Spatial distribution of rotavirus immunization coverage in Ethiopia: a geospatial analysis using the Bayesian approach.

ABSTRACT

INTRODUCTION: Rotavirus causes substantial morbidity and mortality every year, particularly among under-five children. Despite Rotavirus immunization preventing severe diarrheal disease in children, the vaccination coverage remains inadequate in many African countries including Ethiopia. Measuring rotavirus immunization coverage in 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 immunization coverage in Ethiopia. METHODS: Rotavirus immunization coverage data were obtained from the recent Ethiopian Demographic and Health Survey (EDHS 2019). Covariate data were assembled from different publicly available sources. A Bayesian geostatistics 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 (ß) 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 (ß) - 0.45; 95% credible interval (95% CrI) (- 0.73, - 0.18)] and distance to the nearest health facilities [mean regression coefficient (ß) - 0.71908; 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 immunization services should be also implemented in areas with low coverage.