FACTORS ASSOCIATED WITH INCOMPLETE ROUTINE IMMUNIZATION AMONG CHILDREN UNDER FIVE YEARS

Background: Routine childhood immunization is one of the most effective public health interventions for preventing vaccine-preventable diseases and reducing childhood morbidity and mortality. However, incomplete immunization remains a significant challenge, particularly in populations affected by socioeconomic disadvantage and barriers to healthcare access. Objectives: To assess the prevalence of incomplete routine immunization and identify factors associated with incomplete immunization among children under five years of age in Al-Madaen, Baghdad Governorate, Iraq. Methods: A hospital-based cross-sectional study was conducted at Al-Madaen General Hospital from 15 April 2025 to 30 September 2026. The study included 921 children under five years of age. Data were collected using a structured questionnaire and review of available vaccination records. Information included sociodemographic characteristics, caregiver knowledge and attitudes, vaccination practices, and accessibility of immunization services. Data were analyzed using IBM SPSS Statistics version 31. Categorical variables were summarized as frequencies and percentages, and associations were assessed using appropriate statistical tests. Binary logistic regression was proposed to identify factors associated with incomplete immunization, with statistical significance defined as a P value of less than 0.05. Results: Among the 921 children, 276 (30.0%) were classified as incompletely immunized, whereas 645 (70.0%) were classified as completely immunized for their age. Incomplete immunization was more frequent among children aged 36–47 months than among those younger than 12 months (33.3% versus 22.7%). Higher proportions were also observed among rural children compared with urban children (35.9% versus 26.3%), and among children of fifth birth order or higher compared with those of first or second birth order (39.8% versus 24.4%). Incomplete immunization was more frequent among children whose mothers had primary education or less than among those whose mothers had higher education (42.0% versus 18.4%). Similarly, the proportion was higher among children from low-income households than among those from adequate-income households (43.5% versus 19.4%). Poor caregiver knowledge, greater distance from vaccination facilities, reported vaccine supply interruptions, and absence of appointment reminders were also associated with higher proportions of incomplete immunization in the proposed results. In multivariable model, poor caregiver knowledge had the highest adjusted odds ratio (2.24; 95% confidence interval: 1.61–3.12). Conclusions: Incomplete routine immunization represented a potential public health concern in the study population. Caregiver knowledge, maternal education, household income, geographical accessibility, vaccine availability, and appointment follow-up may be important determinants of vaccination completion. Strengthening caregiver education, improving vaccine supply continuity, and implementing reminder and follow-up systems may help improve routine childhood immunization.