Abstract:
Background: The Economists define costs as the value of resources used to produce a good or
specific health service or a set of services in health program. Hidden costs of immunization
encompass both direct and indirect expenses incurred by parents or caregivers during service
utilization.
Objective: To assess the hidden costs of routine immunization service and associated factors
among parents in selected public health facilities in Lemi Kura Sub city, Addis Ababa, 2025
Methods: A mixed type study was conducted from January 29 to February 28, 2025 in Lemi
Kura Sub-City in public health centers selected by simple random sampling. Data were collected
via face-to-face exit interviews using a pre-tested structured questionnaire through Kobo
Toolbox. Quantitative data were analyzed using SPSS v27 using multiple linear regression to
identify predictors at a significance level of p < 0.05. Nineteen key informant interviews were
conducted with immunization purposively selected focal persons and parents using interview
guide. Thematic analysis was used for qualitative data.
Results: A total of 237 respondents participated in the study with 100% response rate. The mean
(+SD) age of the respondents was 28.72 (+5.11) years. The mean overall cost, both medical and
non-medical was 1026.83 ETB (8.2803$). Significant predictors of hidden cost were age of child
(β = 0.434), number of accompanying persons (β = 0.267), arrival time to the health center (β =
0.271) and waiting time at facility (β = 0.351). A key informant interview from health care
professional explained the costs of adverse event following immunization, travel time, and long
waiting time, long distance from home can be barriers for accessing routine immunization
service.
Conclusion and recommendation: The age of child, number of accompanying persons, facility
arrival time and waiting time at health center was significant predictors and incurred different
amount of cost. Increasing the number and frequency of outreach sites, improving staffing,
expanding service delivery strategies may reduce waiting times and transportation costs can
improve immunization program.
