Peer-reviewed article
Sociodemographic and geographic determinants of childhood immunization coverage and equity in Ghana: Analysis of the 2022 demographic and health survey.
Ahlam Tunteeya Saani, Goldfield Edem Azumah ·
Summary
Written by AI, not yet AICS's view · claude-haiku-4-5-20251001This study analysed immunization coverage among 3,788 children aged 12-35 months in Ghana using 2022 national health survey data. Full immunization coverage reached 69.5%, but substantial gaps exist across wealth, education, and region, with a 35.7 percentage point difference between regions. Dropout rates are concerning, particularly for measles-rubella vaccines. Facility delivery, antenatal care visits, wealth, and maternal education independently predict full immunization completion.
Key points
- Full immunization coverage is 69.5%, with 25.7% partial immunization and 4.8% zero-dose children
- Regional inequality is largest at 35.7 percentage point gap, followed by maternal education (18.3 points) and wealth (17.4 points)
- Dropout rate of 28.9% between measles-rubella first and second doses indicates major retention challenge
- Facility delivery (aOR=1.43), four or more antenatal care visits (aOR=1.55), higher wealth (aOR=1.39), and maternal secondary education (aOR=1.34) independently predict full immunization
- The study recommends completion-focused interventions including tracking systems, reminders, and targeted outreach to disadvantaged populations
Limitations
The study is cross-sectional and cannot establish causation. It measures coverage at a single time point and cannot assess changes in immunization practices over time or the effectiveness of specific policy interventions.
Abstract
BACKGROUND: Childhood immunization remains a cornerstone of public health in sub-Saharan Africa, yet substantial gaps in coverage, equity, and schedule adherence persist. This study examines immunization coverage, sociodemographic disparities, predictors of completion, and policy implementation effectiveness in Ghana using nationally representative data. METHODS: Data from 3,788 children aged 12-35 months in the 2022 Ghana Demographic and Health Survey were analysed using stratified two-stage cluster sampling across 614 enumeration areas. Weighted coverage estimates were calculated for individual vaccines and composite indicators including full immunization, dropout rates, and timeliness. Design-adjusted chi-square tests identified bivariate associations between sociodemographic factors and immunization outcomes. Multivariate logistic regression models incorporated sociodemographic characteristics, healthcare utilization, and information access to identify independent predictors. Equity analysis employed concentration indices, rate ratios, and intersectional stratification. FINDINGS: Full immunization coverage reached 69.5% (95% CI: 67.3 to 71.7%), with 25.7% partial immunization and 4.8% zero-dose children. Substantial inequalities emerged across wealth (17.4 percentage point gap), maternal education (18.3 percentage point gap), and region (35.7 percentage point gap). The concentration index of 0.045 indicated modest pro-rich inequality. Dropout rates were concerning, particularly 28.9% attrition between measles-rubella first and second doses among age-eligible children. In adjusted models, facility delivery (aOR=1.43, 95% CI: 1.08 to 1.90), four or more antenatal care visits (aOR=1.55, 95% CI: 1.19 to 2.01), higher wealth (aOR=1.39, 95% CI: 1.04 to 1.87), and maternal secondary or higher education (aOR=1.34, 95% CI: 1.04 to 1.72) independently predicted full immunization. INTERPRETATION: Ghana's immunization program achieves broad initial access but faces critical challenges in retention, timeliness, and equity. Policy priorities should emphasize completion-focused interventions including tracking systems, reminder mechanisms, and targeted outreach to disadvantaged populations.