Low Immunization Coverage Research Articles

AI based predictive acceptability model for effective vaccine delivery in healthcare systems

Vaccine acceptance is a crucial component of a viable immunization program in healthcare system, yet the disparities in new and existing vaccination adoption rates prevail across regions. Disparities in the rate of vaccine acceptance result in low immunization coverage and slow uptake of newly introduced vaccines. This research presents an innovative AI-driven predictive model, designed to accurately forecast vaccine acceptance within immunization programs, while providing high interpretability. Primarily, the contribution of this study is to classify vaccine acceptability into Low, Medium, Partial High, and High categories. Secondly, this study implements the Feature Importance method to make the model highly interpretable for healthcare providers. Thirdly, our findings highlight the impact of demographic and socio-demographic factors on vaccine acceptance, providing valuable insights for policymakers to improve immunization rates. A sample dataset containing 7150 data records with 31 demographic and socioeconomic attributes from PDHS (2017–2018) is used in this paper. Using the LightGBM algorithm, the proposed model constructed on the basis of different machine-learning procedures achieved 98% accuracy to accurately predict the acceptability of vaccines included in the immunization program. The association rules suggest that higher SES, region, parents’ occupation, and mother’s education have an association with vaccine acceptability.

Factors Contributing to Low Immunization Coverage among Children 0-59 Months in Bolgatanga Municipality: A Study in Upper East Region, Ghana

Factors Contributing to Low Immunization Coverage among Children 0-59 Months in Bolgatanga Municipality: A Study in Upper East Region, Ghana

Study on Trend of Immunization Coverage in Mutum Biyu Ward "B" From 2016-2019 in Gassol Local Government Area, Taraba State, Nigeria

This study examines the trend of immunisation coverage for Bacille Calmette-Guerin (BCG), Oral Polio Vaccine (OPV), Measles, and Yellow Fever in Mutum Biyu Ward 'B' of Gassol local Government Area, Taraba State, Nigeria, from 2016 to 2019. The DHIS2 Nigeria platform was used to gather secondary data using a quantitative, cross-sectional approach. In order to analyse the completion and non-completion rates of Routine Immunisation (RI) schedules, vaccination cards and carer recollection were the main sources of immunisation histories. One-way ANOVA testing and descriptive statistics were used in the data analysis. The study's findings showed that vaccination coverage varied over time. The BCG coverage saw notable fluctuations, peaking in the years 2017 and 2019. In 2018, OPV coverage rose on average but somewhat decreased. Measles vaccination rates were steady at first, then they fell in 20l8 and then sharply recovered in 2019. The vaccination rate for yellow fever was low in 20l6, improved slightly in 2017, declined sharply in 2018, and then reached its peak in 2019. The study recommended localized use of geo-mapping to identify and map communities with low immunisation coverage in Mutum Biyu Ward "B" of Gassol LGA, Taraba State.

Eleven-Year Report of High Number of Diphtheria Cases in Children in East Java Province, Indonesia.

A high incidence of diphtheria cases in children in East Java province, Indonesia, has been observed since the beginning of this century. Despite many efforts, the outbreaks continue. This study aims to explain the high incidence of diphtheria in children in East Java province since 2013. This cross-sectional surveillance report-based study used data from 38 districts in East Java since 1 January 2013. Collected data included demographics, clinical information, additional examinations, immunization history, and close contact management. Over eleven years, there were 4009 diphtheria patients, of whom 2921 (72.86%) were under 18 years of age. Boys (59.77%) outnumbered girls, and the most common age category was >60-144 months (51.66%). Most cases had incomplete or zero immunization (76.16%). Tonsillopharyngeal diphtheria was the most common type (69.60%). The five top districts with the most cases were Surabaya, Sidoarjo, Kabupaten Blitar, Kota Malang, and Kabupaten Malang. The eleven-year case fatality rate (CFR) was 2.36% (69/2921). This study shows that diphtheria cases in children and adolescents in East Java have consistently been high, and low immunization coverage might still be the leading cause. There has also been a shift in the district distribution. Diphtheria outbreaks require complete and sustainable efforts, not just outbreak response immunizations.

