# Socio-economic determinants for reduced uptake of routine childhood vaccination in Afghanistan

## TL;DR

Low childhood vaccination rates in Afghanistan are linked to factors like maternal education, household wealth, and language spoken, suggesting targeted strategies could improve coverage.

## Contribution

This is the first study to quantify the association between household head's language and childhood immunization status using Afghanistan's MICS 2022–23 data.

## Key findings

- Children from Pashto-speaking households had significantly higher odds of being unvaccinated or under-vaccinated.
- Maternal education significantly influences vaccination status, with no formal education increasing under-vaccination risk.
- Household wealth is positively correlated with full vaccination rates.

## Abstract

Coverage of many routine childhood vaccinations in Afghanistan is low and declining. For instance, only 60% of eligible children received doses of the pentavalent vaccine in 2013–18, and this fell to 51% in 2022/23.

To help explain the underlying causes behind this trend, this study aims to identify socio-demographic factors relating to caregivers whose children are either entirely unvaccinated or only partially vaccinated.

A secondary analysis of Multi Indictor Cluster survey (MICS) 2022/23 data was conducted that focused on the level of vaccination children had received by the time they reach their first birthday. Children were categorized into unvaccinated, under-vaccinated, and fully vaccinated groups and binary and multinomial logistic regression models were fitted with household characteristics included as explanatory variables.

The study data comprised 6,178 children aged 12–23 months with a predominance of rural areas (76.2%). In the multinomial analysis, children from Pashto-speaking households had significantly higher odds of being unvaccinated (OR = 3.54, 95% CI: 2.62–4.79) and under-vaccinated (OR = 2.19, 95% CI: 1.74–2.75) compared with those who were fully vaccinated. Maternal education was found to be highly significant, with children whose mothers had no formal education found to be more likely to be under vaccinated (69.1% unvaccinated/under-vaccinated) compared to those with primary education (41.9% unvaccinated/under-vaccinated, adjusted odds ratio: 0.59. 95% CI: 0.43–0.81). Children from the richest households had a full vaccination rate of 55.9% and were less likely to be unvaccinated than fully vaccinated (adjusted odds ratio: 0.22, 95% CI: 0.14–0.35).

Full vaccination coverage is low, with approximately one-third of Afghan children aged 12–23 months receiving complete vaccine schedules. However, this study shows that rates vary significantly with a range of cultural, economic, and educational factors. These findings suggest that improving maternal healthcare access and education, along with focused outreach in specific demographic groups, may be effective in enhancing immunization coverage.

Main findings: Maternal education, household wealth, and language spoken by the head of household were significantly associated with full childhood immunization coverage in Afghanistan.Added knowledge: This is the first study to quantify the association between the language spoken by the household head and childhood immunization status using nationally representative MICS 2022–23 data from Afghanistan. In the context of the ongoing ban on female education since August 2021, the findings also highlight the critical role of maternal education in improving vaccination coverage, underscoring the need for sustained advocacy to restore and support girls’ and women’s access to education in AfghanistanGlobal health impact for policy and action: The findings highlight the need for linguistically tailored and equity-focused immunization strategies to improve vaccine coverage among underserved population groups in fragile settings.

Main findings: Maternal education, household wealth, and language spoken by the head of household were significantly associated with full childhood immunization coverage in Afghanistan.

Added knowledge: This is the first study to quantify the association between the language spoken by the household head and childhood immunization status using nationally representative MICS 2022–23 data from Afghanistan. In the context of the ongoing ban on female education since August 2021, the findings also highlight the critical role of maternal education in improving vaccination coverage, underscoring the need for sustained advocacy to restore and support girls’ and women’s access to education in Afghanistan

Global health impact for policy and action: The findings highlight the need for linguistically tailored and equity-focused immunization strategies to improve vaccine coverage among underserved population groups in fragile settings.