Paternal factors affecting under-five immunization status in Sub-Saharan Africa: A systematic review and meta-analysis

Abstract

While maternal influences on childhood immunization have been extensively studied in sub-Saharan Africa (SSA), paternal socioeconomic factors remain underexplored despite their potential impact on vaccination outcomes. This systematic review and meta-analysis aimed to synthesize current evidence on the influence of paternal characteristics on full childhood immunization status in SSA. A comprehensive literature search was conducted in PubMed, Google Scholar, Embase, and Scopus for studies published between January 2014 and March 2025. Studies were included if they examined paternal factors, such as education, employment, and decision-making power, in relation to childhood immunization among children under five in SSA. Data were extracted from 16 eligible studies, and a meta-analysis was conducted using MetaXL and IBM SPSS to calculate pooled prevalence and effect sizes. The Downs and Black checklist was used for risk of bias assessment. Of the 16 studies included, seven contributed data to the meta-analysis on full immunization. The pooled prevalence of full immunization was 60 % (95 % CI: 37-81 %) across SSA. Children of fathers with primary education or higher were nearly three times more likely to be fully immunized than those whose fathers had no formal education (OR = 2.72, 95 % CI: 1.22-6.03, I² = 98 %). While the association between paternal employment status and child immunization was statistically non-significant (OR = 1.74, 95 % CI: 0.10-29.20, I² = 91 %), qualitative findings suggest employment influences health-seeking behavior. Decision-making power within households also emerged as an important factor, with joint parental decision-making linked to higher immunization coverage. Interventions aiming to improve immunization outcomes should consider strategies to engage fathers, promote joint decision-making, and address underlying gender norms. Further research is needed to understand better the mechanisms through which paternal factors influence vaccine uptake in diverse SSA settings.

Keywords: Childhood immunization; Paternal involvement; Socioeconomic factors; Sub-Saharan Africa; Systematic review and meta-analysis; Vaccine uptake.