Completion of the National Childhood Immunization Schedule and Associated Factors Among Children Aged 24-35 Months in Afghanistan: A Nationwide Analysis of MICS 2022-23.

BACKGROUND: Childhood immunization coverage remains low in Afghanistan, but evidence is limited regarding completion of the broader national immunization schedule beyond the first year of life. This study estimated full-schedule immunization coverage and examined factors associated with its completion among Afghan children aged 24-35 months. METHODS: We analysed nationally representative data from the Afghanistan Multiple Indicator Cluster Survey (MICS) 2022-23, including 6342 children aged 24-35 months. Full immunization was defined according to the MICS TC.11b indicator for completion of all vaccinations included in the national childhood immunization schedule. Survey-weighted analyses estimated vaccine-specific coverage, within-series dropout and provincial variation. A prespecified survey-weighted multivariable logistic regression model was used to identify factors associated with full-schedule completion. RESULTS: Only 16.2% (95% CI 14.7-17.7) of children had completed the full national immunization schedule. Coverage was particularly low for Inactivated Poliovirus Vaccine (IPV2) (24.6%) and measles-containing vaccine (MCV)- 2 (36.8%), and 49.2% of children who had received IPV1 had not received IPV2. Full-schedule completion varied markedly across provinces, from 3.1 to 37.7%. In the adjusted analysis, maternal primary education (AOR 1.55, 95% CI 1.11-2.19) and secondary or higher education (AOR 1.72, 95% CI 1.15-2.57), paternal primary education (AOR 1.68, 95% CI 1.13-2.50) and secondary or higher education (AOR 1.94, 95% CI 1.48-2.55), and maternal mobile-phone ownership (AOR 1.29, 95% CI 1.03-1.61) were associated with greater odds of full-schedule completion. CONCLUSION: Completion of the national childhood immunization schedule remains very low in Afghanistan, with substantial attrition across multi-dose vaccine series and marked geographical variation. Strengthening continuity of vaccination, follow-up for later doses, and accessible family-focused vaccination communication may help improve schedule completion.