Determinants of incomplete childhood vaccination among children aged 0–23 months in Ghana: a facility-based cross-sectional study

Vaccination provides lifelong protection, preventing an estimated 600,000 adult deaths and 2.5 million childhood deaths globally each year. Although Ghana has made significant progress in routine vaccination, disparities persist across regions and districts. National statistics often mask these local-level gaps. This study aimed to identify the factors influencing incomplete vaccination among children aged 0–23 months at Tetteh Quashie Memorial Hospital in Akuapem North. A cross-sectional study was conducted among 214 caregivers of children aged 0–23 months. Kobo Collect was used as the data collection tool and the data were exported to STATA v17.0 for analysis. Vaccination status was assessed against Ghana’s Expanded Programme on Immunization (EPI) schedule. Descriptive statistics, Fisher’s exact test, and logistic regression analyses were performed to identify factors associated with incomplete vaccination, with p-values < 0.05 considered statistically significant at 95% confidence level. Results were presented in tables and graphs. The prevalence of incomplete childhood vaccination was 27.1% (95% CI [21.3%–33.6%]). Muslim mothers (aOR = 12.9; 95% CI: 4.11–18.22; p = < 0.01) and single-parent households (aOR = 13.9; 95% CI: 4.35–44.97; p < 0.01) were more likely to have incomplete vaccination, while awareness of vaccine-preventable diseases (aOR = 0.01; 95% CI: 0.00-0.02; p < 0.01) was less likely to be associated with incomplete vaccination. Children aged 5–6 months were less likely to be incompletely vaccinated (aOR = 0.29; 95% CI: 0.11–0.74; p = 0.010). Children aged 9 months and above were more likely to be incompletely vaccinated (aOR = 2.7; 95% CI: 1.24–5.99; p = 0.012). Fourth-born children were less likely to be incompletely vaccinated compared to firstborns (aOR = 0.16; 95% CI: 0.03–0.74; p = 0.020). Health-related factors, including the time from home to the vaccination facility (< 0.01) and the average waiting time at the facility (p < 0.01), were significantly associated with vaccination status. This study found that vaccination coverage declined across successive doses, with incomplete vaccination associated with caregiver religion, family setting, low awareness, and the child’s age. Targeted education and improved access are needed to increase completion rates and achieve universal vaccination goals.