Seroprevalence of hepatitis B virus markers of infection and immunity among people living in Libreville, Gabon

ObjectivesIn Gabon, data on hepatitis B virus (HBV) infection are limited to hepatitis B surface antigen (HBsAg) detection among specific populations and rural regions. This is the first study aimed at determining the seroprevalence of HBV markers among the Gabonese population. MethodsA retrospective study was conducted from January 2002 through December 2022. All patients who requested HBV marker screening (HBsAg, anti-HBc, anti-HBs, anti-HBe, hepatitis B e antigen) were included in this study. ResultsA total of 496 people were included in this study. The prevalence of HBV exposure was high (59.5%) and significantly associated with age, sex, pregnancy status, and social status. Among individuals with evidence of HBV exposure, only 89 (33.7%) had effectively cleared the virus. Overall, HBsAg was detected in 108 of the 496 (21.8%) people included in the study. HBsAg infection was more common among individuals in the 16-25 (35.1%) and 26-35-year (30.6%) age groups. Moreover, most of HBsAg-infected patients were health care workers (HCWs) (P = 0.0096). Among the 496 individuals included in this study, 126 (25.4%) were still susceptible to HBV. Most of the susceptible female patients were pregnant (P <0.0001). HCWs had a significantly lower probability of being naïve to HBV infection (P = 0.0001). There was a similar prevalence of susceptibility in male and female patients (50 [24.5%] male and 76 [26.0%] female patients). Only 15.1% of the studied population was vaccinated. ConclusionsOur findings revealed a high seroprevalence of HBV infection in the study area and very low HBV immunization coverage. Additional care and resources should be provided to promote HBV vaccination and block vertical HBV transmission.

CHILD MIGRATION TRENDS IN INDIA: INSIGHTS FROM NATIONAL DATASETS

The child migration in India is a complex socio-economic phenomenon profoundly impacting childrens well-being and development. This paper analyzes trends and vulnerabilities among child migrants using national datasets, focusing on education, health, and socio-economic disparities.The study identifies a significant increase in internal migration, predominantly rural, driven by familial and economic factors. Gender disparities show higher migration rates among boys, influenced by socio-cultural norms and economic incentives. The regional disparities highlight Goa, Kerala, and Maharashtra as key migration hubs, shaped by economic opportunities and cultural dynamics. Despite higher literacy rates, migrant children face challenges like early employment and educational disruptions. Health outcomes vary, with improved nutrition but lower immunization coverage compared to non-migrant peers.Child marriage rates among migrant girls underscore socio-economic inequities. Vulnerability analysis reveals risks among economically disadvantaged and rural migrants, necessitating targeted policy interventions. The policy recommendations stress legal enforcement against child marriage and robust implementation of education and child labor laws. Collaborative efforts involving government, NGOs, and communities are crucial to address the needs of child migrants, especially from marginalized groups.This research paper informs inclusive policies to protect child migrants rights and opportunities, aiming for a more equitable societal framework.

Prevalence and viral suppression of hepatitis B virus infection among people living with HIV on antiretroviral therapy in Sierra Leone

ObjectiveSub-Saharan Africa is one of the regions with the highest burdens of HIV and hepatitis B virus (HBV), but data on the impact of antiretroviral therapy (ART) on HBV DNA...

An assessment of factors associated with full vaccination coverage rate among children aged 12-23 months in Masvingo district; Zimbabwe. A cross-sectional study

Introduction: Immunization is one of the most cost-effective nursing interventions aimed at reducing ill health and premature death among children. Despite tremendous efforts by governments, vaccination coverage remains low, especially in developing countries. Masvingo district is one of the districts with low vaccination coverage in the country. Objectives: This study sought to assess immunization coverage, identify determinants of vaccination coverage and assess factors associated with low full immunization coverage in Masvingo district, Zimbabwe. Methods: An analytical cross-sectional study design was conducted between January 2019 and February 2019. Masvingo province was purposively selected due to its low vaccination coverage (60.3%) according to the Zimbabwe Demographic and Health Survey 2015. WHO cluster sampling was used to select households. A total of 354 children and their mothers residing in Masvingo district were recruited for the study. Pre-tested interviewer-administered questionnaires were used to collect data. Bivariate analysis was employed to assess factors associated with low vaccination coverage. Results: An estimated 89.5% of children aged 12-23 months were fully vaccinated by card or mothers’ recall. Factors significantly associated with full vaccination coverage rates (P&lt;0.001) included birth order, distance to the nearest health facility, waiting time, place of birth, number of Antenatal care visits, possession of a vaccination card, place of residence, mother/caregiver’s highest level of education, household expenditure per month, and overall knowledge of the vaccination schedule. After controlling for all these factors, only household expenditure per month (P=0.001), having a vaccination card (P=0.047), and overall knowledge of the vaccination schedule (P=0.002) were statistically significant predictors of full vaccination coverage rates. Conclusion: Although full vaccination coverage is improving, it is still below the Global Vaccine Action Plan target. Factors associated with low full vaccination coverage include marital age, marital status, level of education, religion, household expenditure, distance to the health center, waiting time, and Antenatal Care and Post-natal Care care utilization. There is no single factor solely responsible for low vaccination coverage; rather, it is influenced by a combination of multiple factors. Nursing interventions at community level should focus on increasing community mobilization strategies that foster saturation coverage to achieve herd immunity for all vaccine preventable child diseases.

