Determinants of Incomplete Immunization Among Children Aged 12 to 23 Months in the Lower Manya Krobo Municipality Eastern Region of Ghana

Abstract

Background: Immunization is a cornerstone of child health, yet coverage gaps persist due to socioeconomic and health system barriers. Aim: This study examined determinants of incomplete immunization among children aged 12– 23 months, focusing on demographic, socioeconomic, and health system factors. Methodology: A cross-sectional survey of 344 caregivers was conducted. Chi-square tests assessed associations between demographic and health system variables and immunization status, while binary logistic regression identified independent predictors of incomplete immunization. Results: Of the children studied, 68.9% were fully immunized and 31.1% missed at least one vaccine, with Yellow Fever most frequently missed (13.4%). Chi-square analyses revealed significant associations with age, income, occupation, marital status, distance to facility, transport mode, vaccine availability, waiting time, and clinic crowding. Logistic regression confirmed that age group, income level, vaccine availability, and clinic crowding were independent predictors of incomplete immunization, while occupation lost significance after adjustment. Conclusion: Both socioeconomic status and health system capacity are pivotal determinants of immunization outcomes. Younger caregivers, low-income households, and those affected by vaccine shortages or clinic crowding are at greatest risk. Strengthening vaccine supply chains, reducing clinic congestion, expanding caregiver education, and addressing socioeconomic inequities are essential strategies to improve immunization coverage and equity. Contribution: By situating the analysis within the Ghanaian context, this study contributes to the literature on immunization determinants in low- and middle-income countries. It provides actionable evidence for policymakers and health practitioners seeking to achieve universal immunization coverage and safeguard child health.