Minimum immunization coverage and maternal factors associated with childhood vaccination among children aged 12–23 months in Somalia

Abstract

Immunization remains one of the most effective strategies for preventing childhood morbidity and mortality, yet coverage in Somalia continues to be among the lowest globally. Persistent insecurity, population mobility, and systemic health system challenges limit the uptake of routine childhood vaccines. Given the extremely low levels of full immunization coverage reported nationally, this study assessed minimum immunization coverage, defined as a proxy indicator representing receipt of at least one dose of key childhood vaccines. The objective was to estimate the prevalence of minimum immunization coverage and examine maternal and household factors associated with childhood vaccination among children aged 12 to 23 months. This study analyzed nationally representative data from the 2020 Somalia Health and Demographic Survey. A total of 2,969 children aged 12 to 23 months were included. Weighted descriptive statistics were used to summarize population characteristics, with percentages adjusted for the complex survey design, while bivariate and multivariable logistic regression analyses identified factors associated with minimum immunization coverage. All analyses accounted for the complex sampling design, and statistical significance was set at p < 0.05. Only 4% of children received the minimum recommended vaccinations. Significant disparities were observed across regions, with coverage ranging from 1% to 9%. In the adjusted analysis, children of mothers aged 25–34 years (AOR = 0.40, 95% CI: 0.25–0.63, p < 0.001) and 35–49 years (AOR = 0.36, 95% CI: 0.15–0.87, p = 0.023) had lower odds of receiving minimum immunization coverage compared with children of mothers aged 15–24 years. Maternal primary education (AOR = 2.45, 95% CI: 1.36–4.42, p = 0.003) and secondary or higher education (AOR = 5.80, 95% CI: 2.69–12.50, p < 0.001), higher household wealth, and regional location were significantly associated with minimum immunization coverage. Minimum immunization coverage among Somali children remains critically low, reflecting persistent inequities in access to routine vaccination services. Maternal age, maternal education, household wealth, and regional location were key factors associated with immunization uptake. Strengthening routine immunization systems, expanding outreach to underserved and mobile populations, and addressing socioeconomic barriers may help increase vaccine coverage and reduce preventable childhood mortality in Somalia.