Evaluation of Vaccination Status, Awareness, and Seroprevalence of Hepatitis B Virus Infection among Female Sex Workers in Jos

Study’s Excerpt/Novelty This study is the first to systematically evaluate the immunization status, awareness, and seroprevalence of hepatitis B virus (HBV) infection specifically among female sex workers in Jos, Nigeria, highlighting a significant gap in the existing literature. It reveals a high HBV prevalence rate of 24.4% within this population, with critical insights into demographic variations such as age, marital status, and educational level. The findings underscore an urgent need for targeted vaccination programs, given the alarmingly low immunization coverage, with only 10.5% of participants fully vaccinated against HBV. Full Abstract The hepatitis B virus (HBV) is the cause of hepatitis B infection, which can lead to malignancy and chronic liver cirrhosis. There is a dearth of research on the incidence of HBV among Nigerian women who work as sex workers despite the country being characterized as an endemic zone with prevalence among different occupational groups. The study evaluates the immunization status, awareness of the virus, and seroprevalence and predictors of hepatitis B virus infection among female sex workers. A descriptive cross-sectional study including 86 female sex workers in Jos brothels was conducted. Blood samples were collected using the RecombiLISAHbsAg ELISA kit (CTK Biotech Inc., San Diego, USA) to qualitatively detect HBsAg.Twenty (21) out of the 86 subjects tested positive, yielding a 24.4% prevalence rate. The highest prevalence was found among women in the 36–40 age range (40%), while the lowest (0.0%) was found among those in the age group &lt;20 years. Married sex workers recorded the highest prevalence of 50%, while separated/divorced recorded the lowest prevalence of 10.0%. Also, female sex workers without a formal education had the highest prevalence of 66.7%. In comparison, the lowest prevalence of 0.0% was found among those with tertiary education. Those who engaged in sex work for less than five years had the highest prevalence of 30.8%, while the lowest was recorded among those who had five years and above in the sex trade, with a prevalence rate of 0.0%. There was no statistically significant correlation seen between these high percentages and HBV infection. Out of the 86 female sex workers, only 9 had received all three doses of the immunization. This high frequency of vaccine-preventable illness is intolerable; therefore, immunizing this high-risk HBV reservoir population should be justified

Personal-Level Disposition as Predictors of Infant-Survival Skills among Nursing Mothers in Selected Primary Health Care Facilities in Sokoto State, Nigeria

Background information: Infant mortality is a major public health concern worldwide, especially in developing countries. It was reported that 5.2 million children die before the age of 5 years annually, and 47% of these deaths occur in sub- Saharan Africa alone. The Sustainable Development Goals (SDGs), especially Goal 3, aim to reduce under-five mortality to as low as 25 per 1000 live births by 2030. To achieve this goal, interventions that address the underlying factors contributing to infant mortality are necessary. Maternal health, including maternal knowledge, attitudes, and practices, is a crucial factor influencing infant survival, especially in low- and middle-income countries. This study investigated the Personal-level Disposition Factors Influencing survival skills among Nursing Mothers in Selected PHCs in Nigeria.  Methodology: The study design adopted for this research project was a cross-sectional study. Data were collected from 120 respondents who were conveniently selected from two primary health care facilities in Sokoto state with a semi- structured questionnaire (83% reliability). Data were analyzed using appropriate statistical tools.  Result: The results show that all female participants had similar characteristics at a full glance at some areas. The mean age of respondents was 28.32±6.49 years with an age range of 19 to 41 years of age. The Knowledge responses were grouped on a scale and the results showed that most of the respondents had a high level of knowledge regarding infant survival skills. The overall motivation score was moderate. There were significant correlations (at p &lt; 0.05) between knowledge level (R = -0.201), Motivation (R = - 0.170), and Behavioural skills.  Conclusion: The report suggested that there should be an aggressive use of peer educators to expand rural health workers in areas with poor adoption of good health interventions, and low immunization coverage in Northwest of Nigeria.

