Educational determinants of immunization coverage among internally displaced persons (IDPs) in Mogadishu: a cross-sectional study.

Background: Immunization remains a cornerstone of global public health; however, Somalia faces critical challenges in achieving equitable vaccination coverage, particularly among internally displaced individuals (IDPs). The National immunization rates for diseases such as diphtheria-tetanus-pertussis (DTP3), measles, and polio remain below 50%, exacerbated by decades of conflict, fragile healthcare infrastructure, and socioeconomic disparities. IDPs in Somalia encounter unique barriers, including overcrowded living conditions and limited access to healthcare and mobility, which disrupt care continuity. This study examined the immunization coverage disparities between IDPs and urban residents in Somalia, focusing on the sociodemographic and attitudinal determinants of vaccine uptake. By analyzing factors such as education, income, marital status, and vaccine perceptions, this study aimed to inform targeted strategies to improve vaccination access in conflict-affected settings.

Method: A cross-sectional study was conducted in March 2025 across two IDP camps (ANFAC and Sahal) in Somalia's Banadir Region. Using stratified systematic sampling, 384 participants were enrolled, and data were collected via structured questionnaires administered in Somali. Vaccination status was verified through immunization cards or self-reports, and the predictor variables included age, education, occupation, income, marital status, and attitudes toward vaccine safety and efficacy. Statistical analysis employed Chi-square tests and multivariate logistic regression were used to identify the determinants of vaccine uptake with adjustments for confounders.

Result: This study revealed significant immunization disparities primarily associated with educational attainment. Participants with secondary education achieved vaccination rates of 72.6% versus 41.2% among those without formal education. Multivariate analysis identified secondary education (AOR = 3.82, 95% CI: 1.74-8.40, p = 0.001) and tertiary education (AOR = 7.95, 95% CI: 3.33-19.01, p < 0.001) as the strongest predictors of full vaccination, followed by marital status (divorced/widowed: AOR = 0.33, 95% CI: 0.14-0.81, p = 0.015). Household income and positive vaccine attitudes showed no significant association in the adjusted model.

Conclusion: Educational disparities emerge as the most critical barrier to immunization among Somali IDPs. The findings highlight the need for integrated interventions prioritizing community-led education programs and mobile vaccination clinics with cold chain capacity. These strategies, combined with health system strengthening for mobile populations, could reduce zero-dose children by 50% and advance Immunization Agenda 2030 targets. The study underscores that improving access to education may have greater impact on vaccine uptake than economic interventions alone.