Incomplete basic vaccination and associated factors among children aged 12-23 months in resource-limited Countries; recent DHS of 48 Countries: Spatial and Multilevel regression analysis

Mihret Getnet ^* Melak Jejaw Tadele Biresaw Belachew Banchlay Addis Endalkachew Dellie Tesfahun Zemene Tafere Nigusu Worku Demiss Mulatu Geberu Lake Yazachew Getachew Teshale Misganaw Guadie Tiruneh Kaleb Demissie

• University of Gondar, Gondar, Ethiopia

Background: Childhood basic vaccinations are a cost-effective and essential preventive health strategy on a global scale in resource-limited nations. Sustainable Development Goals are planned to reach these ambitious targets, which is crucial to identify underserved populations and address the barriers they face in accessing life-saving immunizations. To date, no spatial analyses have been performed to identify areas of hotspots of incomplete basic vaccination among children in resource-limited countries globally. Therefore, determining the geographic distributions of incomplete basic vaccinations and associated factors is important for prioritizing intervention programmes in resource-limited countries. Objective: To assess incomplete basic vaccinations and associated factors among children aged 12-23 months in resource-limited countries; recent DHS of 48 countries. Methods: Data for the study were drawn from the Demographic and Health Survey (DHS), a nationally representative cross-sectional survey conducted by considering era of Millennium Development Goals and Sustainable Development Goals. Forty eight resource-limited countries and a total weighted sample of 202,029 children (12-23 months) were included in our study. The data extraction, recoding and analysis were done using STATA V.17. For the spatial analysis ArcGIS version 10.7 software, and for the SaTScan analysis, SaTScan version 10.1 software was used. We employed multilevel logistic regression to investigate associated factors of incomplete basic vaccination among children aged 12-23 months. Results: The overall incompleteness of basic vaccination among children in resource limited countries was 51 % (95%CI: 50 -51%). The spatial analysis revealed that the incomplete basic vaccination among children significantly varied across resource limited countries. (Global Moran's I=0.208468, p<0.001). Based on the final model of multilevel analysis; age, marital status, maternal educational status, husband education, maternal occupation, media exposure, wealth index, ANC visit, birth order, place of delivery, mode of delivery, health insurance coverage, perception of distance from a health facility, place of residence, community media exposure, community education and country-level income status were statistically significant variables associated with incomplete basic vaccination. Conclusion and recommendations: The spatial distribution of incomplete basic vaccination was significantly varied across the resource-limited countries. Both individual and community level factors were significantly associated with incomplete basic vaccination.