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Access Barriers to Healthcare and Full Childhood Immunization Coverage in East Africa (2015-2023): A Propensity Score Matched Analysis.

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Title: Access Barriers to Healthcare and Full Childhood Immunization Coverage in East Africa (2015-2023): A Propensity Score Matched Analysis.
Authors: Dellie, Endalkachew1 (AUTHOR) endalkachew.dellie@uog.edu.et, Tsehay, Chalie Tadie1 (AUTHOR), Teshale, Getachew1 (AUTHOR), Aschalew, Andualem Yalew1 (AUTHOR), Hagos, Asebe1 (AUTHOR), Tafere, Tesfahun Zemene1 (AUTHOR), Baykemagn, Nebebe Demis1 (AUTHOR), Worku, Nigusu1 (AUTHOR)
Source: Inquiry (00469580). 4/13/2026, Vol. 63, p1-12. 12p.
Subject Terms: *Health services accessibility, *Immunization, *Retrospective studies, *Children, Cross-sectional method, Child health services, Descriptive statistics, Vaccination coverage, Medical records, Acquisition of data, Cluster sampling, Confidence intervals, Data analysis software, Health equity, Sensitivity & specificity (Statistics)
Geographic Terms: East Africa
Abstract: Barriers to accessing healthcare are significant obstacles to achieving full immunization coverage, yet their impact remains underexplored in existing literature. Therefore, we assessed the effect of barriers to accessing healthcare on full immunization coverage in East African countries. This study used a cross-sectional design, using pooled demographic and health survey data (2015-2023) from 11 East African countries. After removing observations with missing data, the final weighted sample included 48 351 children aged 12 to 35 months, all born within 5 years of each country's survey period. The outcome variable was full immunization coverage, whereas the treatment variable was barriers to accessing healthcare. We used propensity score-matching to estimate the average treatment effect of barriers to healthcare access on vaccination coverage, comparing children who faced these barriers (treated) with those who did not (untreated). Approximately two-thirds of children aged 12 to 35 months in East Africa (65.5%; 95% CI: 65.1-65.9) were from mothers who reported at least 1 barrier to accessing healthcare. The average treatment effect on the treated (ATT) estimate revealed that facing at least 1 barrier to accessing healthcare reduced the probability of completing the recommended vaccination by 3.8 percentage points (ATT = −0.038, 95% CI: −0.063, −0.014). Among the assessed barriers, challenges obtaining permission to visit health facilities, lack of companionship when seeking care, distance to the health facility, and difficulty obtaining money for treatment reduced full vaccination coverage by 12.1, 10.2, 8.2, and 2.2 percentage points, respectively. This study revealed that barriers to accessing healthcare, including geographical inaccessibility, lack of companionship, financial constraints, and the need for permission to seek care, negatively affect childhood vaccination coverage. Therefore, our findings underscore the need for public health interventions that address these barriers to enhance childhood vaccination coverage. [ABSTRACT FROM AUTHOR]
Copyright of Inquiry (00469580) is the property of Sage Publications Inc. and its content may not be copied or emailed to multiple sites without the copyright holder's express written permission. Additionally, content may not be used with any artificial intelligence tools or machine learning technologies. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)
Database: Education Research Complete
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  Data: Access Barriers to Healthcare and Full Childhood Immunization Coverage in East Africa (2015-2023): A Propensity Score Matched Analysis.
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  Data: <searchLink fieldCode="JN" term="%22Inquiry+%2800469580%29%22">Inquiry (00469580)</searchLink>. 4/13/2026, Vol. 63, p1-12. 12p.
