Spatial distribution and multilevel analysis of full vaccination coverage among children aged 12–23 months in Democratic Republic of Congo

Abstract

BACKGROUND : Vaccination is one of the most cost-effective public health interventions for reducing child morbidity and mortality. However, full vaccination coverage remains suboptimal in many low- and middle-income countries, including Democratic Republic Congo (DRC). This study aimed to assess spatial distribution and risk factors of full vaccination coverage among children aged 12–23 months in DRC. METHODS : A cross sectional secondary data analysis on 2023/24 DRC Demographic and Health Survey data with a total weighted sample of 3897 children aged 12–23 months was used. Moran's I and Getis-Ord Gi* statistics was used to identify clustering patterns of full vaccination coverage. Multilevel analysis was used to examine factors associated with full vaccination coverage. RESULT : The prevalence of full vaccination was 14.9% (95% CI: 13.8, 16.0). Moran's I 0.4 (p value = 0.01) indicated spatial clustering of full vaccination coverage. Full vaccination coverage was associated with maternal age 25–34 years (AOR = 1.54, 95% CI: 1.06–2.24), secondary and above education (AOR = 1.84, 95% CI: 1.18–2.88), being married (AOR = 1.55, 95% CI: 1.15–2.09), rich household wealth (AOR = 1.64, 95% CI: 1.06–2.51), 1–7 antenatal care visits (AOR = 2.25, 95% CI: 1.40–3.62), health facility delivery (AOR = 3.34, 95% CI: 1.87–5.97), and rural residence (AOR = 0.59, 95% CI: 0.39–0.89). CONCLUSION : Full vaccination coverage in DRC is low and unevenly distributed; with cold spots in Mongala, part of Bas Uele and Tshuapa regions. Hence, targeted interventions focusing on identified cold spot areas, improving maternal education, expanding healthcare access, and promoting antenatal care and institutional delivery are essential to increase vaccine coverage.