Jul 2026· BMJ public health· Vol 4, pp. e003980· 0 citations· 38 references
Medicine
TL;DR
This study assesses the prevalence of zero-dose children and associated factors in urban areas of the Somali region to inform targeted interventions and highlights the urgent need for improved identification and mapping in underserved communities.
Abstract
Abstract Introduction Despite global progress in immunisation, vaccine coverage remains uneven in many low- and middle-income countries. Urbanisation has widened disparities, particularly among children in informal settlements. Ethiopia has a high zero-dose burden, with the Somali region identified as a hotspot. However, urban areas in this region remain understudied. This study assesses the prevalence of zero-dose children and associated factors in urban areas of the Somali region to inform targeted interventions. Methods Using a mixed-methods approach, data were collected from 842 households in three urban towns through community surveys and six key informant interviews. The primary outcome was the proportion of zero-dose children, defined as those who had not received the first dose of the DTP-containing vaccine (Penta-1) during their first year of life, based on vaccination card records or caregiver recall. This included children who had never received any vaccine or had received some vaccines but not Penta-1. Quantitative data were analysed using logistic regression, while qualitative findings were examined thematically using the GAVI IRMMA framework. Strict quality control measures ensured the reliability of results. Results Of 842 targeted households, 827 participated (98.2% response). Findings reveal that 30% of children surveyed were identified as zero-dose for vaccination. Children were significantly more likely to be zero-dose if their mothers had no antenatal care (adjusted OR, AOR ~5.0), required permission for vaccination (AOR ~3.4), delivered at home (AOR ~3.1), or did not receive the second dose of tetanus toxoid (AOR ~2.7). In contrast, higher perceived household wealth and at least one postnatal care visit reduced the likelihood of zero-dose by about 45% and 55%, respectively. Zero-dose children were concentrated in urban peripheries and informal settlements with limited healthcare access, poor identification strategies and reliance on facility-based vaccination services. Conclusions The study highlights a higher prevalence of zero-dose children in urban areas, underscoring the urgent need for improved identification and mapping in underserved communities. Strengthening advocacy, diversifying immunisation approaches and addressing systemic barriers are essential to improving vaccine access and reducing the zero-dose burden.
BACKGROUND
Achieving the goals of Immunisation Agenda 2030 (IA2030) requires a clear understanding of vaccination timeliness and its determinants. We assessed vaccination timeliness and associated factors in two rural districts of northern Ghana.
METHODS
We conducted a community-based analytical cross-sectional study among 3371 caregivers of children aged 0-59 months in Gushegu (n = 1361) and Nanumba South (n = 2010) Districts, Northern Ghana, from 24 April to 4 May 2025. The study examined the timeliness of 19 vaccine doses in Ghana's national immunisation schedule. Vaccination status was classified as early, age-appropriate, delayed, unvaccinated, or up to date based on recommended age windows. Cox proportional hazards models were used to identify factors associated with vaccination timeliness.
RESULTS
Timely vaccination declined progressively across the immunisation schedule in both districts. Bacille Calmette-Guérin had the highest age-appropriate coverage (64.2% in Gushegu and 52.6% in Nanumba South), whereas timeliness decreased across multi-dose vaccine series. Age-appropriate coverage for pneumococcal conjugate vaccine declined from 60.9% to 20.5% in Gushegu and from 51.1% to 21.5% in Nanumba South between the first and third doses. Similarly, timely Pentavalent vaccination declined from 59.6% to 19.8% and from 52.1% to 23.0%, respectively. Rotavirus vaccine age-appropriate coverage dropped to 8.6% in Gushegu and 9.4% in Nanumba South for the third dose. Delays increased with successive doses and were greater in Nanumba South. Possession of a vaccination card was the strongest predictor of timely vaccination (Gushegu: aHR 30.82, 95% CI 12.02-79.03; Nanumba South: aHR 19.09, 95% CI 6.84-53.26). Higher caregiver education improved timeliness, while home or traditional birth attendant delivery reduced timeliness.
CONCLUSION
Timely vaccination remains suboptimal in both districts, with marked declines across the immunisation schedule. Strategies to improve vaccination card retention, caregiver education, access to vaccination services, and facility-based deliveries may enhance vaccination timeliness.
M. Konlan, R. Bhandari, M. Adjei et al.· Vaccine· 0 citations
INTRODUCTION
Immunization is a fundamental health component preventing an estimated 2.5 million deaths annually. Despite the documented successes of immunization, disparities of vaccine uptake exist in low- and middle-income countries and across their respective communities. This research assessed the barriers related to recall-based vaccination uptake among communities in Kigali city, the capital of Rwanda.
METHODS
A mixed-methods study was implemented on a sample of 210 households and communities across the three districts of the City of Kigali. The quantitative study used a multistage sampling technique according to the WHO Immunization Coverage Survey to select the households from the districts of Kigali city. While the 3 focus group discussions and 6 interviews were implemented in communities not included in the quantitative survey. A thematic analysis was performed on the qualitative data. The quantitative data were analyzed using SPSS 23 and summarized numerically and graphically. Statistical tests performed for association were Chi-square tests and a binary logistic regression was used to establish the relationship between recall-based vaccine uptake and its associated factors. All statistical tests were considered significant when p < 0.05.
