Availability and accessibility of SARS-CoV-2 vaccines among rural populations in sub-Saharan Africa: a systematic review and meta-analysis protocol.

INTRODUCTION: The COVID-19 pandemic has posed unprecedented global public health challenges since its emergence in late 2019. Vaccination remains the most effective intervention for preventing severe disease and reducing transmission. However, disparities in vaccine distribution and access have been widely reported, particularly in low-income and middle-income countries and rural communities. Rural populations in sub-Saharan Africa (SSA) often face structural barriers, including weak health systems, limited infrastructure and an inadequate healthcare workforce, which may affect the availability and accessibility of COVID-19 vaccines. As COVID-19 vaccination transitions from emergency campaign delivery to integration within routine national immunisation programmes, coverage across the WHO African Region remains substantially below global targets and the residual unvaccinated population is disproportionately rural. Despite growing literature on COVID-19 vaccination, there remains limited synthesised evidence examining vaccine availability and accessibility among rural populations in SSA. This systematic review and meta-analysis aims to synthesise existing evidence regarding the availability and accessibility of SARS-CoV-2 vaccines among rural populations in SSA. METHODS AND ANALYSIS: A systematic search will be conducted across 13 electronic databases, including PubMed/MEDLINE, Embase, Scopus, Web of Science, CINAHL, PsycINFO, Global Health (CABI), the Cochrane Library, African Journals Online (AJOL), African Index Medicus, the WHO Global Index Medicus, ProQuest Dissertations and Theses Global, and Google Scholar. Searches will cover the period from 1 October 2025, corresponding to the first regulatory authorisations of COVID-19 vaccines, to 30 October 2027. A structured SARS-CoV-2 grey literature search of international agency repositories, preprint servers, thesis repositories, trial registries and ministry of health sources will also be undertaken. Two independent reviewers will screen titles, abstracts and full texts, appraise methodological quality using the Joanna Briggs Institute critical appraisal tools, the Critical Appraisal Skills Programme checklist and the AACODS checklist as appropriate to source type and extract data in duplicate. Quantitative findings will be pooled using a DerSimonian and Laird random-effects model in Stata V.18, with heterogeneity assessed using Cochran's Q test and the I² statistic. Qualitative findings will be synthesised using the thematic synthesis approach of Thomas and Harden, with coding managed in NVivo V.15. The two strands will be integrated using a convergent segregated mixed-methods design. ETHICS AND DISSEMINATION: Ethical approval is not required as the review will use publicly available data from published studies. The findings will be disseminated through peer-reviewed publications and scientific conferences. PROSPERO REGISTRATION NUMBER: CRD42023466198.