AUTHOR=Mamo Habtie Getnet , Melaku Mequannent Sharew , Aychiluhm Setognal Birara 

TITLE=A multilevel analysis of factors associated with unimmunized children in Ethiopia

JOURNAL=Frontiers in Public Health

VOLUME=Volume 13 - 2025

YEAR=2025

URL=https://www.frontiersin.org/journals/public-health/articles/10.3389/fpubh.2025.1433606

DOI=10.3389/fpubh.2025.1433606

ISSN=2296-2565

ABSTRACT=IntroductionIn Ethiopia, 16% of deaths among children aged less than 5 years are attributable to diseases that can be prevented through vaccination. However, studies carried out in Ethiopia to date have not investigated how community- and individual-level factors affect children who receive no vaccine at all. Hence, this study aimed to assess the factors associated with unimmunized children in Ethiopia.MethodsThis study is a secondary analysis of Demographic and Health Survey (DHS) data. A weighted sample of 6,219 children aged less than 5 years was included after a stratified two-stage cluster sampling. To determine the factors that influence unimmunized children, a multivariable multilevel logistic regression model was developed. In addition, adjusted odds ratio (AOR) with 95% confidence interval (CI) was used to select variables that have statistically significant effects on unimmunized children.ResultsThe prevalence of unimmunized children aged less than 5 years in Ethiopia was 22.45% (95% CI: 21.4–23.5). In the multivariable multilevel analysis, individual-level factors associated with increased odds of having unimmunized children included no media exposure (AOR 1.33, 95 CI: 1.02–1.63), place of delivery (AOR 1.5, CI: 1.22–1.91), and the child’s relationship to the household head—specifically between the household head and a daughter (AOR 1.5, 95 CI: 1.05–2.41) or categorized as others (AOR 1.8, 95, CI: 1.15–2.74). Community-level predictors associated with unimmunized children included place of residence (AOR 1.8, 95, CI: 1.12–2.58), distance from the health facility (AOR 1.32, 95, CI: 1.09–1.60), and community poverty level (AOR 1.4, 95, CI: 1.05–1.78).ConclusionIn Ethiopia, approximately one-fourth of children could not get basic vaccinations. Media exposure, place of delivery, relationship with the household head, place of residence, distance from the health facility, and community poverty were found to be factors significantly associated with unimmunized children.