RESULTS
Quantitative findings of this study reported that all 155 children ≤ 6 years were vaccinated. It also divided the barriers into four main categories: decision barriers, information barriers, accessibility barriers, and challenges in health facilities. A binary logistic regression predicted recall-based vaccine uptake based on 11 explanatory variables. The variables statistically significant were age and household size, with respective p < 0.001, and knowledge of vaccine-preventable diseases with a p-value of 0.038. Qualitatively, FGDs and interviews revealed fear of side effects, denial of vaccination in absence of husbands, long waiting time and poor communication from providers in facilities as factors that discourage attendance for immunization.
CONCLUSION
Barriers to recall-based categorization of vaccination frequency were mainly health system-related challenges, including insufficient supplies, costs for pregnant women for first-time vaccinations and denial vaccination in the absence of husbands. These findings call upon Rwandan health authorities and partners to address predictors of vaccination behavior associated with systemic challenges, intentional refusal and enhance immunization service delivery.
A. M. Hassan, Asawir Mohammed, Hiba Makki et al.· BMC Public Health· 0 citations
Malaria remains a major cause of morbidity and mortality in sub-Saharan Africa. In Cameroon, malaria accounts for 48% of all hospital admissions, 30% of morbidity, and 67% of childhood mortality per year. Despite the introduction of RTS, S in several African countries, real-world evidence on community acceptability following vaccine rollout remains limited, particularly at the district level. Understanding caregivers’ willingness to vaccinate is critical for optimizing uptake and guiding context-specific implementation strategies.
A community-based cross-sectional study was conducted between March and November 2024 in the Soa Health District (HD). A total of 541 caregivers of children under 25 months were recruited using a non-probability convenience sampling method. Data were collected using a structured pre-tested questionnaire and analysed using R software. Modified Poisson regression models with robust variance estimation was used to obtain crude and adjusted prevalence ratio (CPR and APR) with 95% confidence intervals (95% CIs), a statistical significance was set at p-value < 0.05.
Among the 541 caregivers, 73.4% expressed willingness to vaccinate their children against malaria. Higher vaccine acceptability was independently associated with residing in Koulou (APR = 1.4; 95% CI: 1.1–2.0), Ngali 2 (APR = 10.6; 95% CI: 1.2–2.2), and Soa (APR = 1.6; 95% CI: 1.1–2.2) compared with Ntsouessong; female sex (APR = 1.2; 95% CI: 1.0–1.3); origine from the North-West, South-West, West, and Littoral regions (APR = 1.2; 95% CI: 1.1–1.4); use street medicine (APR = 1.3; 95% CI: 1.0–1.6) or prescribed medicine (APR = 10.2; 95% CI: 10.0–1.5) rather than traditional medicine for malaria treatment; prior awareness of the malaria vaccine (APR = 1.2; 95% CI: 1.1–1.4). All
p
< 0.05.
Acceptability of the malaria vaccine among caregivers in the Soa HD was relatively high and was significantly influenced by geographic location, sex, region, health-seeking behaviour, and awareness of the vaccine. Targeted health education and culturally sensitive community engagement strategies are essential to improve vaccine acceptability and support the successful scale-up of malaria vaccination programmes in Cameroon and other endemic settings.
Not applicable.
Ludrique Dang, Fabien Fouda Ombogo, Bime Brenda Burinyuy et al.· BMC Public Health· 0 citations
Malaria remains a leading cause of child mortality in sub-Saharan Africa. Cameroon introduced the RTS,S/AS01 malaria vaccine in 2024, but real-world evidence on its early effects, coverage, and safety remains limited. This study evaluated these parameters among children under 36 months in the high-transmission Soa Health District. A community-based analytical cross-sectional study was conducted from February to May 2025. Households were selected by stratified cluster sampling (62 clusters, 622 participants). Children aged < 36 months who had resided in the district for ≥ 3 months were eligible. Vaccination status and malaria episodes (confirmed by rapid diagnostic test or microscopy) during the preceding six months were abstracted from cards. Primary exposure was ≥ 2 doses of RTS,S/AS01; primary outcome was documented malaria episodes. Multivariable modified Poisson regression with robust standard errors was used to estimate risk ratios (RR) adjusted for age, breastfeeding, insecticide-treated net (ITN) use, and intermittent preventive treatment in infancy (IPTi). The effect of the vaccine was measured as (1–adjusted RR) × 100. Coverage and adverse events were also assessed. Among 622 children (mean age 17.9 months, 51.4% female), documented coverage of dose 1 was 56·8% (95% CI 53.5–61.7), dropping to 46·6% for dose 2 and 39·0% for dose 3. Perceived free access (aRR 1.97, 95% CI 1.47–2.64) and knowledge of a nearby vaccination facility (aRR 1.86, 95% CI 1.41–2.45) were strongly associated with uptake. In the cross-sectional analysis, children who received ≥ 2 doses were associated with a 50% lower occurrence of malaria episodes (aRR 0.50, 95% CI 0.34–0.73, p = 0.001) compared with those receiving ≤ 1 dose. Minor adverse events occurred in 27% (fever 93%, injection site swelling 10%). In this high-burden Cameroonian setting, two or more doses of RTS,S/AS01 were associated with a lower occurrence of malaria episodes favourable safety profile. Coverage remains suboptimal, and dropout is high. Ensuring free access and strengthening community awareness are critical for maximising vaccine uptake.
