Childhood vaccination in Mali: Determinants and differences between conflict-affected and non-conflict regions from the 2023–2024 Demographic and Health Survey

BACKGROUND: Armed conflict may disrupt immunization services and increase barriers to childhood vaccination. This study examined determinants of full basic childhood vaccination in Mali and assessed whether they differed between conflict-affected and non-conflict regions. METHODS: We conducted a secondary analysis of the 2023-2024 Mali Demographic and Health Survey, including 2859 children aged 12-23 months. Full basic vaccination was defined as receipt of Bacille Calmette-Guérin vaccine, three doses of pentavalent vaccine, three doses of oral polio vaccine (excluding the birth dose), and measles vaccine. Survey-weighted logistic regression models were fitted nationally and separately for conflict-affected and non-conflict regions. Interactions between conflict status and selected explanatory variables were tested. RESULTS: Full basic vaccination coverage was 51.87%. Coverage did not differ significantly between conflict-affected and non-conflict regions (50.08% vs 52.64%; p = 0.467), and conflict status was not independently associated with vaccination after adjustment. Antenatal care attendance and facility-based delivery were consistently associated with higher odds of full vaccination. In conflict-affected regions, media exposure and shorter perceived distance to health facilities were also associated with higher vaccination uptake. A significant interaction was observed between conflict status and distance to health facility (p = 0.01). CONCLUSIONS: Childhood vaccination coverage in Mali remains suboptimal. Although overall coverage was similar across conflict and non-conflict regions, determinants differed by context, highlighting the need for tailored strategies to improve vaccine uptake.