Published in PLOS One on 2026-03-20, 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: Tadesse Tarik Tamir, Muluken Chanie Agimas, Dessie Abebaw Angaw
Source: PLOS One • DOI 10.1371/journal.pone.0344293
Read the complete primary study ↗ · Creative Commons Attribution licence
From the researchers
Abstract
Vaccination is one of the most cost-effective strategies for enhancing public health and well-being. Despite widespread immunization efforts, zero-dose vaccination among children remains a pressing public health challenge in sub-Saharan Africa (SSA) and there exists a notable gap in research regarding its current burden, spatial distribution and determinants. Hence, this study was aimed at assessing prevalence, spatial patterns and determinants of zero-dose vaccination among children aged 12–23 months in SSA, 2025.
A secondary data analysis of community-based cross-sectional Demographic and Health Survey data from 2015 to 2024 was conducted using a total weighted sample of 58,443 children aged 12–23 months. Descriptive statistics were summarized using texts, tables, and figures, and a multilevel spatial analysis was applied to identify the determinants of zero-dose vaccination. Adjusted odds ratios (AORs) with 95% confidence intervals (CIs) were computed to determine the level of significance, with a p-value < 0.05 considered statistically significant.
The prevalence of zero-dose vaccination among children aged 12–23 months in SSA was 13.3% with 95% CI (10.2%, 16.3%). The hot spot clusters were located in most of Nigeria, Angola, Ethiopia, Madagascar, Guinea, Cote d’Ivoire, the southern border of Mauritania, and southeastern of Mali and Mozambique. The poorest household wealth index (AOR = 1.30; 95% CI: 1.10–1.53), home delivery (AOR = 2.60; 95% CI: 2.39–2.83), having no media exposure (AOR = 1.25; 95% CI: 1.14–1.35), no (AOR = 2.41; 95% CI: 2.17–2.68) or low antenatal care visits (AOR = 1.37; 95% CI: 1.26–1.49), having no tetanus toxoid vaccination (AOR = 1.63; 95% CI: 1.49–1.79), having no (AOR = 1.81; 95% CI: 1.62–2.03) or only primary maternal education (AOR = 1.28; 95% CI: 1.16–1.43), perceived problem of distance to health facility (AOR = 1.13; 95% CI: 1.05–1.21) and rural residence (AOR = 1.25; 95% CI: 1.07–1.67) were significantly associated with zero-dose vaccination.
In SSA, zero-dose vaccintion was high compared to the global target of no tolerance for zero-dose. The distribution of zero-dose vaccination was spatially clustered with individual and community level factors significantly associated with it. Therefore, spatially targeted interventions taking these factors into account should be implemented by stakeholders in the SSA region to address zero-dose children.
Introduction
Vaccination is defined as a simple, safe, and effective method of protecting individuals against harmful diseases prior to actual exposure [1,2]. It works by using the body’s natural defenses to build resistance to specific infections, thereby strengthening the immune system [1]. A vaccine prepares and empowers the body so that it may generate antibodies against certain pathogens, viruses, or bacteria without permitting the organism to damage the body [1]. This enables the body’s defenses to ‘remember’ the particular illness which they may encounter later on, and respond more proficiently [3]. Various methods of administering vaccine include injections, oral pills, ointments, or nasal sprays. They are essential for averting grave medical problems and have the ability to shield individuals from the early stage of infant life to old age [2]. Getting vaccinated ensures protection to the individual, which also strengthens community immunity, ensuring safety for those who are unable to get the vaccine, including newborns or those with some medical issues [3]. Preventive health care starts with vaccination which is not only a necessity for children but also a legal condition for social involvement [4,5]. Internationally, it is acclaimed for being one of the most economically efficient measures intended to boost public health and foster wellbeing at the same time catalyzing sustainable development [6]. Vaccination programs are foreseen to avert about 5.1 million deaths yearly from diseases that have available vaccines [7]. Currently, over 100 million children are vaccinated against diphtheria, tetanus, whooping cough, tuberculosis, polio, measles, and Hepatitis B [8]. Immunization has proven to be a reliable public health measure; however, some children are still not vaccinated with the first dose of diphtheria- tetanus- pertussis vaccine known as zero-dose children [9,10].
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 Tadesse Tarik Tamir, Muluken Chanie Agimas, Dessie Abebaw Angaw. 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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