Determinants of childhood immunization coverage in Somalia: evidence from the Somalia Demographic and Health Survey 2020

Abstract

Somalia has one of the lowest childhood immunization coverage rates globally, with only 34.8% of children aged 0–59 months having received at least one vaccine and a high burden of zero-dose children. Immunization uptake is influenced by socioeconomic, maternal, healthcare access, and geographic factors. This study examined determinants of childhood immunization coverage in Somalia to inform equity-focused strategies. A cross-sectional analysis was conducted using nationally representative data from the 2020 Somalia Demographic and Health Survey (SDHS), including 7,373 mother–child pairs. bivariate and multivariable logistic regression models assessed associations between sociodemographic, economic, maternal, healthcare access, and geographic characteristics and child vaccination status, accounting for survey design and confounders. Overall vaccination coverage was 34.8%. Health facility delivery was the strongest independent predictor (AOR = 1.93; 95% CI:1.68–2.22; p < 0.001). Children from the highest household wealth quintile had higher odds than the poorest (AOR = 2.45; 95% CI:2.00–3.00; p < 0.001). Maternal primary and secondary education were positively associated with vaccination (AOR = 1.58; 95% CI:1.34–1.87 and AOR = 1.94; 95% CI:1.40–2.67; respectively; p < 0.001). Nomadic residence was associated with higher odds compared with rural residence (AOR = 1.69; 95% CI:1.46–1.96; p < 0.001). Compared with infants aged 0–11 months, children aged 12–23 months (AOR = 1.36; 95% CI:1.10–1.69; p = 0.005) and 24–59 months (AOR = 1.33; 95% CI:1.12–1.59; p = 0.001) were more likely to be vaccinated. Lack of radio exposure was associated with lower vaccination odds (AOR = 0.64; 95% CI:0.50–0.82; p < 0.001). Children living in Gedo region had markedly lower odds of vaccination than those in Awdal region (AOR = 0.26; 95% CI:0.17–0.39; p < 0.001). Childhood immunization coverage in Somalia remains critically low, reflecting socioeconomic, maternal, healthcare access, and geographic inequalities that require strategies targeting disadvantaged populations and regions.