Provincial Trends in Childhood Vaccine Coverage in Afghanistan From 2000 to 2024: An Ecological Study of Findings From the Institute for Health Metrics and Evaluation

This study analyzes vaccination coverage trends across 34 provinces in Afghanistan from 2000 to 2024, using data from the Institute for Health Metrics and Evaluation (IHME). Coverage rates for bacillus Calmette-Guérin (BCG), diphtheria-tetanus-pertussis third dose (DTP3), measles-containing vaccine first dose (MCV1), polio vaccine (three doses), pneumococcal conjugate vaccine third dose (PCV3), hepatitis B vaccine third dose (HepB3), Haemophilus influenzae type b vaccine third dose (Hib3), and rotavirus vaccine (RotaC) were assessed using the Kruskal-Wallis and Friedman tests. The Friedman test and Kruskal-Wallis H test were used to assess significant differences in vaccination coverage trends across the 34 provinces in Afghanistan from 2000 to 2024, enabling a comprehensive analysis of provincial and temporal trends. A downward trend in vaccination coverage was observed during the COVID-19 pandemic and after international aid limitations following the political change that occurred in Afghanistan in 2021. This decline in coverage may be associated with disruptions in vaccine distribution during these critical periods. Besides individual factors, vaccination adherence is influenced by health system factors, including vaccine availability and accessibility. The results of the Kruskal-Wallis and Friedman tests showed significant variability in vaccination coverage trends across the 34 provinces from 2000 to 2024. These findings highlight the need for intensive efforts to improve vaccination coverage in all 34 provinces to protect those most at risk.