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Vaccine. 2019 Apr 3;37(15):2106-2121. doi: 10.1016/j.vaccine.2019.02.045. Epub 2019 Feb 27.

Vaccine non-receipt and refusal in Ethiopia: The expanded program on immunization coverage survey, 2012.

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Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, MI, USA. Electronic address:
Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, MI, USA.
Ethiopian Public Health Institute, Addis Ababa, Ethiopia.
Department of Public Health, St. Paul's Hospital Millennium Medical College, Addis Ababa, Ethiopia.
Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, MI, USA; Department of Internal Medicine, Division of Infectious Disease, University of Michigan Medical School, Ann Arbor, MI, USA.



Rates of full childhood immunization in Ethiopia are well below the WHO global goal of 90% coverage by 2020. This study explores associations between sociodemographic characteristics and healthcare services utilization with experiences of not receiving a vaccine in Ethiopia.


This analysis uses data from Ethiopia's 2012 Expanded Program on Immunization Coverage Survey. The relationships between explanatory variables, including sociodemographic and healthcare utilization factors, and various reasons a child was not vaccinated were assessed with Rao-Scott chi-square tests. Multivariable logistic regression analyses examined significant predictors of these experiences.


The sample includes the caregivers of 2,722 children. Experiences of not receiving a vaccine were characterized overall and by type of experience: whether a caregiver ever refused vaccination for their child (2.9%), ever decided to not take their child to a health center for vaccination (3.6%), and ever went to a health facility for vaccination but child was not vaccinated (12.0%). Region of residence, possession of a vaccination card, and the setting of the child's last routine vaccination were predictors of not receiving a vaccine. Caregivers reported negative perceptions of vaccines were among their reasons for refusing a vaccine or declining to take their child to a health facility for vaccination.


Prior experiences with health facilities, such as where a child received their last routine vaccine, play a key role in future vaccination. Vaccine receipt at an outreach event is associated with not bringing a child to a health facility for vaccination, which may indicate an unwillingness to visit or difficulty accessing health centers. Further, negative perceptions of vaccines may result in vaccine refusal or delay. Findings of this study provide public health officials with a better understanding of factors related to vaccination experiences and can inform development of interventions that will improve childhood vaccination rates in Ethiopia.


Ethiopia; Expanded program on immunization; Missed opportunities; Vaccine non-receipt; Vaccine refusal

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