Systemic barriers to achieving yellow fever vaccination coverage targets among children aged 9-23 months in the Democratic Republic of the Congo.
Despite efforts to improve vaccination coverage, many children remain insufficiently protected in sub-Saharan Africa where health systems remain fragile. This study aimed to identify systemic barriers to achieving yellow fever vaccine coverage targets in the Democratic Republic of the Congo (DRC). An analytical cross-sectional survey was conducted from January to August 2024 in 156 health areas across six provinces of the DRC. The study population included 1247 children aged 9-23 months and their mothers or guardians. Data collected covered sociodemographic, socioeconomic, and contextual characteristics related to the organization of the health system. Logistic regression was used to identify factors associated with lack of vaccination coverage at a significance level of p < 0.05. Yellow fever vaccine (YFV) coverage was 80.8%. Multivariate analysis identified several barriers to YFV coverage: maternal occupation (aOR = 1.82), precarious housing (aOR = 3.14), the presence of at least two children in the household (aOR = 1.42), the rainy season (aOR = 5.92), absence of community awareness activities (aOR = 4.42), and reliance on a fixed vaccination strategy (aOR = 5.73). These findings highlight the importance of socioeconomic and organizational determinants in access to vaccination. Strengthening outreach strategies, community mobilization, and adapting services to environmental constraints appear essential to improve vaccination equity and achieve coverage targets in endemic settings.