Zero dose immunization among children aged 12–59 months in Somaliland using 2020 SDHS data

Zero-dose children, defined as those who have not received a single dose of diphtheria-tetanus-pertussis vaccine (DPT1), represent a critical equity gap in global immunization efforts. Despite national efforts, little is known about the extent and distribution of zero-dose children in Somaliland, where fragile health systems and regional disparities may contribute to immunization inequities. This study aimed to estimate the prevalence of zero-dose immunization and examine regional and sociodemographic patterns among children aged 12–59 months in Somaliland. A descriptive cross-sectional analysis was conducted using data from the 2020 Somaliland Demographic and Health Survey (SDHS). The study population included 447 children aged 12–59 months with valid DPT1 vaccination data. Zero-dose status was defined as the absence of any reported receipt of DPT1, based on vaccination cards, maternal recall, or immunization marks. Weighted frequencies and proportions were used to summarize immunization status across key maternal, household, and geographic variables. Data analysis accounted for the complex survey design using Stata 17, and visualizations were generated with GeoPandas in Python. Half of the children (50%) were identified as zero dose. Zero-dose prevalence was higher among children whose mothers had no education (53%), were from the poorest wealth quintile (62%), or perceived distance to health facilities as a major barrier (55%). Regional disparities were evident, with Togdheer (62%) and Woqooyi Galbeed (54%) reporting the highest zero-dose prevalence, while Sanaag had the lowest (32%). Zero-dose immunization prevalence in Somaliland remains high and varies significantly across sociodemographic and regional lines. These findings underscore the need for targeted, equity-driven strategies to reach under-immunized populations in Somaliland.