Gender-Associated Factors on the Occurrence and Prevalence of Zero-Dose Children in Sub-Saharan Africa: A Critical
Godfrey Musuka1, Enos Moyo2, Patrick Gad Iradukunda3,4
1International Initiative for Impact Evaluation, Harare P.O. Box 0002, Zimbabwe.
Insights
Gender disparities significantly impact childhood immunisation in Sub-Saharan Africa, leading to more zero-dose children. Addressing women's empowerment, male involvement, and structural barriers is crucial for equitable vaccine access.
Area of Science:
- Public Health
- Global Health
- Pediatrics
Background:
- Immunisation is a key public health intervention for preventing childhood infectious diseases.
- Sub-Saharan Africa (SSA) faces challenges in achieving equitable immunisation coverage.
- Gender disparities are significant barriers to routine childhood immunisation in SSA, contributing to zero-dose and under-immunised children.
Purpose of the Study:
- To critically examine gender-associated barriers to routine childhood immunisation in SSA.
- To inform the development of more inclusive and equitable health interventions for immunisation in the region.
Main Methods:
- A critical literature review was conducted using PRISMA-P and CRD guidelines.
- The Population-Concept-Context (PCC) framework guided study selection for articles published between 2015 and 2025.
- Thematic analysis synthesised findings from 24 selected studies out of 3683 retrieved articles.
Main Results:
- Key themes identified include women's empowerment and autonomy (decision-making, financial control, gender-based violence).
- Prevailing gender norms, patriarchal structures, and low male involvement negatively impacted vaccine uptake.
- Socioeconomic factors (poverty, access, workload) and health system responsiveness were also significant barriers.
Conclusions:
- Gender dynamics profoundly affect childhood immunisation outcomes in SSA.
- Future policies must incorporate gender insights to enhance immunisation equity.
- Addressing these barriers is essential to reduce preventable child morbidity and mortality in SSA.
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.
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