{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,21]],"date-time":"2026-08-21T18:32:17Z","timestamp":1787337137743,"version":"build-2736575974"},"reference-count":40,"publisher":"Public Library of Science (PLoS)","issue":"8","license":[{"start":{"date-parts":[[2026,8,21]],"date-time":"2026-08-21T00:00:00Z","timestamp":1787270400000},"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>Despite global progress, significant disparities persist in routine childhood vaccination coverage, commonly in low- and middle-income countries, including Ethiopia. Ethiopia has made considerable progress in extending immunization services through the national Expanded Program on Immunization. However, still significant coverage gaps remain, particularly among the vulnerable population such as urban slums and pastoralist areas. This study seeks to capture the perspectives of healthcare professionals and program managers to understand the challenges, best practices, and opportunities for strengthening immunization service delivery in these marginalized settings.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec002\">\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>An exploratory qualitative study was conducted in urban slum and pastoralist areas of Ethiopian regions from November to December, 2023. Purposive sampling technique was used to select 39 key informants, including healthcare providers, health extension workers, maternal and child health directors, Woreda Immunization officers, and focal persons. The interview guides were developed with Human-Centered Designand the World Health Organization\u2019s behavioral and social drivers frameworks. Open Code software version 4.03 was used to perform thematic analysis, employing both deductive and inductive coding approaches. Inter-coder reliability and daily debriefing were used to ensure the trustworthiness of the study.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec003\">\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Key barriers affecting the routine childhood immunization service included inconsistent vaccine supply, limited cold-chain capacity, low financing, high workloads, and challenges in reaching these populations. However, best practices such as community engagement, involvement of local community structures, mobile teams and the inclusion of the private sector demonstrated notable successes. Healthcare professionals recommended improving supply chains, enhancing healthcare providers training and supervision, and increasing community awareness as crucial strategies to reach under-immunized groups.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec004\">\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>This study identified that persistent health system challenges remain in delivery of routine childhood vaccination, while there is best practices in some areas. Strengthening health system capacity in terms of human power and necessary, combined with active community engagement, is essential to achieving equitable vaccine coverage among under-immunized populations.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1371\/journal.pone.0356253","type":"journal-article","created":{"date-parts":[[2026,8,21]],"date-time":"2026-08-21T17:46:11Z","timestamp":1787334371000},"page":"e0356253","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":0,"title":["Challenges, opportunities and best practices in routine childhood vaccination services delivery in urban slums and pastoralist regions of Ethiopia: An exploratory qualitative study in marginalized settings"],"prefix":"10.1371","volume":"21","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-6576-1869","authenticated-orcid":true,"given":"Nardos","family":"Gelana","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Finina","family":"Abebe","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Menen","family":"Tsegaw","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yordanos","family":"Tadesse","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Melkamu Ayalew","family":"Kokebie","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tseganesh","family":"Gedlu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hanna","family":"Alemayehu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tesfaye","family":"Bikes","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yeshiwork","family":"Eshetu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mesfin","family":"Kassaye","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Adugna","family":"Endale","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rachana","family":"Sharma","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hiwot","family":"Getachew","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hnin Su","family":"Mon","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tolasa","family":"Yadate","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2026,8,21]]},"reference":[{"key":"pone.0356253.ref001","author":"World Health Organization"},{"key":"pone.0356253.ref002","year":"2026"},{"key":"pone.0356253.ref003"},{"issue":"1","key":"pone.0356253.ref004","doi-asserted-by":"crossref","first-page":"82","DOI":"10.1186\/s12939-022-01678-5","article-title":"Vaccine equity in low and middle income countries: a systematic review and meta-analysis","volume":"21","author":"HA Ali","year":"2022","journal-title":"Int J Equity Health"},{"key":"pone.0356253.ref005","author":"Ethiopia Mini Demographic and Health Survey 2019"},{"key":"pone.0356253.ref006","article-title":"Barriers to childhood immunization in sub-Saharan Africa: A systematic review","journal-title":"BMC Public Health"},{"issue":"19","key":"pone.0356253.ref007","doi-asserted-by":"crossref","first-page":"2150","DOI":"10.1016\/j.vaccine.2014.01.081","article-title":"Understanding vaccine hesitancy around vaccines and vaccination from a global perspective: a systematic review of published literature, 2007-2012","volume":"32","author":"HJ Larson","year":"2014","journal-title":"Vaccine"},{"issue":"1","key":"pone.0356253.ref008","doi-asserted-by":"crossref","first-page":"556","DOI":"10.1186\/s12889-017-4473-7","article-title":"Immunization, urbanization and slums - 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