Vaccination coverage, dropout and predictors of schedule-complete vaccination among children aged 0-59 months in Gushegu and Nanumba South districts, northern Ghana: A cross-sectional study.

Abstract

National vaccination estimates often mask important subnational disparities that are critical for improving local immunisation programme performance. This analytical cross-sectional study, conducted from 24 April to 4 May 2025, assessed vaccination coverage, dropout rates, and predictors of schedule-complete vaccination among 3,371 children aged 0-59 months in the Gushegu and Nanumba South districts of northern Ghana. Vaccination status was determined using home-based records and caregiver recall across 19 vaccine-doses. Schedule-complete vaccination was defined as receipt of all age-appropriate vaccines on the Ghana Expanded Programme on Immunisation schedule, excluding the malaria vaccine. Approximately 1% of children had never received any vaccination. Birth-dose coverage was notably low, with OPV0 coverage of 44.2% in Gushegu and 50.5% in Nanumba South, compared with BCG coverage of 98.0% and 93.6%, respectively. Coverage declined across the primary series from 96% for Penta 1 to 88% for Penta 3. Rotavirus vaccine dose 3 coverage was particularly low (40.5% for Gushegu and 44.0% for Nanumba South), despite first-dose coverage exceeding 80%. Uptake of second-year-of-life vaccines was also suboptimal, with MR2 coverage reaching only 57.6% in Gushegu and 66.1% in Nanumba South. Dropout rates for most vaccine series remained below 10%. Place of delivery, child age, and caregiver relationship to the child were significant predictors of schedule-complete vaccination. Persistent antigen-specific coverage gaps highlight the need to strengthen birth-dose delivery, improve completion of vaccine schedules, and enhance integration between childbirth and immunisation services.