Minimum Immunization Coverage and Maternal Determinants among Children Aged 12–23 Months in Somalia: Analysis of the 2020 SDHS

Background Immunization remains one of the most effective strategies for preventing childhood morbidity and mortality, yet coverage in Somalia continues to be among the lowest globally. Persistent insecurity, population mobility, and systemic health system challenges limit the uptake of routine childhood vaccines. Given the extremely low levels of full immunization coverage reported nationally, this study assessed minimum immunization coverage, defined as receipt of at least one dose of BCG, pentavalent, oral polio (excluding birth dose), and measles vaccines. The objective was to estimate the prevalence of minimum immunization coverage and examine maternal and household determinants among children aged 12 to 23 months. Methods This study analyzed nationally representative data from the 2020 Somalia Health and Demographic Survey. A total of 2,969 children aged 12 to 23 months were included. Weighted descriptive statistics were used to summarize population characteristics, while bivariate and multivariable logistic regression analyses identified factors associated with minimum immunization coverage. All analyses accounted for the complex sampling design, and statistical significance was set at p < 0.05. Results Only 4 percent of children received the minimum recommended vaccinations. Significant disparities were observed across regions, with coverage ranging from 1 to 9 percent. In the adjusted analysis, maternal primary (AOR = 2.45, p = 0.003) and secondary education (AOR = 7.24, p < 0.001), higher household wealth (middle: AOR = 6.05, p < 0.001; fourth: AOR = 3.47, p = 0.006; highest: AOR = 7.04, p < 0.001), and urban residence (AOR = 1.87, p = 0.035) were independently associated with greater odds of minimum immunization. Children living in Nugaal, Mudug, Galgaduud, and Hiraan also had significantly higher odds of being immunized compared with the reference region. Conclusion Minimum immunization coverage among Somali children remains critically low, reflecting persistent inequities in access to routine vaccination services. Maternal education, household wealth, place of residence, and regional location were key determinants of uptake. Strengthening routine immunization systems, expanding outreach to underserved and mobile populations, and addressing socioeconomic barriers are essential to increase vaccine coverage and reduce preventable childhood mortality in Somalia.