Musuka, GodfreyMoyo, EnosIradukunda, Patrick GadGashema, PierreMadziva, RodaHerrera, HelenaDhliwayo, TapiwaMutata, ConstantineMataruse, NoahMano, OscarMbunge, ElliotDzinamarira, Tafadzwa2026-01-152026-01-152025-10-06Musuka, G.; Moyo, E.; Iradukunda, P.G.; Gashema, P.; Madziva, R.; Herrera, H.; Dhliwayo, T.; Mutata, C.; Mataruse, N.; Mano, O.; et al. Gender-Associated Factors on the Occurrence and Prevalence of Zero-Dose Children in Sub-Saharan Africa: A Critical Literature Review. Tropical Medicine and Infectious Disease 2025, 10, 286. https://doi.org/10.3390/tropicalmed10100286.2414-6366 (online)10.3390/tropicalmed10100286http://hdl.handle.net/2263/107327DATA AVAILABILITY STATEMENT : The original contributions presented in this study are included in the article. Further inquiries can be directed to the corresponding author.BACKGROUND : Immunisation remains one of the most effective and cost-efficient public health interventions for preventing infectious diseases in children. Despite global progress, Sub-Saharan Africa (SSA) continues to face challenges in achieving equitable immunisation coverage. Gender-related disparities, rooted in sociocultural and structural inequalities, significantly influence the prevalence of zero-dose and under-immunised children in the region. This review critically examines the gender-associated barriers to routine childhood immunisation in SSA to inform more inclusive and equitable health interventions. METHODS : A critical literature review was conducted generally following some steps of the PRISMA-P and CRD guidelines. Using the Population–Concept–Context (PCC) framework, studies were selected that examined gender-related barriers to routine immunisation for children under five in Sub-Saharan Africa. Comprehensive searches were performed across PubMed, Google Scholar, and relevant organisational websites, targeting articles published between 2015 and 2025. A total of 3683 articles were retrieved, with 24 studies ultimately meeting the inclusion criteria. Thematic analysis was used to synthesise the findings. RESULTS : Four major themes emerged: (1) women’s empowerment and autonomy, including limited decision-making power, financial control, and the impact of gender-based violence; (2) male involvement and prevailing gender norms, where patriarchal structures and low male engagement negatively influenced vaccine uptake; (3) socioeconomic and structural barriers, such as poverty, geographic inaccessibility, maternal workload, and service availability; and (4) education, awareness, and health system responsiveness. CONCLUSIONS : Gender dynamics have a significant impact on childhood immunisation outcomes in Sub-Saharan Africa. Future policies must integrate these insights to improve immunisation equity and reduce preventable child morbidity and mortality across the region.en© 2025 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license.GenderImmunisationZero-doseSub-Saharan Africa (SSA)Zero doseArticle