<p>Nearly forty percent (39.6%): 95% CI [32.0 - 45.5] of children met the definition for zero dose, and more than half (56.2%) of the children were under-immunized. Only 19.2%: 95% CI [13.5 - 23.3] of children aged 12-23 months received all basic vaccinations in Afar and Somali region. The following factors were all significantly associated with a child 12-23 months being zero doses: older age of the father, travel time above 15 minutes to the nearest health facility, household not visited by a health extension worker, and a caretaker’s poor knowledge about immunization. Variations in the level of knowledge and attitude among different segments of the community were noted. While some of the communities have a deep understanding of the immunization program, many believe there are no benefits to immunizing children according to the qualitative findings.</p>