Abstract
BACKGROUND: Childhood immunization is a critical public health intervention that significantly reduces child morbidity and mortality. However, despite global progress, disparities in immunization coverage persist, particularly in low-income and conflict-affected settings such as Somalia. Zero-dose immunization, defined as the complete absence of routine vaccinations, remains a major challenge, leaving children vulnerable to vaccine-preventable diseases. Understanding the prevalence and sociodemographic determinants of zero-dose immunization is essential for developing targeted interventions. METHODS: This study analyzed data from the 2020 Somalia Demographic and Health Survey (SDHS) to estimate the prevalence of zero-dose immunization among children aged 12-23 months and assess its distribution across key sociodemographic and geographic factors. The study defined zero-dose children as those who had not received the first dose of the diphtheria-tetanus-pertussis vaccine (DPT1). Descriptive statistical analyses were conducted to examine variations in zero-dose prevalence by maternal characteristics, household wealth, healthcare access, and geographic region. RESULTS: The prevalence of zero-dose immunization among Somali children was 44.0%, with significant disparities across socioeconomic and regional characteristics. Zero-dose prevalence was highest among children of younger mothers (54.0% for those aged 15-19 years) and those whose mothers had no formal education (49.0%). Household wealth was also a key determinant, with zero-dose prevalence reaching 53.0% in the poorest households compared to 29.0% in the wealthiest. Geographic disparities were evident in the administrative regions of Somalia, with the highest zero-dose prevalence recorded in Lower Juba (62.0%), Bay (62.0%), and Banadir (55.0%), while the lowest was observed in Togdheer (24.0%) and Sool (28.0%). Children residing in rural areas had lower immunization coverage, likely due to limited healthcare access. CONCLUSION: The high prevalence of zero-dose immunization in Somalia underscores the urgent need for targeted interventions to improve vaccine uptake. Addressing disparities related to maternal education, household wealth, and geographic accessibility is crucial. Strengthening routine immunization services, expanding community outreach, and improving healthcare infrastructure in high-prevalence regions are necessary to reduce the proportion of zero-dose children and improve child health outcomes.