Determination of immunisation status of children between 2-5 years of age who attending to teaching institute with concern to both national immunization schedule and optional vaccines

Background: In order to know the causes for non-immunisation, search for societal reasons for primary immunisation along with evaluating coverage. Aim of this current study is to determine the immunisation status of children between 2-5 years of age who are attending teaching health care centre with concern to both National Immunisation Schedule and Optional vaccines. Methods: Study analysed the children's immunisation status, factors affecting their immunisation coverage, and reasons for partial or incomplete immunisation. The information was obtained from the parents using a questionnaire. Information such as socio-demographic variables, immunisation status, causes of their partial immunisation and lack of immunisation. The "vaccination card and the recall" approach was used to determine the recipient's immunisation status. Results: Study found that 70.4% of children had received all recommended vaccinations. Lack of information and ignorance are significant contributors to under-immunization. Other statistically significant contributing factors for the low immunisation coverage include female gender, rural background, low socioeconomic status, born at home, lower mother age, and being from a joint household. BCG vaccination coverage was higher than pentavalent vaccine coverage, probably because of multiple doses needed. Only 77% of kids received vitamin A solution. Conclusions: Paediatrician should mention the next vaccination date and dose at each appointment in order to lower the vaccination dropouts. Parents should be informed regarding the date of vaccination of their child through SMS message, calls, and social media groups.

Space-time heterogeneity of measles, mumps, and rubella vaccination indicators in children from BrazilHeterogeneidad espaciotemporal de los indicadores de inmunización con la vacuna triple viral en la población infantil de Brasil

To evaluate immunization coverage and dropout rates of the measles, mumps, and rubella vaccine across Brazilian regions. This ecological study employing a space-time approach used data from the National Immunization Program (PNI) and the Live Births Information System (SINASC). We estimated the annual variation (2014 to 2021) in immunization coverage and dropout rate of the measles, mumps, and rubella vaccine in children aged 12 and 15 months in the 5 570 Brazilian municipalities. Statistical analysis was conducted for the municipalities contained in each Brazilian region using the space-time scan technique, considering the Poisson probabilistic model and the hypothesis that municipalities with lower immunization coverage or high dropout rates would form space-time clusters. From 2014 to 2021, 38.3% and 12.9% of municipalities achieved a coverage ≥ 95.0% in the first and second doses respectively; 53.6% of municipalities had a high dropout rate (20.0% to 49.9%) and 37.2% had a very high dropout rate. The Northeast region had primary clusters for low coverage of the first (2018 to 2021) and second vaccine doses (2020 to 2021) with higher relative risks (RR) compared to other primary clusters. The RR for high dropout rate was elevated in all Brazilian regions (1.57 to 26.23). In some Brazilian regions, the dropout rate has been high since 2014, signaling a risk of measles resurgence. In turn, space-time analysis indicated lower vaccination coverage in 2020, suggesting the influence of the COVID-19 pandemic.

Differences in Mean Anti-Pertussis Antibody Levels in Children with Acellular Pertussis Immunization and Whole Pertussis Without Booster

Background: The incidence of pertussis is increasing every year, especially in developing countries. Low immunization coverage and decreased immunity are some of the factors causing the re-increase in pertussis cases. The protection provided by the pertussis vaccine whole and acellular pertussis given as a baby will decrease with age. This study aims to determine the difference in mean levels of anti-pertussis antibodies in children who received acellular pertussis and whole pertussis immunization without a booster. Methods: A cross-sectional study was carried out at the pediatric polyclinic of Dr. M. Djamil General Hospital Padang from December 2022 to December 2023. Research subjects were children aged 5-9 years with a history of whole pertussis immunization (DPwT) 3 times or acellular pertussis immunization (DPaT) 3 times. The research subjects were examined for anti-pertussis antibody titers using the ELISA technique. Results: Thirty-four children with a history of DPwT immunization 3 times and 34 children with a history of DPwT immunization 3 times were research subjects, with mean age 6.94±1.49 in the DPwT group and 6.88 ±1.61 in the DPaT group. The mean anti-pertussis antibody level in the DPwT group (9.54 IU/mL) was higher than the DPaT group (6.96 IU/mL) but was not statistically significant (p&gt;0.05). The average antibody results showed that the antibody levels in both groups were below the antibody titer threshold that provides protection against pertussis. The results of the analysis showed that there was a significant difference in the incidence of AEFI between the DPwT and DPaT immunization groups (p&lt;0.05). Conclusion: There was no difference in anti-pertussis antibody levels in children who received DPwT and DPaT immunization 3 times. Pertussis immunization is a required booster so that antibody levels are sufficient to provide protection against pertussis.

