Geospatial mapping to assess the distribution and determinants of zero dose vaccination status hot spots among children in Ethiopia using EDHS 2019: Spatial and geographical weighted regression.

Zero-dose vaccine status refers to a child who has not yet received any childhood vaccines. Globally, zero-dose vaccination status is the major public health problem. In sub-Saharan African countries, among five children, one child did not access the vaccines. The efforts to identify the factors contributing to the zero-dose vaccine have not yet been addressed in Ethiopia. To assess the distribution and determinants of zero dose vaccination status hot spots among children in Ethiopia using Ethiopian demographic health survey 2019. A secondary analysis of a cross-sectional study was used among a total of 3208 participants. Stata-14, Arc geographic information system-10.3, and Sat Scan software were used to analyze the data. Moran's I statistic was used to assess the non-random distribution of zero-dose vaccination status. Spatial and geographically weighted regression was used to map the distribution and determinants of zero-dose vaccination status in Ethiopia. The Getis-Ord-statistics and Sat Scan analysis were also used to identify the hot spot area and significant clusters respectively. To identify significant factors, a p-value <0.05 was used. The prevalence of zero-dose vaccination status among children aged 12-35 months old was 16.3% (95%CI, 15%-17.6%). The distribution of zero-dose vaccination status in Ethiopia was not randomly distributed across the area (Moran's I value = 0.4, p<0.001). The hotspot area of zero-dose vaccination status in Ethiopia was located in Afar, Somalia, and the south nations region. The primary cluster was located at 5.479641 N and 42.196835 E within a 405.96 km radius in the Somali region. The highest effect (β, 0.23-0.24) of give birth at home on zero-dose vaccination status was observed in Afar, Somalia, and Tigray, whereas the lowest effect of home delivery (β, 0.21-0.22) was observed in south nations, Gambela, and the western part of Benishangul Gumuz. Additionally, the poor wealth index had the highest effect on zero-dose vaccination status (β, 0.06-0.07) in south nations, Benishangul Gumuz, and the Gambela region, and the lowest effect of the poor wealth index (β, 0.03-0.04) was observed in Somalia and the Afar region. The zero dose child in Ethiopia was low. Geographically, the highest proportion of zero-dose vaccination status among children was in the Somali and Afar regions. Home delivery had the highest and most positive effect on zero-dose vaccination status in Afar, Somalia, and the Tigray region. Additionally, the poor wealth index had the highest and most positive effect in Somalia and the Afar region. Expanding delivery at the health facility and economic empowerment of women are recommended to improve vaccination in Ethiopia.

Agimas MC ，Asmamaw M ，Hailu MK ，Kidie T ，Abuhay HW ，Yismaw GA ，Derseh NM ... -  《PLoS One》

Spatial variation and associated factors of home delivery among reproductive age group women in Ethiopia, evidence from Performance Monitoring for Action Ethiopia Survey 2019, spatial and multilevel logistic regression analysis.

Home birth is described as a delivery that takes place at home without the presence of a skilled birth attendant. In 2017, nearly 295,000 mothers died from various pregnancy and childbirth-related problems, accounting for approximately 810 maternal deaths per day. Therefore, this study aims to investigate the spatial distributions of home birth and associated factors in Ethiopia using the Performance Monitoring for Action Survey (PMAS) 2019) to get information that helps to take geographic-based interventions and can assist health planners and policymakers in developing particular measures to reduce home deliveries. In PMA-ET 2019, a community-based cross-sectional study was conducted in collaboration with Addis Ababa University, Johns Hopkins University, and the Federal Ministry of Health from September 2019 to December 2019, in Ethiopia. A multi-stage cluster sampling procedure was employed to draw from the stratified 2019 PMAS sample. A weighted total of 5,796 women were included in this study. ArcGIS version 10.7 software was used to visualize the spatial analysis. In addition, STATA version 14 of the statistical software was used for multilevel analysis The Bernoulli model was applied using Kulldorff's SaTScan version 9.6 software to identify significant purely spatial clusters for home delivery in Ethiopia. Intra-class Correlation Coefficient (ICC), Likelihood Ratio (LR) test, Median Odds Ratio (MOR), and deviance (-2LLR) values were used for model comparison and fitness. Adjusted Odds Ratios (AOR) with a 95% Confidence Interval (CI) and p-value <0.05 in the multilevel logistic model were used to declare significant factors associated with home delivery. The spatial distribution of home delivery was non-random in Ethiopia. Statistically significant high hotspots of home delivery were found in Somali, Afar, Sidama, most of South Nation Nationality and People Region (SNNP), most parts of Amhara, south west Ethiopia, and Oromia region. In the multilevel logistic regression model; Women from the lowest wealth quintile were 1.68 times [AOR = 1.68; 95% CI: 1.31, 2.15] higher odds of giving birth at home as compared to their counterparts. Regarding maternal educational status, mothers who had no education, primary education, and secondary education had 9.91 times [AOR = 9.91, 95% CI: 5.44, 18.04], 6.62 times [AOR = 6.62, 95% CI: 3.65, 12.00] and 2.99 times [AOR = 2.99, 95% CI: 1.59, 5.63] higher odds of giving birth at home compared to mothers who attained higher education, respectively. In addition, community-level factors were significantly associated with home delivery, women who had high community-level poverty were 1.76 times [AOR = 1.76; 95% CI: 1.14, 2.72] higher odds of home delivery compared to women who had low community-level poverty. Home delivery was statistically found to be a significantly high hot spot in Somalia, Afar, Sidama, most of the South Nation Nationality and People area (SNNP), most of Amhara, southwest Ethiopia, and the Oromia region of Ethiopia. Significant factors associated with home delivery in Ethiopia were women with lower levels of education, poor wealth, living in rural areas, high levels of community poverty, divorced or separated widowed marital status, and older maternal ages. Therefore, health institutions, health professionals, National and regional policymakers health planners community leaders and all concerned should give priority to the identified hot spot clusters to design an effective intervention program to reduce home delivery.

