Document
Metadata
Authors
Hana Mahdi Dahir, Farduus Ibraahim Mohamed, Ayan Husein Korse, Saralees Nadarajah
Title
Spatial distribution and multilevel determinants of unvaccinated children in Somaliland: analysis of the 2020 Somaliland Health and Demographic Survey (SLHDS)
Journal
BMC Public Health
Year of Publication
2026
Abstract
Background: Children who have never received any vaccination represent one of the clearest markers of health system inequity. In this study, unvaccinated status was defined as caregiver report that a child under five years had never received any routine vaccine, reflecting complete non-vaccination rather than dose-specific (e.g., DTP1-based) definitions. This study examined the prevalence and determinants of unvaccinated children in Somaliland using nationally representative data. Methods: We analyzed data from 1,104 children under five years from the 2020 Somaliland Health and Demographic Survey (SLHDS). Multilevel logistic regression models were fitted to assess individual-, household-, and community-level factors associated with being unvaccinated. Results: The prevalence of unvaccinated children was 79.9%. In the fully adjusted model, children of mothers with secondary education had significantly lower odds of being unvaccinated compared with those whose mothers had no education (AOR = 0.32; 95% CI: 0.14–0.74). Antenatal care attendance was strongly associated with reduced odds of non-vaccination (1–3 visits: AOR = 0.37; 95% CI: 0.28–0.52; ≥4 visits: AOR = 0.40; 95% CI: 0.26–0.64). Older children were less likely to be unvaccinated compared to infants aged 0–8 months (9–23 months: AOR = 0.37; 95% CI: 0.19–0.72; 24–59 months: AOR = 0.32; 95% CI: 0.19–0.58). Children not currently breastfeeding had lower odds of being unvaccinated (AOR = 0.68; 95% CI: 0.52–0.90). At the community level, residence in areas with high ANC utilization was associated with substantially lower odds of non-vaccination (AOR = 0.37; 95% CI: 0.25–0.57). Descriptive mapping revealed marked regional variation, with particularly high prevalence observed in Awdal and Sool. Conclusion: Complete non-vaccination in Somaliland is strongly associated with maternal education, engagement with antenatal care, child age, breastfeeding status, and community-level health service utilization. Integrated maternal–child health strategies and targeted regional interventions are urgently needed to reduce the exceptionally high burden of unvaccinated children. © The Author(s) 2026.
DOI
10.1186/s12889-026-27020-0
Category
Medicine and Health Sciences