Correlates of Full, Partial, and Non‑Immunisation among Children Aged 12-23 Months in Gokwe South District, Rural Zimbabwe.

Abstract

Childhood immunisation coverage is often lower in rural and hard-to-reach areas of Zimbabwe than national targets, potentially leaving children vulnerable to vaccine-preventable diseases. We examined factors associated with immunisation status among 12-23-month-old children in rural Zimbabwe, using a cross-sectional study among caregivers of 12-23-month-old children. These were selected using a multistage sampling strategy, with households randomly selected within health facility catchment areas. Logistic regression models identified correlates of incomplete immunisation. Among 573 caregiver-child pairs (54.8% male), 62.1% of children were fully immunised, 24.6% partially immunised, and 13.3% not immunised; coverage did not differ by sex (p = 0.12). Bivariate analyses showed significant associations with possession of a child health card, maternal education, place of birth, religious affiliation, knowledge of immunisation schedules, and caregiver satisfaction with healthcare (p < 0.05). In the adjusted binary logistic regression model, caregiver dissatisfaction (AOR = 2.6; 95% CI: 1.7-4.0), absence of a child health card (AOR = 3.5; 95% CI: 2.2-5.5), limited knowledge of new vaccines (AOR = 1.9; 95% CI: 1.2-3.1), and apostolic affiliation (AOR = 0.44; 95% CI: 0.26-0.73) independently predicted non-immunisation. Multinomial regression showed that home birth, low maternal knowledge, and lack of health cards differentiated partial from complete non-immunisation. Improving caregiver health literacy, strengthening health-system responsiveness, ensuring continuity of child health records, and engaging apostolic religious communities may substantially improve childhood immunisation coverage in rural Zimbabwe.