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. 2025 Aug 19;25(1):630.
doi: 10.1186/s12887-025-05926-9.

Routine immunization coverage among children under 24 months and its determinants in Eastern and Oti regions of Ghana

Chris Guure  1 , Yakubu Alhassan  2 , Samuel Dery  2 , Jessica Asante  2 , Emmanuel T Sally  3 , Ernest Tei Maya  4 , Frances Baaba da-Costa Vroom  2 , Seth K Afagbedzi  2 , Cornelius Tenku  5 , Carla Lewis  5 , Natia Ubilava  5
Affiliations

Routine immunization coverage among children under 24 months and its determinants in Eastern and Oti regions of Ghana

Chris Guure et al. BMC Pediatr. .

Abstract

Background and objective: Immunization is a cornerstone of public health, significantly reducing child mortality and morbidity worldwide. Despite global progress, millions of children, particularly in low- and middle-income countries (LMICs), still lack access to lifesaving vaccines. In Ghana, disparities in vaccination coverage persist, with sub-national inequities affecting the achievement of universal immunization. This study aimed to evaluate routine immunization coverage among children under two years of age in Ghana's Eastern and Oti regions, focusing on identifying gaps and informing targeted interventions to improve immunization outcomes.

Method: A cross-sectional study was conducted using a multistage stratified sampling approach. Data were collected from 1,114 eligible children aged 24-35 months across 73 enumeration areas in 11 districts. Vaccination information was obtained from vaccination cards or caregiver recall. Descriptive statistics and binary logistic regression were used to analyze vaccination coverage and identify factors associated with full immunization. Data were weighted to account for the multistage sampling design.

Results: Full vaccination coverage for all antigens (excluding hepatitis B) was 18.7% (95% CI: 16.5%-21.1%), with higher rates in rural 19.7% (95% CI: 16.8%-23.1%) than urban areas 17.4% (95% CI: 14.3%-21.0%). Coverage for basic antigens was 78.8% (95% CI: 76.3%-81.1%), with rural areas 82.4% (95% CI: 79.2%-85.3%) outperforming urban areas 74.4% (95% CI: 70.4%-78.0%). The Oti region had higher coverage for basic antigens 85.3% (95% CI: 81.3%-88.5%) and the national schedule 62.1% (95% CI: 52.2%-62.4%) compared to the Eastern region. In the Eastern region, older children were more likely to be fully vaccinated (aOR: 1.06, 95% CI: 1.01-1.12, p = 0.021), while in the Oti region, age (aOR: 0.96, 95% CI: 0.89-1.04) was not a significant factor.

Conclusion: The study highlights significant disparities in vaccination coverage between urban and rural areas and across regions. Targeted interventions are needed to address gaps in coverage, particularly in urban areas where full vaccination rates remain lower. Strengthening health systems, leveraging technology, and improving community engagement are critical steps toward achieving equitable and high vaccination coverage for all children in Ghana.

Keywords: Children under two; Determinants of immunization; Ghana; Routine immunization; Vaccination coverage.

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Conflict of interest statement

Declarations. Ethics approval and consent to participate: All methods were conducted following the regulations and principles of the Helsinki Declaration (World Medical Association, 2013). This study was approved by the Ghana Health Service Ethics Review Committee (GHS-ERC:026/05/24). Consent to participate and to extract children’s (aged 24–35 months) information from the immunization folder was obtained from the children’s parents and, in some cases, their caregivers. The parents or caregivers who provided informed consent were 18 years and above. The parents or caregivers either signed or thumbprinted the informed consent forms on behalf of the children. The study was voluntary, and the consenting process was explained to participants so they could willingly decide to participate. Participants had the flexibility to withdraw at any time during the survey process. Permission to conduct the study in the selected facilities was obtained from the Ghana Health Service through Simprints Technology. The various regional and district directorates for health services were engaged for permission in their respective regions and districts to conduct the research. Consent for publication: Not applicable. Competing interests: The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Eligibility of samples in the study
Fig. 2
Fig. 2
Full vaccination coverage of all antigens
Fig. 3
Fig. 3
Full Vaccination coverage of basic antigens
Fig. 4
Fig. 4
DHS full Vaccination coverage of antigens according to the national schedule
Fig. 5
Fig. 5
Antigen specific coverages among children in the study
See this image and copyright information in PMC

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