Published in PLOS One on 2026-08-28, this study is presented as an attributed evidence briefing. The excerpts below are the original researchers’ words, reproduced under their Creative Commons Attribution licence. Health Signal has selected the abstract and, where needed, opening background paragraphs; the complete methods, results, limitations and references remain in the linked paper.
Original authors: Michael Ekholuenetale
Source: PLOS One • DOI 10.1371/journal.pone.0357171
Read the complete primary study ↗ · Creative Commons Attribution licence
From the researchers
Abstract
Understanding COVID-19 vaccine uptake is particularly important in studies of inequity in vaccination access, as differences in uptake may reflect underlying social and structural inequalities. Evidence suggests that socioeconomic status is a key driver for COVID-19 vaccination uptake in Nigeria. This study examines the socioeconomic inequality in COVID-19 vaccination uptake among reproductive-age Nigerian women.
Data from the 2024 Nigeria Demographic and Health Survey (NDHS) was analyzed for a sample of 36,555 women of reproductive age (15–49 years). COVID-19 vaccination uptake was the outcome variable measured in this study. A socioeconomic decomposition analysis was conducted to identify the factors contributing to inequalities in COVID-19 vaccination uptake across the socioeconomic gradient.
The least disadvantaged women had the highest COVID-19 vaccination uptake (31.6%), whereas the most disadvantaged women had the lowest COVID-19 vaccination uptake (19.2%). The concentration index curve showed that COVID-19 vaccination uptake among Nigerian women was significantly higher among the least disadvantaged group. In addition, having higher education, secondary education, being exposed to mass media, employed, covered by health insurance, being aged 30 years or older, from South West, South South and South East geopolitical zones respectively, were positive contributors to socioeconomic inequality in COVID-19 vaccination uptake.
There was low uptake rate of COVID-19 vaccination among Nigerian women, with approximately one-third of the least disadvantaged, one-quarter of the moderately disadvantaged, and one-fifth of the most disadvantaged women reported receiving a COVID-19 vaccine. This shows that the dream of achieving equitable vaccination coverage will require concerted efforts and targeted strategies that prioritize disadvantaged women, including context-specific policies aimed at reducing socioeconomic barriers to access.
Introduction
The development of effective and safe vaccines against SARS-CoV-2 has greatly mitigated morbidity and mortality of the COVID-19 pandemic. The coronavirus disease 2019 (COVID-19) pandemic has posed unprecedented challenges to global health systems [1], with vaccination emerging as the most effective strategy for reducing infection, severe illness, and mortality [2,3]. Evidence from previous studies suggests that socioeconomic status is a key driver for COVID-19 vaccination uptake in Nigeria in particular and Sub-Saharan Africa at large [4–6]. Since the introduction of COVID-19 vaccines in 2020, several countries have made significant progress in scaling up the vaccination programme [7]. However, inequitable access and uptake remain major barriers, particularly in low- and middle-income countries (LMICs) [8]. Despite the global efforts to ensure equitable vaccine distribution through initiatives like COVAX [9], disparities in vaccination coverage persist across and within countries, often reflecting underlying socioeconomic inequalities [10].
Nigeria, the most populous country in Africa [11], presents a particularly important context for examining these inequalities. The country has faced longstanding challenges related to health system capacity, uneven distribution of healthcare resources, and high levels of poverty and income inequality. Health financing in Nigeria is largely driven by out-of-pocket expenditure, which disproportionately affects low-income households and limits access to essential health services. These structural inequities have been further exacerbated by the COVID-19 pandemic, which disrupted health services and deepened existing socioeconomic vulnerabilities. Women represent a key population group in the context of COVID-19 vaccination [12,13], particularly in Nigeria where gender norms and socioeconomic conditions significantly influence health-seeking behaviour. Women often face unique barriers to accessing healthcare services, including limited financial autonomy, lower educational attainment, and little decision-making power within households.
Reading this evidence
Use the full paper to check the study design, participant selection, comparator and outcome definitions before drawing a practical conclusion. An association does not by itself show cause and effect. A reported performance measure needs its denominator and uncertainty. A finding from a particular facility, sample or time period should retain that scope when it is discussed elsewhere.
This briefing makes the source accessible within the wider financing & policy desk. It does not assess an individual patient or certify a product. When considering relevance to another health system, examine the original authors’ account of context and limitations, then seek local implementation evidence. The related reporting below provides other studies to read alongside this one; it is a topic connection, rather than a claim that their results are directly comparable.
© 2026 Michael Ekholuenetale. Excerpts reproduced under CC BY. Selection, formatting and contextual notes by Health Signal. The researchers are the authors of the source study, not members of Health Signal’s staff.
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