Hidden Costs Of Routine Immunization Service And Associated Factors Among Parents In Selected Public Health Centers In Lemikura Sub City, Addis Ababa, Ethiopia, 2025

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.