Published in PLOS One on 2026-07-02, this study is presented as an attributed evidence briefing. The excerpts below are the original researchers’ words, reproduced under their Creative Commons Attribution licence. Health Signal has selected the abstract and, where needed, opening background paragraphs; the complete methods, results, limitations and references remain in the linked paper.
Original authors: Habtamu Guaguahu Feleke, Mulat Belay Simegn, Daniel Tarekegn Worede, Werkneh Melkie Tilahun
Source: PLOS One • DOI 10.1371/journal.pone.0345899
Read the complete primary study ↗ · Creative Commons Attribution licence
From the researchers
Abstract
The pneumococcal conjugate vaccine (PCV) and rotavirus vaccine (RVV) have been introduced to Ethiopia’s expanded childhood immunization program in 2011 and 2013, respectively.
A cross-sectional study among 2,055 children aged 12–35 months was employed. Data were extracted from the Kids Record file of the 2019 Ethiopian Mini Demographic and Health Survey. Spatial regression models were fitted and compared using corrected Akaike Information Criteria, Bayesian Information Criteria and adjusted R2. Spatial predictors were determined to be statistically significant if their p-value was < 0.05.
Incomplete uptake of recently introduced immunizations was observed in nearly half (48.83%) of children aged 12–35 months. Its distribution throughout Ethiopia’s regions shows significant spatial clustering, with the eastern part of SNNPR and Somali regions having hot spots. A total of 3 significant clusters, located in southern Oromia, east and west Hararge, the entire SNNPR, and the majority of the Somali region, with a high rate of incomplete uptake of newly introduced vaccines, were identified during SaTScan analysis. Not having vaccination cards, household size more than 5 members, home delivery, not having postnatal care, and less than 18 maternal age at first birth are positive significant spatial factors while parents not being head of the household were identified as negative significant spatial factors.
There is high incomplete uptake and spatial disparities of PCV and RVV. To improve vaccination coverage among children aged 12–35 months, policymakers and health planners should prioritize targeted interventions in hotspot areas, strengthen maternal health service utilization, and enhance vaccination tracking systems. Promoting community awareness and improving access to essential health services will be critical to ensuring equitable immunization uptake across the country.
Introduction
Immunization is a primary intervention for preventing and controlling infectious diseases, which declines the prevalence of immune-preventable diseases [1–4]. Every year, nearly 2 million children under five die globally from pneumonia and diarrhea [5,6]. In developing nations, diarrhea leading cause of under-five fatalities, with rotavirus being the primary driver of severe diarrheal disease [7–9]. In Ethiopia, pneumonia and diarrhea are leading causes of illness and death in young children [10–12]. Rotavirus accounts for about 28% diarrheal hospitalizations and 6% diarrheal deaths among under-fives [13–17]. The high economic cost of managing these vaccine-preventable diseases underscores the need for prevention [1,18–20]. PCV and RVV vaccines effectively reduce the burden of diarrheal gastroenteritis and pneumonia in Ethiopian children [21,22].
Previous studies revealed that disparities in wealth status [3,23–29], birth order [19,26,29], sex of the child [25,30], maternal level of education [3,23,24,26–29,31–33], number of antenatal care (ANC) visits [3,25,26,28,29,31], marital status [3,24,30,31,34], place of delivery [3,24–26,28,29,31–33,35], mode of delivery [25,35], postnatal care (PNC) within two weeks of delivery [3,27–29,36,37], availability of a vaccination card at home or health facility [30,31,33,37–43], maternal age [29,30,44–47], place of residence [24,31,32,48,49], number of under-five children [3,50–52], relationship with household head [53], sex of household head [19], parity [52], maternal age at first delivery [54,55], pregnancy status [49], twin delivery [56], number of family members [25,49,52,57–59], healthcare access, household factors, computing health priorities, and cultural beliefs contribute to the uneven distribution of vaccine uptake [60–66].
Reading this evidence
Use the full paper to check the study design, participant selection, comparator and outcome definitions before drawing a practical conclusion. An association does not by itself show cause and effect. A reported performance measure needs its denominator and uncertainty. A finding from a particular facility, sample or time period should retain that scope when it is discussed elsewhere.
This briefing makes the source accessible within the wider public health desk. It does not assess an individual patient or certify a product. When considering relevance to another health system, examine the original authors’ account of context and limitations, then seek local implementation evidence. The related reporting below provides other studies to read alongside this one; it is a topic connection, rather than a claim that their results are directly comparable.
© 2026 Habtamu Guaguahu Feleke, Mulat Belay Simegn, Daniel Tarekegn Worede, Werkneh Melkie Tilahun. Excerpts reproduced under CC BY. Selection, formatting and contextual notes by Health Signal. The researchers are the authors of the source study, not members of Health Signal’s staff.
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