Published in PLOS One on 2026-04-15, 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: Ahlam Tunteeya Saani, Goldfield Edem Azumah, Patricia Fast
Source: PLOS One • DOI 10.1371/journal.pone.0337505
Read the complete primary study ↗ · Creative Commons Attribution licence
From the researchers
Abstract
Childhood immunization remains a cornerstone of public health in sub-Saharan Africa, yet substantial gaps in coverage, equity, and schedule adherence persist. This study examines immunization coverage, sociodemographic disparities, predictors of completion, and policy implementation effectiveness in Ghana using nationally representative data.
Data from 3,788 children aged 12–35 months in the 2022 Ghana Demographic and Health Survey were analysed using stratified two-stage cluster sampling across 614 enumeration areas. Weighted coverage estimates were calculated for individual vaccines and composite indicators including full immunization, dropout rates, and timeliness. Design-adjusted chi-square tests identified bivariate associations between sociodemographic factors and immunization outcomes. Multivariate logistic regression models incorporated sociodemographic characteristics, healthcare utilization, and information access to identify independent predictors. Equity analysis employed concentration indices, rate ratios, and intersectional stratification.
Full immunization coverage reached 69.5% (95% CI: 67.3 to 71.7%), with 25.7% partial immunization and 4.8% zero-dose children. Substantial inequalities emerged across wealth (17.4 percentage point gap), maternal education (18.3 percentage point gap), and region (35.7 percentage point gap). The concentration index of 0.045 indicated modest pro-rich inequality. Dropout rates were concerning, particularly 28.9% attrition between measles-rubella first and second doses among age-eligible children. In adjusted models, facility delivery (aOR=1.43, 95% CI: 1.08 to 1.90), four or more antenatal care visits (aOR=1.55, 95% CI: 1.19 to 2.01), higher wealth (aOR=1.39, 95% CI: 1.04 to 1.87), and maternal secondary or higher education (aOR=1.34, 95% CI: 1.04 to 1.72) independently predicted full immunization.
Ghana’s immunization program achieves broad initial access but faces critical challenges in retention, timeliness, and equity. Policy priorities should emphasize completion-focused interventions including tracking systems, reminder mechanisms, and targeted outreach to disadvantaged populations.
Introduction
Vaccination stands as one of public health’s most effective interventions, having prevented millions of deaths and nearly eradicated diseases. [1] However, substantial gaps persist in achieving universal coverage, ensuring schedule completion, reaching disadvantaged populations equitably, and administering vaccines at age-appropriate intervals that optimize protection during vulnerable periods. [2,3]
Sub-Saharan Africa faces challenges in immunization delivery despite sustained investments and policy commitments. [4] The region accounts for a disproportionate share of unimmunized and under-immunized children globally, with coverage plateaus, periods where immunization rates stagnate despite continued programmatic investment, and recent reversals threatening progress toward Sustainable Development Goal targets and the Immunization Agenda 2030 objectives. [4] Persistent inequalities in coverage across socioeconomic, geographic, and demographic dimensions indicate that universal policy frameworks have not translated into equitable service delivery. [5] Dropout rates between vaccine doses remain elevated, timeliness of administration frequently deviates from recommended schedules, and health system weaknesses including stock-outs, inadequate cold chain capacity, and insufficient healthcare worker training compromise programme effectiveness. [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 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 Ahlam Tunteeya Saani, Goldfield Edem Azumah, Patricia Fast. 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.
Explore connected evidence
- Evidence brief: Progress and gaps in childhood immunization among two-year-olds in Ghana (1993–2022): A trend and equity analysis
- Evidence brief: Prevalence, spatial patterns and determinants of zero-dose vaccination among children aged 12–23 months in Sub-Saharan Africa: A multilevel spatial analysis
- Evidence brief: Magnitude of childhood immunization and its associated factors in Sub-Saharan Africa: A mixed effect count regression analysis