Basic Vaccinations among Children Aged 12-23 Months in Northeast India: Trend, Pattern and Factors Influencing Low Coverage.

India has experienced tremendous progress in childhood immunization through centralized flagship programs since 1985. There is a wide variation of immunization coverage of children aged 12-23 months among Indian states and regions. The North East (NE) region, including eight sister states, has witnessed low immunization coverage (68.4%) with higher dropouts (25%) and nonvaccinations (7.0%). NE Indian states substantially improved childhood immunization from 22.8% in 1992-93 to 68.4% in 2019-2021; still, it is below the national average (77%) and the lowest among the Indian States/UTs. Highly predictive determinants for the outcome of childhood vaccination status include maternal characteristics antenatal care for pregnancy, place of delivery, education level, and media exposure. A large section of the backward hilly tribes is also needed special attention to improving the levels of childhood vaccinations in NE states.

Women's School "Ratho Ebhu" to Empower Women in Stunting Prevention-Based Family Centered Nursing in Pamorah Village, Tragah Prefecture

Stunting is a national problem, the solution of which requires cross-sectoral cooperation. Stunting is a chronic condition that cannot be cured but can be controlled. The growth and development period for toddlers is a period that happens quickly and will never be repeated. Stunting cases in children can be used as a predictor of the low quality of a country's human resources. Stunting causes poor cognitive abilities, low productivity, and an increased risk of disease, resulting in long-term losses for the Indonesian economy. Pamorah Village is the 2022 stunting locus village; there are 26 stunted children. The results of interviews with partners leading the Pamorah Village PKK driving team found that health problems related to high cases of stunting in children are still a problem caused by several factors, including the low number of Posyandu visits, low immunization coverage, distant access to health services, high cases of early marriage, low awareness of clean and healthy living behavior, low levels of exclusive breastfeeding, child care is handed over to grandmothers because parents work outside the island so that nutritional parenting patterns follow grandmother's family culture, some pregnant women do not have check-ups with health workers and health facilities, short pregnancy intervals due to low number of mothers of productive age who use contraception. The aim of community service is to increase community knowledge and change community behavior in health through women's schools in an effort to prevent stunting. The expected output is a pocket book on women's school health education and training, as well as publications in the mass media, women's school learning plans, and the publication of community service journals.

Overcoming Maternal and Child Health Problems in Rw 16 Citatah Village, Cipatat District, West

Based on the analysis of the situation from the initial survey data of community service activities, several health problems were obtained in RW 16, it can be concluded that there are 3 maternal and child health problems that are priorities for the community service team to overcome, namely: The prevalence of stunting in children under five years old, low coverage of immunization in children, and nutritional problems in pregnant women. The purpose of this service is to solve maternal and child health problems by providing health education to the community. This service activity employs the extension approach as its methodology. Data collection using questionnaire sheets that become material for evaluation. The outcomes of this service include the assessment of counseling participants' comprehension by oral questioning at the beginning and conclusion of the session. The community seemed enthusiastic about providing responses and answers and was actively involved during the counseling process. So it can be concluded that there is a social change in the form of changes in the way people think about health, especially maternal and child health, tracking the development and growth of children, early detection of diseases, and many other benefits that cause changes in the way people view health.

Immunization Status, Immunization Coverage, and Factors Associated with Immunization Service Utilization Among HIV-Exposed and HIV-Infected Children in India.

HIV-infected and HIV-exposed children are known to have a lower immunization coverage. However, the current immunization coverage for this group of children in India is unknown. The present study assessed the immunization status, service-utilization issues, and factors associated with immunization status among them. A descriptive, cross-sectional, and multisite study was conducted in four districts (Nadia, Murshidabad, South and North 24 Parganas) of West Bengal, a state in the Eastern part of India. Children aged between 12 and 59 months were included in the study. A sample size of 131 was calculated using Cochrane's formula. Onsite data was collected using an interviewer-administered predesigned, pre-tested, face-validated, semi-structured schedule. Immunization status was the outcome variable. The unadjusted association of the outcome variable with other variables was tested by the Chi-square test and the adjusted association was tested by regression analysis. The mean age of the children was 35.5 months (±15.7) and 50.4% were male. There were 18 (13.7%) HIV-infected children. Eighty-four percent of children were adequately immunized, but when considered along with the birth dose of the Hepatitis-B (Hep-B) vaccine, this reduced to 58.8%. Murshidabad district had the lowest proportion of fully immunized children (50%), while South 24 Parganas district had the lowest proportion of completely immunized children (60%). More than 95% of vaccinations were done in government facilities. Service utilization issues identified were lack of awareness of vaccine due dates and facing stigma from providers. Immunization status was associated with experience of stigma, mode and place of delivery by Chi-square test, it was only associated with stigma by regression analysis. Relatively lower immunization coverage among children born of HIV-infected women can be attributed to parents' unawareness about vaccination due dates and facing stigma while accessing service. Measures like documenting vaccine due dates and training healthcare providers on non-discriminatory, respectful care may improve vaccination coverage.

