Routine childhood immunization coverage, timeliness, dropout, and missed opportunities in Northern Ghana: Evidence from a community-based survey in Tamale Metropolis, Ghana

Routine childhood immunization plays a crucial role in reducing vaccine-preventable diseases and child mortality. However, sustained progress requires not only high coverage but also timely administration, continuity across multi-dose schedules, and minimization of missed opportunities for vaccination. Persistent subnational inequities, post-COVID-19 disruptions, and gaps in service delivery threaten progress toward Immunization Agenda 2030 targets. This study assessed routine immunization coverage, timeliness, dropout rates, and missed opportunities for vaccination among children aged 12–59 months in the Tamale Metropolis of northern Ghana. We conducted a descriptive analysis of 1,020 children aged 12–59 months, drawn from a larger community-based cross-sectional study involving 1,577 children aged 0–59 months in the Tamale Metropolis. Multi-stage sampling was used to select mothers or caregivers of eligible children in this study. Trained research assistants collected data from November to December 2022 through face-to-face interviews, and a review of home-based records using a validated questionnaire. Findings were summarized using descriptive statistics. Our findings showed that 35.0% of the children were fully vaccinated according to the complete national immunization schedule, while 10.0% received no basic vaccines. Crude coverage for vaccines administered at 6, 10, and 14 weeks exceeded 70%., Notably, coverage was low for MenA (44.3%), MR2 (44.1%), and Rota3 (43.2%). A significant proportion of children received vaccine doses either before the recommended age, at intervals shorter than recommended, or delayed by more than two months. Dropout was high and varied across subdistricts, with Rota 1–3 reaching 51.6%. Among children with missed opportunities for vaccination, about 50% of missed doses were corrected within one to two months. Persistent gaps in timeliness, high dropout rates, and missed opportunities for vaccination threaten Ghana’s ability to achieve IA2030 targets. Strengthening digital immunization registries, defaulter tracing systems, targeted interventions, and enhanced engagement with healthcare providers is essential to ensure comprehensive vaccine coverage.