Decomposition of Wealth-Related Inequalities in Childhood Zero-Dose Vaccination: Analysis of the 2016 Ethiopian Demographic and Health Survey

Vaccination prevents 3.5-5 million deaths annually, yet inequities persist within low- and middle-income countries, including Ethiopia. Zero-dose children, those who have not received any routine vaccines, are often found in the poorest and most marginalized communities. In 2019, 16.3% of Ethiopian children aged 12-35 months were zero-dose, highlighting persistent wealth-related disparities. The aim for the present study was to examine wealth-related inequalities in zero-dose status among Ethiopian children aged 12-23 months and identify key contributing factors. A secondary analysis of the 2016 Ethiopian Demographic and Health Survey was conducted, including 1,890 children aged 12-23 months. Zero-dose status was defined as not receiving the first dose of a diphtheria-, tetanus-, and pertussis-containing vaccine. Wealth-related inequality was measured using the Erreygers corrected concentration index (CnI), and contributing factors were assessed using Wagstaff decomposition analysis. Overall, 25.7% of children were zero-dose, with the highest prevalence among those whose mothers had no education, received no antenatal care (ANC), delivered at home, or lived in rural or pastoralist areas. The CnI (-0.15; P