Prevalence and Factors Contributing to Missed Opportunities for Vaccination in Mogadishu, Somalia

"Understanding these dynamics is crucial for developing targeted interventions to enhance vaccination coverage, address access barriers, and mitigate the burden of vaccine-preventable diseases in the country."

Somalia, a country grappling with protracted conflict, political instability, and fragile health systems, faces considerable challenges in achieving and sustaining high vaccination coverage rates. Previous studies have highlighted the presence of missed opportunities for vaccination (MOVs) among children attending healthcare facilities, where opportunities to administer vaccines are overlooked, regardless of the reason for the facility visit. This study aimed to determine the prevalence of and identify the factors contributing to MOV in the urban area of Mogadishu, Somalia.

A cross-sectional study was conducted at various healthcare facilities in Mogadishu, Somalia, from January to March 2024. A total of 234 caregivers of children under five years of age were interviewed using a structured questionnaire. Data on sociodemographic characteristics, health service utilisation, and reasons for missed vaccinations were collected. Logistic regression analysis was used to identify factors associated with MOV.

The prevalence of MOV in Mogadishu was high, at 26.5% (6% were zero-dose children and had never been vaccinated). Key factors contributing to MOV included low socioeconomic status, lack of caregiver awareness about vaccination schedules, logistical challenges within the healthcare system, and misconceptions about vaccine safety and efficacy. Knowledge and beliefs of mothers about vaccination significantly affected the MOVs in children. Select findings:
 

• Caregivers who don't know that all children should be vaccinated are 13 times more likely to have missed opportunities for immunisation compared to caregivers who know [adjusted odds ratio (AOR) = 13.006, 95% confidence interval (CI) = 1.175-143.924, p = 0.003].
• Children who were delivered in the home unassisted [AOR= 6.280, 95% CI: 2.010-19.629] were 6 times more likely to be unvaccinated compared with their counterparts.
• The proportion of missed opportunity(ies) for vaccination was associated with caregiver attitude, with participants having no idea about the side effects of vaccines being 3 times more likely to miss their children's vaccination compared to participants who know the side effects [AOR= 3.620, 95% CI: 1.320-9.924].

The study highlighted a significant prevalence of missed opportunities for vaccination in Mogadishu, Somalia. "Addressing these requires a multifaceted approach: increasing public awareness, improving healthcare infrastructure, ensuring reliable vaccine supply chains, and implementing tailored community engagement and educational campaigns to overcome misconceptions and build trust in vaccination programs."