Coverage and determinants of childhood immunization in Somalia: A systematic review and meta-analysis.

TL;DR

Childhood immunization coverage in Somalia remains low, with only 42.2% achieving full immunization and 16.1% completing four basic vaccines. Key determinants include facility birth, maternal education, and rural residence, though antenatal care visits showed an unexpected inverse association.

Key findings

• Full immunization coverage in Somalia is 42.2%; only 16.1% of children received all four basic vaccines
• Facility births strongly increase immunization likelihood (AOR=2.10), whereas the inverse association with ≥4 ANC visits (AOR=0.27) suggests implementation gaps in maternal-child service integration
• Maternal education increases immunization odds (AOR=1.14), and unexpectedly, rural children have higher immunization rates than urban children (AOR=1.55)
• Meta-analysis of 11 cross-sectional studies (2010–2025) synthesized coverage estimates and identified structural and sociodemographic determinants of vaccination uptake

Why this matters at the bedside

For clinicians working in or advising on maternal-child health in Somalia, these findings identify major gaps in immunization infrastructure and highlight that prenatal contact points are underutilized for immunization promotion. The inverse ANC-immunization association suggests that high-contact mothers may face access barriers at vaccination visits despite engagement with antenatal care, pointing to potential disconnect between prenatal and immunization services.