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Background Between 2010 and 2016, the proportion of children 12–23 months of age who received full immunization in Malawi decreased from 81% to 76%. Most studies on immunization have mainly focused on the risk factors of vaccination coverage while data on dropouts and equity gaps is very scanty. Thus the aim of the present study was to describe the trend in immunization coverage, dropout rates and effective immunization coverage (EIC) among children ages 12–23 months in Malawi. Methods Secondary analyses of the cross-sectional data obtained from the three waves of the Demographic and Health Surveys (2004, 2010 and 2015–16) were conducted. Using bottleneck analysis, outputs were generated based on service coverage, demand/equity (service utilization) and quality (full immunization). The World Health Organization benchmarks were used to assess gaps in the immunization coverage indicators. Results The coverage was >90.0% in most of the antigens while full immunization status was estimated at 65%, 84% and 73% in 2004, 2010 and 2015, respectively. The highest coverage was observed in Bacillus Calmette–Guérin (BCG) and lowest in oral polio vaccine 1 (OPV1). OPV1 coverage was <90% in the 2004 cohort year, while pentavalent 3 (Penta3) and measles-containing vaccine 1 (MCV1) coverages were <90% in 2004. Dropout rates of Penta3 and MCV1 were significantly >10% in 2004. The logistic regression analyses showed that children were significantly less likely to be immunized with Penta3 and MCV1 in all cohort years compared with Penta1. Conclusions Although immunization coverage was in line with the national and district targets for various antigens, full vaccination coverage (FVC) is still lagging behind. Furthermore, the dropout rates for Penta3 and MCV1 showed upside U-shaped patterns. Thus health education, supervision and orientation of service providers are urgently needed to address disparities that are existing in FVC.

Background Every year, vaccination averts about 3 million deaths from vaccine-preventable diseases (VPDs). However, despite that immunization coverage is increasing globally, many children in developing countries are still dropping out of vaccination. Thus, the present study aimed to identify determinants of vaccination dropouts among children aged 12–23 months in The Gambia. Methods The study utilized cross-sectional data obtained from the Gambia Demographic and Health Survey 2019–20 (GDHS). The percentage of children aged 12–23 months who dropped out from pentavalent and measles vaccination were calculated by (1) subtracting the third dose of pentavalent vaccine from the first dose of Pentavalent vaccine, and (2) subtracting the first dose of measles vaccine from the first dose Pentavalent vaccine. Generalized Estimating Equation models (GEE) were constructed to examine the risk factors of pentavalent and measles vaccinations dropout. Results Approximately 7.0% and 4.0% of the 1,302 children aged 12–23 months had dropped out of measles and pentavalent vaccination respectively. The multivariate analyses showed that when caregivers attended fewer than four antenatal care sessions, when children had no health card or whose card was lost, and resided in urban areas increased the odds of pentavalent dropout. On the other hand, when women gave birth in home and other places, when children had no health card, and being an urban areas dweller increased the odds of measles dropout. Conclusion Tailored public health interventions towards urban residence and health education for all women during ANC are hereby recommended.

Background: Immunization is considered an effective tool for controlling and eliminating life-threatening infectious diseases. However, most studies on immunization have mainly focused on vaccination coverage while data on dropouts and equity gaps is very scanty. Thus, the aim of the present study was to describe the trend in immunization coverage, dropout rates and effective immunization coverages (FVC) among children aged 12–23 months in Malawi.Methods: We conducted secondary analyses of the cross-sectional data taken from three waves of the Demographic and Health Surveys (2004, 2010, and 2015-16). Using the bottleneck analysis, outputs were generated based on service coverage, demand/equity (service utilization) and quality/effective coverage. The World Health Organization benchmarks were used to assess gaps in the immunization coverage indicators.Results: The coverage was above 90.0% in most of the antigens while full immunization status was estimated at 65%, 84%, and 73% in 2004, 2010, and 2015 respectively. The highest coverage was observed in BCG and lowest in Oral Polio Vaccine1 (OPV1). OPV1 coverage was less than 90% in 2004 cohort year, whilst Penta3 and MCV1 coverages were less than 90% in 2004. Additionally, full vaccination coverage (FVC) was 65%, 84%, and 74% in 2004, 2010, and 2015 respectively. Dropout rates of Penta3 and MCV1 were significantly higher than 10% in 2004 however, the dropouts had U-shaped patterns. The logistic region analyses showed that children were significantly less likely to be immunized with Penta3 and MCV1 in all cohort years compared to Penta1.Conclusions: Though immunization coverage was in line with the national and district targets for various antigens between 2004 and 2015, however, the FVC is still lagging behind. Furthermore, the dropout rates for Penta3 and MCV1 showed U-shaped patterns. Thus, health education, supervision, and orientation of service providers are instantly needed to address disparities that are existing in FVC.

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