C. Bekolo, Gladys Aimée Simo Zekeng, Paul Onambele et al.· Tropical Medicine and Health· 0 citations
Background Childhood immunization is an important part of public health efforts to reduce morbidity and mortality from diseases that can be prevented by vaccination. Sub-Saharan Africa (SSA) has the lowest childhood immunization coverage and the highest child mortality rate in the world. Therefore, this study aimed to assess community variation in childhood immunization and to identify determinant factors associated with childhood immunization using mixed effect count regression models. Method This study used data from the 2012–2022 Demographic and Health Survey (DHS), which included 195,000 children between the ages of 12 and 23 months in 33 SSA countries. A various mixed-effects count regression model were employed to identify the variables associated with the prevalence of childhood vaccination. Result In SSA, the mean average childhood immunization was 5.47 (95% CI = 5.46, 5.48), with an 8.38 variance. The mixed effect zero-inflated Poisson model fit the data the best, with the lowest DIC, AIC, and BIC values. The results of the model showed that working mothers, mothers with secondary or higher education (IRR = 1.119; 95% CI: 1.114, 1.125), rich wealth status (IRR = 1.077; 95% CI: 1.073, 1.082), having a health card (IRR = 1.265; 95% CI: 1.258, 1.271), being exposed to the media (IRR = 1.082; 95%CI: 1.077, 1.086), institutional delivery (IRR = 1.168; 95% CI: 1.163, 1.174), receiving eight or more ANC visits (IRR = 1.301; 95% CI: 1.288, 1.314), receiving vitamin A (IRR = 1.350; 95% CI: 1.344, 1.355), using a contraceptive (IRR = 1.187; 95% CI: 1.182, 1.192) and receiving Postnatal Care (PNC) (IRR = 1.075; 95% CI: 1.071, 1.080), were associated with a higher incidence of childhood immunization. While children in rural areas (IRR = 0.972; 95%CI: 0.968, 0.976) had a lower prevalence of childhood vaccinations than children in urban areas. Conclusion SSA had a low coverage of childhood vaccination with significant disparities among countries. Therefore, it is essential to prioritize public health initiatives that target low-income households, rural mothers, uneducated parents, and those who have not utilized maternal health care services for the sake of increasing the coverage of childhood immunizations that in turn enhances the health of children. Furthermore, it is imperative to create policies and initiatives that tackle regional and national variations in childhood immunization rates and to actively work toward their implementation.
Setegn Muche Fenta, H. Fenta, Hailegebrael Birhan Biresaw et al.· PLoS ONE· 0 citations
Malaria remains a major public health challenge in Kenya, particularly among children under five years, despite the introduction of the malaria vaccine as part of routine immunization. Caregiver acceptance is critical to achieving high vaccine uptake and maximizing the vaccine's public health impact. This study examined the determinants of malaria vaccine acceptance among caregivers of children under five years in Kisumu East Sub-County, Kenya, focusing on socio-demographic, health system, and knowledge and perception factors. An analytic cross-sectional mixed-methods study was conducted among 387 caregivers selected through systematic random sampling from public health facilities. Quantitative data were collected using structured questionnaires and analyzed using descriptive statistics, chi-square tests, and multivariable logistic regression, while qualitative data from Focus Group Discussions (FGDs) and Key Informant Interviews (KIIs) were analyzed thematically. Malaria vaccine acceptance was high, with 86.6% of caregivers reporting that their children had received the vaccine. In multivariable analysis, male caregivers were significantly less likely to accept the vaccine than female caregivers (AOR = 0.066, p < 0.001). Health system barriers reduced vaccine acceptance (AOR = 0.107, p = 0.003), whereas receiving vaccine information from community leaders (AOR = 55.989, p = 0.030) and awareness of vaccine side effects (AOR = 12.97, p = 0.011) significantly increased acceptance. Age and education were not significant predictors in the adjusted model. Qualitative findings highlighted trust in healthcare providers, community engagement, and service accessibility as key facilitators, while long waiting times and occasional vaccine stock-outs hindered uptake. Strengthening male involvement, improving service delivery, and leveraging community leadership structures could further enhance malaria vaccine acceptance and uptake.
Salome Ng’ida Mollel, Doreen Othero, Dominic Ouma· International journal of res...· 0 citations
