Published in PLOS One on 2026-08-26, 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: Setegn Muche Fenta, Haile Mekonnen Fenta, Hailegebrael Birhan Biresaw, Seyifemickael Amare Yilema, Denekew Bitew Belay, Maru Mekie, Minilik Derseh, Astewle Andargie Baye, Yegnanew Shiferaw, Ding Geng Chen, Omar Enzo Santangelo
Source: PLOS One • DOI 10.1371/journal.pone.0354918
Read the complete primary study ↗ · Creative Commons Attribution licence
From the researchers
Abstract
Childhood immunization is an important part of public health efforts to reduce morbidity and mortality from diseases that can be prevented by vaccination. Sub-Saharan Africa (SSA) has the lowest childhood immunization coverage and the highest child mortality rate in the world. Therefore, this study aimed to assess community variation in childhood immunization and to identify determinant factors associated with childhood immunization using mixed effect count regression models.
This study used data from the 2012–2022 Demographic and Health Survey (DHS), which included 195,000 children between the ages of 12 and 23 months in 33 SSA countries. A various mixed-effects count regression model were employed to identify the variables associated with the prevalence of childhood vaccination.
In SSA, the mean average childhood immunization was 5.47 (95% CI = 5.46, 5.48), with an 8.38 variance. The mixed effect zero-inflated Poisson model fit the data the best, with the lowest DIC, AIC, and BIC values. The results of the model showed that working mothers, mothers with secondary or higher education (IRR = 1.119; 95% CI: 1.114, 1.125), rich wealth status (IRR = 1.077; 95% CI: 1.073, 1.082), having a health card (IRR = 1.265; 95% CI: 1.258, 1.271), being exposed to the media (IRR = 1.082; 95%CI: 1.077, 1.086), institutional delivery (IRR = 1.168; 95% CI: 1.163, 1.174), receiving eight or more ANC visits (IRR = 1.301; 95% CI: 1.288, 1.314), receiving vitamin A (IRR = 1.350; 95% CI: 1.344, 1.355), using a contraceptive (IRR = 1.187; 95% CI: 1.182, 1.192) and receiving Postnatal Care (PNC) (IRR = 1.075; 95% CI: 1.071, 1.080), were associated with a higher incidence of childhood immunization. While children in rural areas (IRR = 0.972; 95%CI: 0.968, 0.976) had a lower prevalence of childhood vaccinations than children in urban areas.
SSA had a low coverage of childhood vaccination with significant disparities among countries. Therefore, it is essential to prioritize public health initiatives that target low-income households, rural mothers, uneducated parents, and those who have not utilized maternal health care services for the sake of increasing the coverage of childhood immunizations that in turn enhances the health of children. Furthermore, it is imperative to create policies and initiatives that tackle regional and national variations in childhood immunization rates and to actively work toward their implementation.
Introduction
Child mortality is a significant global health problem, with Sub-Saharan Africa (SSA) still having the highest rates worldwide. The child mortality rate is estimated to be about 37 deaths per 1,000 live births, indicating that significant progress has been made in reducing child mortality worldwide [1,2]. However, over 55% of all child mortality worldwide occur in SSA. SSA has a child mortality rate of approximately 76 deaths per 1,000 live births in 2023, which is more than twice the global average and significantly higher than rates in other regions like Europe or North America, which are less than 10 deaths per 1,000 live births [2–4]. In SSA, infectious illnesses including malaria, pneumonia, and diarrhea combine with malnutrition continue to be the main causes of child mortality. Many countries in SSA are not on track to reach the Sustainable Development Goals (SDGs), a worldwide program that aims to reduce child mortality rate to at least 25 fatalities per 1,000 live births by 2030. Investments in healthcare facilities, immunizations, education, nutrition programs, and conflict resolution must continue if the area is to address its disproportionate burden of child deaths and narrow the gap with the rest of the world [1,5,6].
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 public health 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 Setegn Muche Fenta, Haile Mekonnen Fenta, Hailegebrael Birhan Biresaw, Seyifemickael Amare Yilema, Denekew Bitew Belay, Maru Mekie, Minilik Derseh, Astewle Andargie Baye, Yegnanew Shiferaw, Ding Geng Chen, Omar Enzo Santangelo. 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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