Evaluation report
Social Determinants of Childhood Immunization in Ghana: Equity Impact Analysis
Puobebe C, Yoo KJ ·
Summary
Written by AI, not yet AICS's view · claude-haiku-4-5-20251001This study analysed childhood immunization coverage in Ghana using data from 2014 and 2018 surveys involving over 2,800 children aged 12–23 months. Full vaccination coverage was around 73–75%, below target levels, with significant inequalities linked to household income, maternal education, health facility birth, and health card possession. Children born at home, from poorest households, and without health cards were substantially less likely to be fully immunized. The findings highlight that health system improvements and maternal interventions are needed to reach underserved children as Ghana transitions away from Gavi support.
Key points
- Full immunization coverage was 75.5% in 2014 and 73% in 2018, below target levels
- Children born in health facilities had 84% higher odds of complete immunization than those born at home
- Possession of a health card was associated with 83% higher odds of full immunization
- Income-related inequalities were pronounced in OPV0 vaccine with concentration indices of 0.27 (2014) and 0.22 (2018)
- Immunization dropout rate from Penta1 to measles was 10.4% in 2018
Limitations
The study is cross-sectional analysis of survey data from two time points and cannot establish causation or explain mechanisms behind inequalities. The document does not provide information about intervention effectiveness or programme implementation details.
Abstract
Abstract Background Equity is a fundamental principle underlying the global immunization program. Ghana has among the highest rates of childhood immunisation coverage in Sub-Saharan Africa. This study analyses full immunization coverage, calculates immunization dropout rate, and estimates the equity impact by child, maternal, socioeconomic, geographic and place of birth characteristics. Methods We analysed full immunization coverage (1-dose BCG, 3-dose DPT-HepB-Hib (Pentavalent), 4-dose polio, 3-dose pneumococcal (PCV3), 2-dose rotavirus, 1-dose measles (MCV1) and 1-dose Yellow Fever vaccines) of 1127 and 1705 children aged 12–23 months from the 2014 Ghana Demographic Health Survey and the 2018 Ghana Multiple Indicator Cluster Survey respectively. Mean coverage was disaggregated by socioeconomic (household wealth), maternal (maternal age at birth, maternal marital status, maternal education, and maternal exposure to media), sex of child and place of birth characteristics. Concentration indices estimated income-related inequalities and multiple logistic regression assessed the association between full immunization coverage and dimensions of inequality. Results Full vaccination coverage was 75.5% [72–79] and 73% [CI:69–76] in 2014 and 2018 respectively. Penta1 recorded the highest coverage of 96% [95–98] and 95% [CI:93–96] in 2014 and 2018 respectively. OPV0 recorded the lowest coverage of 77.5% [74.3–80.5] and 74.5% [71.0-77.6] in 2014 and 2018 respectively. The immunization dropout rate for Penta1 to measles was 10.4% in 2018. Children born in a health facility had 84% higher odds of being fully immunised compared to children born at home. Children in Possession of a health card had 83% higher odds of complete immunization and children born to mothers aged 25–29 years had 84% higher odds of being fully immunised compared to children born by mothers age < 25. Income related inequalities were pronounced in OPV0 with concentration indices of 0.27 and 0.22 in 2014 and 2018 respectively. Significant inequalities were pronounced in urban residence and children without a health card with concentration indices of 0.2 and 0.4 respectively. Conclusions Ghana’s immunization coverage is below the target levels and significant income-related inequalities exist. Health system and maternal-level health interventions will have the highest impact in promoting equity for the benefit of underserved children. As Ghana prepares to exit as a beneficiary of Gavi, monitoring and evaluation systems need to be strengthened.