Immunization coverage refers to the proportion of children who have received essential vaccinations to protect them from illnesses (1). Africa carries the highest burden of under-five mortality globally, with Sub-Saharan Africa experiencing a rate of 74 deaths per 1,000 live births, compared to the global average of 37 per 1,000 live births (2). A significant proportion of these deaths are attributed to preventable infectious diseases, such as pneumonia, diarrhea, malaria, and measles (3), despite the availability of effective vaccines; measles alone, a highly preventable disease, remains a substantial cause of childhood mortality even though the vaccine has a 95%–97% efficacy when two doses are administered (4). Even with advancements in vaccine accessibility through the WHO's Expanded Programme on Vaccination (EPI), many African countries continue to experience low vaccination rates (5). The situation is particularly severe in Sub-Saharan Africa, where many countries face significant challenges in achieving global vaccination targets (6, 7). Although progress has been made over the past few decades, routine vaccination coverage remains below the desired level in many nations (8). In Somalia, the infant mortality rate is exceedingly high, with approximately 81 deaths per 1,000 live births, primarily attributable to preventable illnesses, including measles, which contributes to approximately 30% of childhood mortality (2, 9).

In Somalia, decades of conflict, political instability, and a weakened healthcare system have created a particularly challenging vaccination landscape, resulting in coverage that remains significantly lower than in many other parts of Africa (10–12). Recent studies from 2020 to 2023 conducted in various locations across Somalia indicate that only about 20%–55% of children receive all necessary vaccines, with measles and polio continuing to be endemic in certain regions (1, 13, 14). Previous indicated that higher household income is linked to improved access to healthcare, including vaccinations (14, 15). Conversely, several studies have associated maternal literacy with better vaccination coverage (1, 13, 14, 16–19). Finally, Studies indicate that ANC visits significantly improve childhood vaccination rates through maternal education, care access, and vaccination schedule adherence (13, 20).

Despite ongoing efforts by the Ministry of Health, along with support from international donors such as WHO, UNICEF, and GAVI, to increase vaccination rates in Somalia to increase vaccination rates, many children remain vulnerable to vaccine-preventable diseases in Somalia, leading to increased morbidity and mortality rates (10, 21). While some research has examined barriers to vaccination, there is a lack of detailed studies focused on Somalia. Our study is essential as it identified specific causes of low vaccination coverage and generated valuable insights directly applicable to improving the efficacy of public health initiatives. The study aimed to examine the vaccination coverage and determinants for children aged 12–23 months at community health centers in Mogadishu, Somalia. By identifying barriers to vaccination, the study aids in developing more targeted interventions and strategies to improve vaccine coverage and child health in the region.

A total of 417 participants with diverse sociodemographic backgrounds were included in the study. All eligible mothers agreed to be included. The majority of mothers were aged 20–26 years (45.8%), followed by those aged 27–33 years (26.4%) and 34–40 years (27.8%). Most participants were married (78.4%) and a significant proportion had no formal education (60.2%). Additionally, the majority of mothers were unemployed (81.1%). Household monthly incomes were distributed as follows: 23.7% of households earned between $100–$200, 27.1% earned between $200–$300, 25.4% earned between $300–$400, and 23.7% earned between $400–$500.

Regarding children, the majority were aged 12–14 Months (50.6%), with a nearly equal distribution of males (48.0%) and females (52.0%). Birth order varied, with 30.7% being first or second born, 44.8% being third or fourth born, and the remainder fifth or above in birth order, as shown in Table 1.

This study examined the vaccination status and determinants for children aged 12–23 months at community health centers in Mogadishu, Somalia. Our study found that 53% of children were fully immunized, while 47% were partially vaccinated. This rate is higher than that observed in previous studies from Galkayo and Mogadishu, where vaccination rates were lower, but still lower than those reported in Hargeisa (1, 13, 14). Additionally, the findings revealed a significant association between household income and partial vaccination status, showing that families with an income between $300 and $400 had a notable most likely of partial vaccination status (AOR: 3.247, 95% CI: 1.784–5.910, p = 0.002). This result is different from previous research which consistently demonstrates that higher household income facilitates access to healthcare services, including vaccinations (14). This discrepancy may be due to methodological differences; our study is a cross-sectional analysis conducted at health centers, while previous research was largely household-based. Furthermore, community health centers often provide supplemental nutrition and childcare resources alongside vaccinations, which may incentivize vaccination adherence among families with low incomes.

In contrast, our study did not find significant associations with sociodemographic factors like maternal literacy and birth order, unlike other research that links higher maternal literacy with better vaccination coverage, indicating that educated parents are generally more informed and adept at accessing healthcare (1, 13, 14, 16–19, 22). This may be due to specific characteristics of our study population or differences in how these factors interact with vaccination coverage in our context.

Our analysis further revealed that children whose mothers had no antenatal care (ANC) visits were significantly less likely to be fully immunized compared to those whose mothers had four ANC visits (AOR = 5.202, p = 0.001). This is consistent with previous studies that found antenatal care attendance significantly influences vaccination rates, with children born in hospitals being more likely to receive full vaccination (13, 20). However, this study did not find some factors to be significantly associated with vaccination coverage as reported in other studies. Discrepancies may arise from differences in study populations, timing of data collection, definitions of vaccination status, study methodologies, or unmeasured factors.

This finding highlights the critical role that ANC visits play in ensuring complete vaccination, as they provide an opportunity for healthcare providers to educate mothers on the importance of vaccines and to ensure the timely administration of vaccines during healthcare visits.

This study found a low full vaccination rate of 53%. Higher vaccination rates correlated with higher income and consistent antenatal care (ANC). We recommend increasing ANC access, addressing socioeconomic barriers, and strengthening community outreach. Future research is essential to understand and address the unique barriers to vaccination experienced by low-income communities, while also prioritizing the development and implementation of innovative community-led engagement approaches.