Spatial Patterns and Factors Associated with Rotavirus Vaccine Dropout Among Children Aged 12–35 Months in Mozambique

Rotarix is a monovalent, two-dose rotavirus vaccine that protects children against rotavirus infection and severe gastroenteritis. When Mozambique introduced Rotarix in September 2015, it was projected to save approximately 8000 lives and over USD 7.1 million in healthcare costs by 2030. However, dropout between doses remains a barrier to full immunization coverage. Using data from the 2022–2023 Mozambique Demographic and Health Survey, this study examined vaccine dropout among 2572 children aged 12–35 months and associated factors. Moran’s I, the Getis-Ord Gi* statistic, and weighted multilevel logistic regression were used to assess spatial patterns and associated factors. The dropout rate was 14.7% (95% CI: 12.8–16.8%), with hot spots in northern and central Mozambique. Rural residence, no antenatal care visits, not presenting a health card, and perceiving distance to a health facility as a major problem were associated with higher odds of dropout. Most provincial differences were attenuated after adjustment, although Inhambane showed lower odds than Maputo City. Integrating immunization into antenatal care, ensuring health card retention and defaulter tracing, expanding rural outreach, and prioritizing northern and central hot spots in district microplanning could reduce dropout and rotavirus disease burden.