Background: In sub-Saharan Africa, missed opportunities for vaccination are a major obstacle to reaching the global target of vaccination coverage. The study’s aim was to identify the factors driving missed opportunities for vaccination indicators, including crude missed opportunities for vaccination, all corrected, uncorrected, and some corrected missed opportunities for vaccination in children aged 12–23 months in sub-Saharan Africa. Methods: This was a multilevel mixed-effects population-based cross-sectional analysis using Demographic Health Surveys and Multiple Indicators Cluster Surveys data collected from 1 January 2019 to 31 December 2023 from twenty-one countries in sub-Saharan Africa. Both multilevel mixed-effects logistic regression and multilevel multinomial logistic regression were undertaken to assess the strengths of association between missed opportunities for vaccination indicators and covariates. Results: We included a total of 23,490 children aged 12–23 months. In multilevel fixed-effects logistic regression, our findings revealed that mothers’ education levels, listening to radio, sales ‘occupation, bicycle as mode of transportation to the nearest health facility, and health insurance were all associated with lower crude missed opportunities for vaccination. In contrast, father’s primary education and watching television were associated with increased risk of missed opportunities for vaccination. In multilevel fixed-effects multinomial logistic regression, mothers’ education levels, watching television, Muslim, and health-insured children were all associated with all corrected missed opportunities for vaccination. In the same line, mothers with primary education, watching television, private health facilities as delivery place, and health-insured children were associated with some corrected missed opportunities for vaccination. In the random-effects, the intraclass correlation coefficient showed missed opportunities for vaccination variances of 18% for crude missed opportunities for vaccination and 27% for all corrected, some corrected, and uncorrected missed opportunities for vaccination between communities in SSA. Conclusions: A variety of driving factors influence MOVs indicators in children aged 12–23 months, mainly caregivers’ education, media exposure, health insurance, occupation, religion, and mode of transportation to the nearest health facility. Effective evidence-based strategies are needed to minimize the influence of barriers on missed opportunities for vaccination in children aged 12–23 months in sub-Saharan Africa.
Tamuzi et al. (2026) studied this question.