Spatial distribution and associated factors of zero-dose immunization among 12–23 month-old children in Ethiopia: spatial and survey regression analysis

Abstract Background Immunization is one of the public health interventions, saving millions of lives. Despite this, many children, especially those living in low- and middle-income countries, continue to miss out on lifesaving vaccines, the worst of which is zero-dosage. It is crucial to identify individuals and obtain timely, reliable information on their geographic distribution and related attributes to support spatially tailored strategies and interventions. Undoubtedly, assessing zero-dose prevalence is an input to achieve the WHO’s 2030 agenda, which attempts to reduce the number of zero-dose children. Hence, this study aimed to determine the prevalence, spatial distribution and associated factors of zero-dose immunization among children in Ethiopia. Methods A secondary analysis of the Ethiopian mini demographic and health survey 2019 data was conducted. Our analysis focused on zero-dose immunization among children aged 12–23 months. Geographic variations in zero-dose prevalence were assessed using spatial analysis techniques, including Moran’s I statistic and inverse distance weighted interpolation. Bivariable and multivariable survey logistic regression models were used to identify factors associated with zero-dose immunization. Results A total of 1008 children aged 12 to 23 months old were retained for the final analysis. The overall weighted prevalence of zero-dose immunization status at national level in Ethiopia was 23.7% [95% CI: 18.7–28.5]. Hot spots of zero-dose immunization were observed in southwest and northeast part of Ethiopia whereas cold spots of zero-dose immunization were observed in the central and northern parts of the country. Rural resident children [AOR = 2.55; 95%CI: 1.05, 6.22], female children (AOR = 1.78; 95%CI: 1.09, 2.91), children not delivered at the health institution (AOR = 4.12; 95% CI: 2.39, 7.08), and children from a mother did not completed four or more ANC visits (AOR = 2.55; 95% CI: 1.37, 4.75) were more likely to be zero-dose as compared to their counter parts. Conclusion There is high prevalence of children being zero-dose among 12–23 months old children in Ethiopia. Interventions tailored on geographic areas, residence, sex of the child, four or more ANC visits and institutional delivery could help to reduce zero-dose children in Ethiopia.