Socio-economic and urban–rural inequities in measles vaccination uptake in Ethiopia

Background

Measles remains a major cause of child morbidity and mortality in low- and middle-income countries despite effective vaccines. In Ethiopia, suboptimal coverage and persistent inequities continue to hinder progress toward elimination targets. This study assessed measles vaccination coverage and its determinants, with a focus on socioeconomic and urban–rural disparities.

Methods

We analysed data from the most recent publicly available nationally representative survey, the Ethiopia Demographic and Health Survey. The study included 997 children aged 12–23 months. Survey-weighted descriptive statistics and multivariable logistic regression were used to identify factors associated with measles vaccination.

Results

National measles vaccination coverage was 59.4% (95% CI: 52.7–66.0), well below the 95% target for herd immunity. Coverage increased markedly with household wealth (43.1% poorest vs. 82.4% richest) and was higher in urban than rural areas (78.1% vs. 51.0%). In adjusted analyses, maternal education remained a strong predictor (secondary: aOR 3.23, 95% CI: 1.27–8.20; higher: aOR 3.71, 95% CI: 1.19–11.53). Rural residence was associated with lower odds of vaccination (aOR 0.42, 95% CI: 0.20–0.91). Utilization of maternal health services, including ≥4 antenatal care visits (aOR 1.69, 95% CI: 1.03–2.77) and skilled birth attendance (aOR 2.38, 95% CI: 1.32–4.30), significantly increased vaccination likelihood. A significant interaction between wealth and residence indicated that poverty disproportionately reduced vaccination uptake in rural areas.

Conclusions

Substantial socio-economic, geographic, and service-related inequities persist in measles vaccination in Ethiopia. Strengthening primary healthcare, improving maternal service utilization, and prioritizing underserved rural populations are critical to achieving equitable immunization coverage. These findings highlight the need for equity-focused strategies in similar low-resource settings.

Key messages

• Measles vaccination coverage in Ethiopia remains low, with marked inequities by residence, maternal education, and access to health services.

• Targeted, equity-focused strategies and strengthened primary healthcare systems are crucial to improving vaccination uptake, particularly in underserved areas.