Three in four children age 12-23 months missed opportunities for vaccination in Sub-Saharan African countries: a multilevel mixed effect analysis of demographic health and surveys 2016-2023.

backgroundDespite vaccination being the most cost-effective means to prevent disease and its adverse consequences, missing opportunities for vaccination remains a critical public health challenge. Many SSA countries still couldn't reach the target endorsed by the Global Vaccine Action Plan. Identifying contributing factors helps policymakers and planners to design potential interventions to avert missing opportunities for vaccination. Thus, this study aimed to assess the prevalence and factors associated with missed opportunities for vaccination.

methodsThis study used nationally representative demographic and health survey data collected from 2016 to 2023 among 44,149 children aged 12 to 23 months in SSA countries. Stata version 14 statistical package was used. Bi-variable and multivariable logistic regression analyses were done to ascertain factors associated with a missed opportunity for vaccination at a p-value less than 0.05 with adjusted odds ratios (AORs) with a 95% confidence interval.

resultThe overall prevalence of missed opportunity for vaccination (MOV) was 75.46% (95% CI: 75.04, 75.87%). The highest prevalence of MOV occurred in Gambia (93.85%), whereas the lowest was reported in Mauritania (41.59%). Children age: 12 to 15 months (AOR = 1.3, 95%CI:1.22, 1.36) and 16 to 18 months (AOR = 1.1, 95%CI: 1.04, 1.16), maternal age 35 to 49 (AOR = 1.1, 95%CI: 1.02, 1.17), married mother (AOR = 0.85, 95%CI: 0.80, 0.90), education: didn't attend formal education (AOR = 1.13, 95%CI: 1.10, 1.22) and completed primary education (AOR = 1.1, 95%CI: 1.02, 1.16), ANC: never attend (AOR = 0.76, 95%CI:0.71, 0.82) and having four and above ANC visit (AOR = 0.9, 95%CI:0.85, 0.96), health insurance users (AOR = 1.4, 95%CI: 1.25, 1.49), male headed household (AOR = 1.35, 95%CI: 1.27, 1.43), religion: Muslim (AOR = 1.5, 95%CI:1.38, 1.57), Animist (AOR = 1.5, 95%CI:1.31, 1.64), and Catholic followers (AOR = 1.2, 95%CI:1.13, 1.31) and Protestant (AOR = 0.88, 95%CI:0.82, 0.95), home delivery (AOR = 0.79, 95%CI:0.75, 0.84), rural dwellers (AOR = 1.1, 95%CI: 1.04, 1.17), ever had media exposure (AOR = 0.91, 95%CI:0.86, 0.97), big problem to reach health facility (AOR = 1.1, 95%CI: 1.02, 1.14), high community wealth status (AOR = 0.91, 95%CI: 0.83, 0.99), low community level educational status (AOR = 1.2, 95%CI: 1.14, 1.38) and human development index: middle (AOR = 1.4, 95%CI: 1.21, 1.59) were factors associated with MOV. CONCLUSION AND RECOMMENDATION: The overall pooled prevalence of missed opportunities for vaccination in Sub-Saharan remains high. Children's age, maternal age, marital status, education, antenatal care visit, health insurance utilization, sex of household head, religion, place of delivery, residence, media exposure, distance to reach health facility, community wealth status, community educational status, and human development index of the countries were significantly associated with MOV. Policymakers have to encourage technology to promote multimedia exposure to increase community awareness about vaccination, encourage engagement of male partner, and religious leaders in child health. Additionally, potential stakeholders should give great emphasis for accessibility of education and health service for rural and remote areas, and poor segments of population through fostering community health workers and outreach programs, and financial support to increase vaccine coverage by averting missed opportunities for vaccinations. Qualitative research is recommended to explore the facilitators and barriers of missed opportunities for vaccinations among children.