{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,26]],"date-time":"2026-08-26T18:19:38Z","timestamp":1787768378178,"version":"build-2784847793"},"reference-count":53,"publisher":"Public Library of Science (PLoS)","issue":"8","license":[{"start":{"date-parts":[[2026,8,26]],"date-time":"2026-08-26T00:00:00Z","timestamp":1787702400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS One"],"abstract":"<jats:sec id=\"sec001\">\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Childhood immunization is an important part of public health efforts to reduce morbidity and mortality from diseases that can be prevented by vaccination. Sub-Saharan Africa (SSA) has the lowest childhood immunization coverage and the highest child mortality rate in the world. Therefore, this study aimed to assess community variation in childhood immunization and to identify determinant factors associated with childhood immunization using mixed effect count regression models.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec002\">\n                    <jats:title>Method<\/jats:title>\n                    <jats:p>This study used data from the 2012\u20132022 Demographic and Health Survey (DHS), which included 195,000 children between the ages of 12 and 23 months in 33 SSA countries. A various mixed-effects count regression model were employed to identify the variables associated with the prevalence of childhood vaccination.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec003\">\n                    <jats:title>Result<\/jats:title>\n                    <jats:p>In SSA, the mean average childhood immunization was 5.47 (95% CI\u2009=\u20095.46, 5.48), with an 8.38 variance. The mixed effect zero-inflated Poisson model fit the data the best, with the lowest DIC, AIC, and BIC values. The results of the model showed that working mothers, mothers with secondary or higher education (IRR\u2009=\u20091.119; 95% CI: 1.114, 1.125), rich wealth status (IRR\u2009=\u20091.077; 95% CI: 1.073, 1.082), having a health card (IRR\u2009=\u20091.265; 95% CI: 1.258, 1.271), being exposed to the media (IRR\u2009=\u20091.082; 95%CI: 1.077, 1.086), institutional delivery (IRR\u2009=\u20091.168; 95% CI: 1.163, 1.174), receiving eight or more ANC visits (IRR\u2009=\u20091.301; 95% CI: 1.288, 1.314), receiving vitamin A (IRR\u2009=\u20091.350; 95% CI: 1.344, 1.355), using a contraceptive (IRR\u2009=\u20091.187; 95% CI: 1.182, 1.192) and receiving Postnatal Care (PNC) (IRR\u2009=\u20091.075; 95% CI: 1.071, 1.080), were associated with a higher incidence of childhood immunization. While children in rural areas (IRR\u2009=\u20090.972; 95%CI: 0.968, 0.976) had a lower prevalence of childhood vaccinations than children in urban areas.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec004\">\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>SSA had a low coverage of childhood vaccination with significant disparities among countries. Therefore, it is essential to prioritize public health initiatives that target low-income households, rural mothers, uneducated parents, and those who have not utilized maternal health care services for the sake of increasing the coverage of childhood immunizations that in turn enhances the health of children. Furthermore, it is imperative to create policies and initiatives that tackle regional and national variations in childhood immunization rates and to actively work toward their implementation.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1371\/journal.pone.0354918","type":"journal-article","created":{"date-parts":[[2026,8,26]],"date-time":"2026-08-26T17:37:05Z","timestamp":1787765825000},"page":"e0354918","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":0,"title":["Magnitude of childhood immunization and its associated factors in Sub-Saharan Africa: A mixed effect count regression analysis"],"prefix":"10.1371","volume":"21","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-4006-3455","authenticated-orcid":true,"given":"Setegn Muche","family":"Fenta","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Haile Mekonnen","family":"Fenta","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hailegebrael Birhan","family":"Biresaw","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Seyifemickael Amare","family":"Yilema","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Denekew Bitew","family":"Belay","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maru","family":"Mekie","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Minilik","family":"Derseh","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Astewle Andargie","family":"Baye","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2422-4768","authenticated-orcid":true,"given":"Yegnanew","family":"Shiferaw","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ding Geng","family":"Chen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2026,8,26]]},"reference":[{"issue":"2","key":"pone.0354918.ref001","doi-asserted-by":"crossref","DOI":"10.1016\/S2214-109X(21)00515-5","article-title":"Global, regional, and national trends in under-5 mortality between 1990 and 2019 with scenario-based projections until 2030: a systematic analysis by the UN Inter-agency Group for Child Mortality Estimation","volume":"10","author":"D Sharrow","year":"2022","journal-title":"Lancet Glob Health"},{"issue":"1","key":"pone.0354918.ref002","doi-asserted-by":"crossref","DOI":"10.1016\/S2214-109X(23)00496-5","article-title":"Global, regional, and national causes of death in children and adolescents younger than 20 years: an open data portal with estimates for 2000-21","volume":"12","author":"F Villavicencio","year":"2024","journal-title":"Lancet Glob Health"},{"key":"pone.0354918.ref003","volume-title":"Levels and trends in child mortality: report 2022","author":"D You","year":"2023"},{"issue":"3","key":"pone.0354918.ref004","doi-asserted-by":"crossref","first-page":"333","DOI":"10.3390\/ijerph21030333","article-title":"Health expenditure, institutional quality, and under-five mortality in Sub-Saharan African countries","volume":"21","author":"K Sibanda","year":"2024","journal-title":"Int J Environ Res Public Health"},{"key":"pone.0354918.ref005","volume-title":"Levels & Trends in Child Mortality: Report 2018, Estimates Developed by the","author":"Estimation, U.N.I.-a.G.f.C.M.","year":"2018"},{"key":"pone.0354918.ref006","volume-title":"Ethiopia Demographic and Health Survey 2016: Key Indicators Report","author":"Agency, C.S. and ICF","year":"2016"},{"key":"pone.0354918.ref007","doi-asserted-by":"crossref","first-page":"106399","DOI":"10.1016\/j.ypmed.2020.106399","article-title":"HPV vaccination introduction worldwide and WHO and UNICEF estimates of national HPV immunization coverage 2010-2019","volume":"144","author":"L Bruni","year":"2021","journal-title":"Prev Med"},{"key":"pone.0354918.ref008","unstructured":"WHO. 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