Behavioural and social drivers of childhood immunisation uptake in sub-Saharan Africa: A rapid qualitative review

BACKGROUND: Immunisation is one of the most successful public health interventions, yet many people in sub-Saharan Africa continue to face significant barriers to accessing vaccination. The WHO's Behavioural and Social Drivers Framework conceptualises factors influencing vaccination decision-making and provides a structured approach for synthesising evidence. This rapid review examines the factors shaping childhood vaccination decisions in sub-Saharan African contexts using the WHO Behavioural and Social Drivers (BeSD) framework. METHODS: We conducted a rapid review, searching three databases: Ovid Medline, Ovid Global Health and African Index Medicus for qualitative and mixed methods with a qualitative component examining childhood immunisation in sub-Saharan Africa. A total of 2441 records were identified, and 617 full texts were assessed for eligibility. Findings were first inductively coded using thematic analysis and then, deductively mapped against the BeSD framework. RESULTS: A total of forty-eight studies were included in this review. Vaccine confidence and perceived benefits were influenced by previous experiences, trust in health systems and government. Practical issues surrounding vaccination delivery remain a significant limitation to the provision of childhood vaccinations. Frequently cited barriers included the indirect costs of vaccination, unclear scheduling and imperfect relationships with healthcare providers. Motivation to get vaccinations was generally reported as high, but supply side barriers often overrode this intent to take up recommended vaccinations. CONCLUSIONS: This review reflects evidence that improving childhood vaccination coverage in Sub-Saharan African contexts requires moving beyond vaccine hesitancy as an individual-level problem. Trusted community intermediaries, particularly community health workers, religious leaders, and traditional authorities, were described as important in bridging informational and relational gaps. Effective immunisation programming most successfully received by caregivers integrated approaches that address health system gaps, engage entire households, leverage existing community trust networks and address gender dynamics.