Enyew EB ，Ayele K ，Asmare L ，Bayou FD ，Arefaynie M ，Tsega Y ，Endawkie A ，Kebede SD ，Tareke AA ，Abera KM ，Kebede N ，Feyisa MS ，Mihiretu MM ... -  《-》

Spatial co-distribution of tuberculosis prevalence and low BCG vaccination coverage in Ethiopia.

While bacille-calmette-guerin (BCG) vaccination is one of the recommended strategies for preventing tuberculosis (TB), its coverage is low in several countries, including Ethiopia. This study investigated the spatial co-distribution and drivers of TB prevalence and low BCG coverage in Ethiopia. This ecological study was conducted using data from a national TB prevalence survey and the Ethiopian demographic and health survey (EDHS) to map the spatial co-distribution of BCG vaccination coverage and TB prevalence. A Bayesian geostatistical model was built to identify the drivers for the spatial distribution of TB prevalence and low BCG vaccination coverage. BCG vaccination coverage was defined as the number of children who received the vaccine divided by the total number of children born within five years preceding the EDHS surveys. Parameter estimation was done using binary logistic regression. Prediction maps for the co-distribution of high TB prevalence and low BCG vaccination coverage were created by overlying spatial prediction surfaces of the two outcomes. Posterior means and a 95% Bayesian credible interval (CrI) were used to summarize the parameters of the model. The national prevalence was 0.40% (95% confidence interval (CI) 0.34%, 0.47%) for TB and 47% (95% CI 46%, 48%) for vaccination coverage. Substantial spatial variation in TB prevalence and low BCG coverage was observed at a regional and local level, particularly in border areas of the country, including the Somali, Afar, and Oromia regions. Approximately 58% of the pixels (i.e., geographical area or spatial units) with high TB prevalence exhibited low BCG coverage in the same location. While travel time to cities (Mean = 0.28, 95% BCI: 0.15, 0.41) and distance to health facilities (Mean = 0.43, 95% CI 0.22, 0.63), were positively associated, population density (Mean = -0.04, 95% BCI -0.05, -0.02) was negatively associated, with the proportion of unvaccinated children for BCG indicating areas near health facilities and cities have better BCG coverage. However, there were no significant predictors for TB prevalence. Substantial spatial co-distribution between high TB prevalence and low BCG coverage was observed in some parts of the country, indicating that there are areas where the TB burden is not being adequately managed through the provision of vaccines in Ethiopia. Scaling up BCG vaccination coverage and TB diagnosis and treatment through improving access to health services in border regions such as Somalia and Afar would be important to reduce the prevalence of TB in Ethiopia.

Wolde HF ，Clements ACA ，Gilmour B ，Alene KA ... -  《Scientific Reports》

Tobacco Product Use and Associated Factors Among Middle and High School Students - National Youth Tobacco Survey, United States, 2021.

Gentzke AS ，Wang TW ，Cornelius M ，Park-Lee E ，Ren C ，Sawdey MD ，Cullen KA ，Loretan C ，Jamal A ，Homa DM ... -  《MMWR SURVEILLANCE SUMMARIES》

Spatial distribution of zero-dose children in Ethiopia: evidence for a targeted intervention from a large-scale cross-sectional evaluation survey.

Ethiopia is the fourth leading contributor to the global total of zero-dose children (those who lack the first dose of diphtheria-tetanus-pertussis containing 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. 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. Spatial autocorrelation was measured using the Global Moran'sIstatistic. 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. A total of 3,646 children aged 12-35 months were included in the study. The spatial distribution of zero-dose children in Ethiopia was non-random (Global Moran'sI = 0.178971, p < 0.001). According to the hotspot analysis, western, eastern and northern parts of Somali and western and central parts of Afar regions had the highest load of zero-dose children (hotspot areas) followed by the Northeastern part of Amhara and southeastern part of Oromia regions. On the other hand, Southern Nations, Nationalities, and Peoples, Sidama, and the Eastern part of the Southwest Ethiopia peoples regions were identified as cold spot areas. The spatial interpolation analysis corresponded with the hotspot analysis results where western and central parts of Afar and western, eastern and northern parts of Somali regions were identified as high-risk areas for zero-dose children. However, Addis Ababa, Dire Dawa, Harari, Southern Nations, Nationalities, and Peoples, Sidama, Southwest Ethiopia Peoples, and parts of Oromia were found to be low-risk areas for zero-dose children. The spatial analysis identified that zero-dose children had a significant spatial variation across the study areas. High clusters of zero-dose children were detected in Afar and Somali regions. Implementing routine and mop-up vaccination campaigns in the identified hotspot areas will help Ethiopia to improve coverage and reduce immunization inequalities.

Shiferie F ，Gebremedhin S ，Andargie G ，DelPizzo F ，Belete K ，Fenta TG ... -  《Frontiers in Pediatrics》