Access Barriers to Healthcare and Full Childhood Immunization Coverage in East Africa (2015-2023): A Propensity Score Matched Analysis

Barriers to accessing healthcare are significant obstacles to achieving full immunization coverage, yet their impact remains underexplored in existing literature. Therefore, we assessed the effect of barriers to accessing healthcare on full immunization coverage in East African countries. This study used a cross-sectional design, using pooled demographic and health survey data (2015-2023) from 11 East African countries. After removing observations with missing data, the final weighted sample included 48 351 children aged 12 to 35 months, all born within 5 years of each country's survey period. The outcome variable was full immunization coverage, whereas the treatment variable was barriers to accessing healthcare. We used propensity score-matching to estimate the average treatment effect of barriers to healthcare access on vaccination coverage, comparing children who faced these barriers (treated) with those who did not (untreated). Approximately two-thirds of children aged 12 to 35 months in East Africa (65.5%; 95% CI: 65.1-65.9) were from mothers who reported at least 1 barrier to accessing healthcare. The average treatment effect on the treated (ATT) estimate revealed that facing at least 1 barrier to accessing healthcare reduced the probability of completing the recommended vaccination by 3.8 percentage points (ATT = -0.038, 95% CI: -0.063, -0.014). Among the assessed barriers, challenges obtaining permission to visit health facilities, lack of companionship when seeking care, distance to the health facility, and difficulty obtaining money for treatment reduced full vaccination coverage by 12.1, 10.2, 8.2, and 2.2 percentage points, respectively. This study revealed that barriers to accessing healthcare, including geographical inaccessibility, lack of companionship, financial constraints, and the need for permission to seek care, negatively affect childhood vaccination coverage. Therefore, our findings underscore the need for public health interventions that address these barriers to enhance childhood vaccination coverage.