Peer-reviewed article
Progress and inequality in child immunization in 38 African countries, 2000–2030: A spatio-temporal Bayesian analysis at national and sub-national levels
Phuong The Nguyen, Ryota Nakamura, Hideyasu Shimadzu, Aminu Kende Abubakar, Phuong Mai Le et al. ·
Summary
Written by AI, not yet AICS's view · claude-haiku-4-5-20251001This study analyzed childhood immunization coverage across 38 African countries from 2000 to 2019 using data from over 1 million nationally representative survey records. Coverage for key vaccines (BCG, MCV1, DPT3, Polio3, and full immunization) improved significantly over the period, but projections show 12 countries will miss global targets by 2030 if current trends continue. Socioeconomic inequalities in immunization access were widespread in 2000 but are expected to decline in most countries by 2030, though Nigeria and Angola face increasing disparities. Regional disparities remain pronounced in Central and Western Africa despite national-level improvements.
Key points
- Childhood immunization coverage improved significantly across most African countries from 2000 to 2019
- 12 countries projected to miss full immunization targets (90% coverage) by 2030 at national level, including high-SDI countries South Africa, Egypt, and Congo Brazzaville
- Socioeconomic inequalities expected to decline or stabilize in 36 countries by 2030, with Rwanda, Burkina Faso, Eswatini, and Morocco projected to eliminate disparities
- Nigeria and Angola face projected increases in inequalities or persistent large gaps despite improvements
- Regional disparities remain pronounced in Central and Western Africa with low coverage and high inequality
Limitations
The analysis was limited to DHS surveys conducted between 2000-2019, excluding more recent data during the COVID-19 pandemic which may have disrupted immunization services. Projections in data-sparse settings may overestimate trends due to limited survey coverage.
Abstract
BACKGROUND: Monitoring progress and inequality in childhood immunization coverage at both national and sub-national levels is essential for refining equity-oriented health programs and ensuring equitable access to care towards achieving global targets in African countries. METHODS AND FINDINGS: Using approximately 1 million records from 104 nationally representative Demographic and Health Surveys (DHS) conducted in 38 African countries (2000-2019), we estimated childhood immunization coverage for key indicators (BCG, MCV1, DPT3, Polio3, and Full immunization), stratified by socioeconomic status. Variations of Bayesian spatio-temporal analysis using Besag, Besag-York-Mollié (BYM) and BYM2 models were employed to assess and project the trends from 2000 to 2030. We evaluated the probability of achieving Universal Health Coverage (80% coverage) and Immunization Agenda (90% coverage) by 2030, at national and sub-national levels. Finally, we conducted a comprehensive inequality analysis using the Slope Index of Inequality (SII) and Relative Index of Inequality (RII) to assess changes over the study period. Childhood immunization coverage improved significantly across most African countries from 2000 to 2019. However, projections suggest that 12 countries are unlikely to achieve global targets for full immunization by 2030 at the national level if current trends continue. Notably, high-Socio-Demographic Index (SDI) countries such as South Africa, Egypt, and Congo Brazzaville are projected to miss immunization targets across all sub-national regions. While socioeconomic inequalities were widespread in 2000, they are projected to decline or stabilize in 36 countries by 2030, with Eswatini, Morocco, Rwanda, and Burkina Faso expected to eliminate disparities. In contrast, Nigeria and Angola are projected to face increasing inequalities or persistent large gaps. Regional disparities in both coverage and inequality remain pronounced, particularly in Central and Western Africa, where coverage remains low and inequality remains high despite overall national-level improvements. The analysis was limited to DHS surveys 2000-2019, excluding more recent data during the COVID-19 period and potentially overestimating trends in data-sparse settings. CONCLUSIONS: This study highlights both progress and persistent challenges in childhood immunization coverage, along with inequalities across 38 African countries. Persistent regional disparities and socioeconomic inequalities require multifaceted strategies that account for demographic, geographic, economic, and political factors to ensure equitable immunization. Greater efforts are needed to close these gaps and support global health goals for the African nations.