Peer-reviewed article
Child vaccination in sub-Saharan Africa: Increasing coverage addresses inequalities
Firew Tekle Bobo, Augustine Danso Asante, Mirkuzie K. Woldie, Angela J Dawson, Andrew D. Hayen ·
Summary
Written by AI, not yet AICS's view · claude-haiku-4-5-20251001This study examined vaccination coverage and wealth-related inequalities across 25 sub-Saharan African countries using Demographic and Health Survey data. Overall, 56.5% of children received full vaccination (BCG, DTP3, OPV3, and measles), while 8.4% remained unvaccinated, with coverage ranging from 24% in Guinea to 93% in Rwanda. The analysis found pro-rich inequalities in vaccination in 23 countries, meaning wealthier families were more likely to have fully vaccinated children. Factors associated with better vaccination uptake included maternal education, facility-based childbirth, antenatal care, household wealth, and access to radio.
Key points
- Full vaccination coverage averaged 56.5% across 25 sub-Saharan African countries, with 35.1% partially vaccinated and 8.4% unvaccinated
- Vaccination coverage varied widely by country, from 24% in Guinea to 93% in Rwanda
- Pro-rich inequality in vaccination coverage was found in 23 of 25 countries, with only Gambia and Namibia showing pro-poor coverage
- Countries with lower overall vaccination coverage had higher inequalities, suggesting disadvantaged groups were disproportionately left behind
- Improved maternal education, facility-based childbirth, antenatal care, household wealth, and radio access were associated with higher vaccine uptake
Limitations
This study is cross-sectional and cannot establish causal relationships between factors and vaccination coverage. It does not evaluate a specific intervention programme, so cannot determine whether particular strategies effectively reduce inequalities.
Abstract
BACKGROUND: Vaccines have substantially contributed to reducing morbidity and mortality among children, but inequality in coverage continues to persist. In this study, we aimed to examine inequalities in child vaccination coverage in sub-Saharan Africa. METHODS: We analysed Demographic and Health Survey data in 25 sub-Saharan African countries. We defined full vaccination coverage as a child who received one dose of bacille Calmette-Guérin vaccine (BCG), three doses of diphtheria, pertussis, and tetanus vaccine (DTP 3), three oral polio vaccine doses (OPV 3), and one dose of measles vaccine. We used the concentration index (CCI) to measure wealth-related inequality in full vaccination, incomplete vaccination, and zero-dose children within and between countries. We fitted a multilevel regression model to identify predictors of inequality in receipts of full vaccination. RESULTS: Overall, 56.5% (95% CI: 55.7% to 57.3%) of children received full vaccination, 35.1% (34.4% to 35.7%) had incomplete vaccination, while 8.4% (95% CI: 8.0% to 8.8%) of children remained unvaccinated. Full vaccination coverage across the 25 sub-Saharan African countries ranged from 24% in Guinea to 93% in Rwanda. We found pro-rich inequality in full vaccination coverage in 23 countries, except for Gambia and Namibia, where we found pro-poor vaccination coverage. Countries with lower vaccination coverage had higher inequalities suggesting pro-rich coverage, while inequality in unvaccinated children was disproportionately concentrated among disadvantaged subgroups. Four or more antenatal care contracts, childbirth at health facility, improved maternal education, higher household wealth, and frequently listening to the radio increased vaccine uptake. CONCLUSIONS: Continued efforts to improve access to vaccination services are required in sub-Saharan Africa. Improving vaccination coverage and reducing inequalities requires enhancing access to quality services that are accessible, affordable, and acceptable to all. Vaccination programs should target critical social determinants of health and address barriers to better maternal health-seeking behaviour.