Immunization Coverage and Its Determinants Among Children Aged 12-23 Months in East Africa: A Bayesian Hierarchical Modeling Approach Based on DHS 2019-2022.

Abstract

Background: Vaccines constitute a fundamental component of public health interventions, preventing the transmission of numerous diseases. Nevertheless, vaccines remain underutilized in various regions globally, particularly in East African nations, where high mortality rates among children under 5 years of age are predominantly attributable to vaccine-preventable diseases. Consequently, this investigation is aimed at evaluating children's vaccination coverage and its associated determinants in East Africa utilizing Bayesian hierarchical modeling based on Demographic and Health Survey (DHS) data (2019-2022).

Methods: This study analyzed nationally representative data from the DHS, a standardized cross-sectional household survey program that collects health and population data using stratified two-stage cluster sampling. Data were drawn from surveys conducted between 2019 and 2022 in five East African countries: Ethiopia (2019), Kenya (2022), Mozambique (2022), Rwanda (2019/20), and Tanzania (2022). A Bayesian hierarchical regression model was applied to identify factors influencing vaccination coverage, evaluating four candidate models using leave-one-out cross-validation to select the best fit. Statistical significance was assessed using 95% posterior credible intervals (CrIs) after confirming model convergence.

Results: A total of 15,703 weighted children aged 12-23 months were included, with an overall survey response rate of 97.2%. A substantial proportion of children (73.81%) were only partially immunized, highlighting a critical gap in achieving full vaccination coverage. The Bayesian hierarchical ordinal logistic regression showed that several factors were significantly associated with the odds of being in a higher vaccination category versus a lower one. Children residing in Kenya had 3.10 times higher odds of being in a higher vaccination category compared with those in Ethiopia (AOR = 3.10; 95% CrI: 2.49-3.86). Maternal media exposure (AOR = 1.25, 95% CrI: 1.15, 1.38), maternal education (secondary or above) (AOR = 1.42, 95% CrI: 1.21, 1.67), health facility delivery (AOR = 1.53, 95% CrI: 1.19, 1.96), postnatal care visit (AOR = 1.28, 95% CrI: 1.15, 1.43), skilled birth attendance (AOR = 1.61, 95% CrI: 1.24, 2.079), and antenatal care (ANC) visits (four and above) (AOR = 4.08, 95% CrI: 3.44, 4.84) were all positively associated with higher odds of being in a higher vaccination category.

Conclusions: Vaccination coverage remains low across East Africa, with significant regional disparities. These results highlight the need for focused interventions in high-risk areas and addressing key determinants to improve childhood vaccination rates.