Spatial distribution and associated factors of non-uptake of DTP3 vaccination among children aged 12-23 months in East Africa: geospatial analysis.

BACKGROUND

The diphtheria-tetanus-pertussis (DTP) vaccine is one of the core vaccines provided through the Expanded Program on Immunization (EPI), which is administered to children in a series of three doses to protect against three bacterial diseases. Previous studies have assessed the factors associated with non-uptake of DTP3 vaccination among children. However, studies incorporating geospatial analysis remain limited, particularly in East Africa. Therefore, this study aimed to assess the spatial distribution and associated factors of non-uptake of DTP3 vaccination among children aged 12-23 months in East Africa.

METHODS

A total weighted sample of 14,200 children were included from demographic and health survey data of seven East African countries conducted from 2018 to 2023. ArcGIS Pro was used to explore the spatial distribution of non-uptake of DTP3 vaccination. Furthermore, spatial clusters were identified using Kulldorff's spatial scan statistics. Multiscale geographically weighted regression analysis was done to assess significant associated factors.

RESULTS

The spatial distribution of non-uptake of DTP3 vaccination in East Africa was clustered. SaTScan identified 291 primary spatial clusters, with a relative risk of 3.97 at a p-value of < 0.001, in the central and most of the northern regions of Mozambique. Multiscale geographically weighted regression revealed that no maternal educational background and fewer than four antenatal care visits were positively associated with non-uptake of DTP3 vaccination, whereas health facility delivery was negatively associated with non-uptake of DTP3 vaccination in East Africa.

CONCLUSIONS

In East African countries, the high rate of non-uptake of DTP3 vaccination was observed in eastern and northeastern parts of Kenya; central and northern parts of Mozambique; northern and southern parts of Madagascar; and southern and eastern parts of Ethiopia. Therefore, it is recommended to launch community-based educational campaigns and strengthen maternal and child health services in these hotspot areas.