1.74 (.86–3.50)
Place of delivery Home Health facility		1.00 2.55 (1.40–4.67)		1.00 2.43 (1.34–4.40)*
Birth order 1st 2nd–5th ≥6		1.00 0.80 (0.22–2.88) 0.94 (0.11–8.26)		1.00 0.74 (.19–2.83) 0.75 (.09–5.88)
No_ of living children 1 2–5 ≥6		1.00 2.07 (0.51–8.48) 1.02 (0.13–8.32)		1.00 2.36 (.55–10.21) 1.46 (.20–10.68)
Ever had a health card No Yes		1.00 0.99 (0.59–1.69)		1.00 0.96 (.545–1.68)
Region Addis Ababa Afar Amhara Oromia Somali Benishangul SNNPR Gambela Harari Tigray Dire Dawa			1.00 0.90 (0.03–0.27) 0.67 (0.193–2.29) 0.26 (0.06–1.05) 0.10 (0.03–0.36) 0.89 (0.24–3.34) 0.35 (0.09–1.37) 0.27 (0.09–0.74) 0.33 (0.10–1.10) 1.33 (0.35–4.98) 0.63 (0.19–2.12)	1.00 0.20 (0.06–0.75)* 1.21 (0.34–4.31) 0.62 (0.18–2.09) 0.31 (0.07–1.33) 1.60 (0.44–5.86) 1.30 (0.38–4.40) 0.61 (0.19–1.92) 0.57 (0.15–2.20) 1.81 (0.42–7.77) 1.01 (0.23–4.39)
Residence Urban Rural			1.00 0.29 (0.10–0.80)	1.00 0.43 (0.22–0.85)*

*p-value < .05, AOR: adjusted odds ratio, CI: confidence interval, 1.00: reference group

Table

ANC	Antenatal care
AOR	Adjusted odds ratio
CI	Confidence Interval
CSA	Central Statistical Agency
DHS	Demographic and Health Survey
EA’s	Enumeration Areas
EMDS	Ethiopian mini Demographic and Health Survey
EPI	Expanded Program on Immunization
ICC	Intracluster correlation coefficient
LLR	Log-likelihood ratio
MCV1	Measles-containing vaccine first dose
MCV2	Measles containing vaccine second dose
RR	Relative Risk
SNNPR	South Nation Nationality and Peoples Region
UNICEF	United Nations Children’s Fund
VIF	Variance inflation factor
WHO	World Health Organization

Data availability statement

The dataset used for this study is publicly available at the MEASURE DHS program website https://www.dhsprogram.com/data.