Is health expenditure on immunisation associated with immunisation coverage in sub-Saharan Africa? A multicountry analysis, 2013–2017

ObjectivesThe designing of contextually tailored sustainable plans to finance the procurement of vaccines and the running of appropriate immunisation programmes are necessary to address the high burden of vaccine-preventable diseases...

Factors contributing to immunization coverage among children less than 5 years in Nadowli-Kaleo District of Upper West Region, Ghana.

Immunization prevents deaths from diseases such as diphtheria, tetanus, whooping cough and measles in about 2.5 million children each year worldwide. Failure to vaccinate children in the required timeframe could result in disease outbreaks among them and increase costs of living among the populations directly affected. Even though Ghana has set 95% as the target for immunization coverage, the Nadowli-Kaleo district has been below this national target. This study was conducted to identify the factors influencing low immunization coverage among children under five years in the Nadowli-Kaleo district, Ghana. An analytical cross-sectional study design was adopted for this study. Systematic sampling method was used to recruit the respondents. The data was collected using KoboCollect online data collection tool and analyzed using Stata Version 17.0. Chi-square test was used to establish the association between child's immunization status and the independent variables. Logistic regression was used to determine the degree of association. A p-value less than 0.05 was considered statistically significant. Fully immunized status among children under-five was a little above average (55.4%). Mother's or caregiver's age, marital status, occupation, and current child's birth order were significantly associated with children full immunization. Also, number of ANC visits, delivery location, and distance to health facility were significantly associated with children full immunization. A child delivered at the health facility had higher chance of 2.12 times to be fully immunized than giving birth at home [AOR = 2.12, 95%CI = 1.14-3.94, and p-value = 0.017]. The health system related factors which were statistically associated with child full immunization included time spent during immunization service and being informed when to come for the next vaccination visit. Coverage for children with fully immunized status was not very encouraging at our study site. We recommend expansion of access to maternal and child health services, encouraging institutional childbirth, and timely regular antenatal visits.

Child Immunization Coverage in Urban Settings of Twelve Provinces Plus Kabul, Afghanistan, 2019.

Background: Low immunization and discrepancies in data sources have been a consistent challenge in Afghanistan. The objective of this was to estimate the coverage of immunization status among children of 12-23 months in urban settings of 12 provinces plus Kabul, Afghanistan in 2019. Methods: A cross-sectional survey was conducted in the capital of 12 cities of polio high-risk provinces plus Kabul during October-December 2019. A two-stage cluster sampling was used to approach 30 clusters and interview seven households. The coverage for 13 vaccines against 10 childhood diseases prioritized by the Afghanistan Immunization program was assessed through observation of vaccine cards or by history from caregivers of children. Epi Info v.7.2.5 was used for data management and analysis. Results: Totally, 3382 caregivers of children aged 12-23 months, of whom 50.8% were boys, were interviewed. The literacy of mothers was 35%, and 86.4% were housewives with no formal employment. The average age of children was 17.07 ± 4.05 months. In total, 1261 (37.29%) children were fully vaccinated, 833 (54.2%) were partially vaccinated, and 288 (8.52%) did not receive any dose of routine vaccine. Of total, 71.82% had vaccination cards, 17.24% had lost them, and 11% had no cards. Generally, coverage of immunization by cards and history was 91.70% for BCG, 52% for Penta, 78% for OPV-4, 63% for PCV2, 61% for Rota2, 68.50% for measles 1, and 58% for IPV. Nangarhar and Kunar provinces have the highest and lowest immunization coverage, respectively. Lack of awareness and time was the main factor cited by partially vaccinated individuals, while misconceptions about vaccines were reported among the unvaccinated. Conclusion: Child immunization levels, varying across cities, were suboptimal in the study population. Realistic goal-setting and awareness campaigns are necessary to address the low immunization coverage and fight against barriers in Afghanistan.