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  Data: *<searchLink fieldCode="DE" term="%22Health+services+accessibility%22">Health services accessibility</searchLink><br />*<searchLink fieldCode="DE" term="%22Immunization%22">Immunization</searchLink><br />*<searchLink fieldCode="DE" term="%22Retrospective+studies%22">Retrospective studies</searchLink><br />*<searchLink fieldCode="DE" term="%22Children%22">Children</searchLink><br /><searchLink fieldCode="DE" term="%22Cross-sectional+method%22">Cross-sectional method</searchLink><br /><searchLink fieldCode="DE" term="%22Child+health+services%22">Child health services</searchLink><br /><searchLink fieldCode="DE" term="%22Descriptive+statistics%22">Descriptive statistics</searchLink><br /><searchLink fieldCode="DE" term="%22Vaccination+coverage%22">Vaccination coverage</searchLink><br /><searchLink fieldCode="DE" term="%22Medical+records%22">Medical records</searchLink><br /><searchLink fieldCode="DE" term="%22Acquisition+of+data%22">Acquisition of data</searchLink><br /><searchLink fieldCode="DE" term="%22Cluster+sampling%22">Cluster sampling</searchLink><br /><searchLink fieldCode="DE" term="%22Confidence+intervals%22">Confidence intervals</searchLink><br /><searchLink fieldCode="DE" term="%22Data+analysis+software%22">Data analysis software</searchLink><br /><searchLink fieldCode="DE" term="%22Health+equity%22">Health equity</searchLink><br /><searchLink fieldCode="DE" term="%22Sensitivity+%26+specificity+%28Statistics%29%22">Sensitivity & specificity (Statistics)</searchLink>
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  Data: <searchLink fieldCode="DE" term="%22East+Africa%22">East Africa</searchLink>
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  Label: Abstract
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  Data: Barriers to accessing healthcare are significant obstacles to achieving full immunization coverage, yet their impact remains underexplored in existing literature. Therefore, we assessed the effect of barriers to accessing healthcare on full immunization coverage in East African countries. This study used a cross-sectional design, using pooled demographic and health survey data (2015-2023) from 11 East African countries. After removing observations with missing data, the final weighted sample included 48 351 children aged 12 to 35 months, all born within 5 years of each country's survey period. The outcome variable was full immunization coverage, whereas the treatment variable was barriers to accessing healthcare. We used propensity score-matching to estimate the average treatment effect of barriers to healthcare access on vaccination coverage, comparing children who faced these barriers (treated) with those who did not (untreated). Approximately two-thirds of children aged 12 to 35 months in East Africa (65.5%; 95% CI: 65.1-65.9) were from mothers who reported at least 1 barrier to accessing healthcare. The average treatment effect on the treated (ATT) estimate revealed that facing at least 1 barrier to accessing healthcare reduced the probability of completing the recommended vaccination by 3.8 percentage points (ATT = −0.038, 95% CI: −0.063, −0.014). Among the assessed barriers, challenges obtaining permission to visit health facilities, lack of companionship when seeking care, distance to the health facility, and difficulty obtaining money for treatment reduced full vaccination coverage by 12.1, 10.2, 8.2, and 2.2 percentage points, respectively. This study revealed that barriers to accessing healthcare, including geographical inaccessibility, lack of companionship, financial constraints, and the need for permission to seek care, negatively affect childhood vaccination coverage. Therefore, our findings underscore the need for public health interventions that address these barriers to enhance childhood vaccination coverage. [ABSTRACT FROM AUTHOR]
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  Data: <i>Copyright of Inquiry (00469580) is the property of Sage Publications Inc. and its content may not be copied or emailed to multiple sites without the copyright holder's express written permission. Additionally, content may not be used with any artificial intelligence tools or machine learning technologies. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract.</i> (Copyright applies to all Abstracts.)
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      – Type: doi
        Value: 10.1177/00469580261441758
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      – Code: eng
        Text: English
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        PageCount: 12
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    Subjects:
      – SubjectFull: Health services accessibility
        Type: general
      – SubjectFull: Immunization
        Type: general
      – SubjectFull: Retrospective studies
        Type: general
      – SubjectFull: Children
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      – SubjectFull: Cross-sectional method
        Type: general
      – SubjectFull: Child health services
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      – SubjectFull: Descriptive statistics
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      – SubjectFull: Vaccination coverage
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      – SubjectFull: Medical records
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      – SubjectFull: Acquisition of data
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      – SubjectFull: Cluster sampling
        Type: general
      – SubjectFull: Confidence intervals
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      – SubjectFull: Data analysis software
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      – SubjectFull: Health equity
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      – SubjectFull: Sensitivity & specificity (Statistics)
        Type: general
      – SubjectFull: East Africa
        Type: general
    Titles:
      – TitleFull: Access Barriers to Healthcare and Full Childhood Immunization Coverage in East Africa (2015-2023): A Propensity Score Matched Analysis.
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              Text: 4/13/2026
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