Zero‐Dose Vaccination Among Children Aged 12–35 Months in Ethiopia

Background Immunization is one of the most successful and cost‐effective public health interventions worldwide. Approximately 62% of zero‐dose children live in just 10 countries, including Ethiopia. In West Arsi Zone, findings from the rapid convenient survey (RCS) were inconsistent with DHIS‐2 reports. Objective The objective was to determine the proportion of zero‐dose vaccination and identify associated factors among children aged 12–35 months in West Arsi Zone, June–August 2023. Methods We conducted a community‐based cross‐sectional study on 1456 children selected using multistage stratified random sampling. Data were collected through face‐to‐face interviews with mothers/caretakers and record reviews using an ODK questionnaire. Data were cleaned and analyzed in Stata 16. Binary logistic regression identified factors associated with zero‐dose vaccination. Variables with p < 0.25 and practical significance were included in multivariable regression; statistical significance was set at p < 0.05. Results The proportion of zero‐dose vaccination was 9.62% (8.10–11.13). The main reasons included unawareness of the need for vaccination (29.57%) and unavailability of the vaccines/vaccinators (15.59%). Factors associated with higher odds of zero‐dose vaccination were as follows: living in kebeles where health posts lacked refrigerators (AOR = 2.08, 95% CI: 1.25–3.45), communities without social mobilization for immunization (AOR = 2.63, 95% CI: 1.44–4.80), caregiver unawareness of HEWs (AOR = 1.77, 95% CI: 1.02–3.07), poor immunization knowledge (AOR = 3.08, 95% CI: 1.83–5.21), negative (AOR = 4.24, 95% CI: 2.25–7.97), or neutral attitude (AOR = 4.21, 95% CI: 2.36–7.52) toward immunization, waiting times > 30 min (AOR = 2.83, 95% CI: 1.67–4.97), lack of health education at the facility (AOR = 2.48, 95% CI: 1.44–4.27), mothers with no ANC (AOR = 4.08, 95% CI: 2.32–7.16), home delivery (AOR = 4.07, 95% CI: 2.30–7.20), and female children (AOR = 1.75, 95% CI: 1.10–2.78). Conclusions Zero‐dose vaccination is consistent with RCS findings and is unacceptably high compared to the national targets (100% Pentavalent 1 coverage nationally; 98% per district). Interventions should focus on increasing community awareness, ensuring vaccines and vaccinator availability, and promoting equal care for male and female children.