Coverage and determinants of childhood immunization in Somalia: A systematic review and meta-analysis
Clinical Snapshot
PICO Framework
| P — Population | Children in Somalia (infants and preschool children) |
| I — Intervention | Childhood immunization programs |
| C — Comparator | Various determinants (place of birth, maternal education, ANC visits, urban vs rural residence) |
| O — Outcomes | Immunization coverage rates (at least one vaccine, four basic vaccines, full immunization) and associated determinants |
Bottom Line
This meta-analysis of 11 cross-sectional studies reveals concerning immunization gaps in Somalia, with only 42.2% of children fully immunized and 16.1% completing four basic vaccines. Health facility births doubled immunization odds, while maternal education positively influenced uptake. The counterintuitive finding that mothers with ≥4 antenatal visits had lower child immunization odds warrants further investigation. For Australian clinicians, these findings highlight the importance of culturally sensitive immunization strategies for Somali refugee populations and support integrated maternal-child health service delivery. However, the exclusive reliance on cross-sectional studies and limited methodological detail in reporting reduces confidence in these estimates.
Key Findings
P Value: Not reported in abstract
Effect Size: At least one vaccine: 57.9%; Four basic vaccines: 16.1%
Primary Outcome: Full immunization coverage: 42.2%
Nnt Or Sensitivity: Health facility birth increases immunization odds by 110% (AOR = 2.10; 95% CI: 1.87-2.35)
Confidence Interval: Various outcomes with 95% CIs provided for determinants
Clinical Application
Findings support integrated maternal-child health services and facility-based births Relevant for culturally appropriate immunization strategies for Somali-Australian communities; may inform targeted public health interventions for refugee populations under Medicare and state immunization programs Primarily relevant to Somali refugee and migrant populations in Australia
Abstract
Childhood immunization is a cost-effective public health intervention, yet coverage remains suboptimal in Somalia. This systematic review and meta-analysis aimed to pool childhood immunization coverage and its determinants in Somalia. The electronic database search strategy yielded 11 eligible cross-sectional studies conducted between 2010 and 2025. Using Comprehensive Meta-Analysis Version 5 (Biostat, Englewood, NJ, USA), the pooled coverage for receiving at least one vaccine was 57.9%, while completion of the four basic vaccines was 16.1%, Full immunization coverage was 42.2%. Children born in health facilities were more likely to be immunized than home births (AOR = 2.10; 95% CI: 1.87-2.35). Unexpectedly, mothers with ≥4 ANC visits had lower odds of child immunization (AOR = 0.27; 95% CI: 0.24-0.30). Maternal education increased immunization likelihood (AOR = 1.14; 95% CI: 1.09-1.20). Children in rural areas were likely to be immunized than urban counterparts (AOR = 1.55; 95% CI: 1.49-1.61). These findings highlight the urgent need to strengthen integrated maternal and child health services.
References
- 1.Dirie, A. M., Ahmed, N. R., Dirie, S. A., Fiidow, O. A., Jimale, K. A., & Mohamed, A. M. (2026). Coverage and determinants of childhood immunization in Somalia: A systematic review and meta-analysis. Human Vaccines & Immunotherapeutics. https://doi.org/10.1080/21645515.2026.2675050
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