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Fisseha Shiferie Tadesse, Speaker at Vaccines Conferences
Project HOPE, Ethiopia
Title : Spatial distribution of zero-dose children in Ethiopia: Evidence for a targeted intervention from a large-scale evaluation survey


Background: Ethiopia is the fourth leading contributor to the global total of zero-dose children (those who lack the first dose of the pentavalent vaccine) and has substantial regional variations in zero-dose children. This study explored the spatial pattern of zero-dose children aged 12-35 months in Ethiopia.

Methods: A survey was conducted in pastoralist regions, developing regions, newly-established regions, conflict-affected areas, underserved urban populations, hard-to-reach areas, internally displaced populations, and refugees and included a total of 3,646 children aged 12-35 months. Spatial autocorrelation was measured using the Global Moran’s I statistic. Getis-Ord Gi* statistics was applied to calculate the spatial variability of the high and low prevalence rates of zero-dose children. The spatial interpolation technique was also applied to estimate unknown values that fall between known values. Inverse distance weighting interpolation method was used to predict the risk of zero-dose children. ArcGIS version 10.8 was used for the spatial analysis.

Results: The spatial distribution of zero-dose children aged 12–35 months in Ethiopia was non-random (Global Moran’s I=0.178971, p< 0.001). According to the hotspot analysis, Somali and Afar regions had the highest load of zero-dose children (hotspot areas) followed by the Northeastern part of Amhara and peripheral areas of Oromia region. On the other hand, SNNP, Sidama, and the Eastern part of the Southwest Ethiopia region were identified as cold spot areas. The spatial interpolation analysis corresponded with the hotspot analysis results where Afar and Somali regions were identified as high-risk areas for zero-dose children followed by the Northeastern part of Amhara and peripheral areas of Oromia region. However, Addis Ababa, Dire Dawa, Harari, Southern Nations, Nationalities, and Peoples, Sidama, Southwest Ethiopia, and parts of Oromia were found to be low-risk areas for zero-dose children.

Conclusion: The spatial analysis identified that zero-dose children had a significant spatial variation across the study areas where high clusters of zero-dose children were detected in Afar and Somali regions, followed by the Northeastern part of Amhara and peripheral areas of the Oromia region. Implementing routine and mop-up vaccination campaigns in the identified hotspot areas will help Ethiopia to improve coverage and reduce immunization inequalities.

Audience Takeaway:

  • Spatial distribution of zero-dose children aged 12-35 months in Ethiopia
  • Areas with the highest load of zero-dose children (hot spot areas)
  • Evidence to design interventions in the identified areas
  • The different techniques to map zero-dose children which can also be applied to other public health problems.


Fisseha Shiferie completed his master’s in international public health from the French School of International Public Health in Paris, France and his Master of Pharmacology from Addis Ababa University, Ethiopia. Currently, he is a 3rd year PhD student at Addis Ababa University. He has been working for over 15 years in managerial, researcher and academician positions in research organizations, international NGOs and GOs including higher academic institutions. He has also worked as an expatriate in France, South Sudan, Ethiopia and Uganda. He is currently leading the Research, Learning and Publication unit at Project HOPE.