Conference Abstract | Volume 9 (ConfPro8): Abstract 100 | Published: 12 Oct 2026
Matthew Konlan1,&, Hilarius Asiwome Kosi Abiwu2, Rajan Bhandari1, Chrysantus Kubio3, Timothy Roberton1
1School of Population and Global Health, The University of Western Australia, Perth, Australia, 2National Malaria Elimination Programme, Division of Public Health, Ghana Health Service, Accra, Ghana, 3Northern Regional Health Directorate, Ghana Health Service, Tamale, Ghana
&Corresponding author: Matthew Konlan, The University of Western Australia, Perth, Australia, Email: matthew.konlan@research.uwa.edu.au, matthewykonlan@gmail.com, ORCID: https://orcid.org/0000-0002-1970-5639
Received: 11 Mar 2026, Accepted: 30 Aug 2026, Published: 12 Oct 2026
Domain: Vaccine Preventable Diseases
Keywords: Vaccination, effective coverage, childhood immunisation, equity, Ghana
©Matthew Konlan et al. Journal of Interventional Epidemiology and Public Health (ISSN: 2664-2824). This is an Open Access article distributed under the terms of the Creative Commons Attribution International 4.0 License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Cite this article: Matthew Konlan et al., Effective vaccination coverage in Ghana: A cascade analysis of card-confirmed and extended schedule coverage, 2014 and 2022. Journal of Interventional Epidemiology and Public Health. 2026;9(ConfPro8):100. https://doi.org/10.37432/JIEPH-CONFPRO8-00100
The COVID-19 pandemic caused significant disruption to routine childhood immunisation services. Standard vaccination coverage estimates that combine all sources of information may obscure documentation quality gaps. This study applied an effective coverage cascade that distinguished between card-confirmed and any-source vaccination to assess changes in full-schedule coverage and equity in Ghana between 2014 and 2022. We also evaluated the additional coverage implications of the expanded 2022 immunisation schedule.
We analysed children’s recode data from the Ghana Demographic and Health Surveys conducted in 2014 (n = 1,171) and 2022 (n = 2,021), focusing on children aged 12–23 months. A seven-step vaccination coverage cascade was constructed using demand for childhood vaccination-verified vaccine mappings. Primary outcomes were full-schedule coverage by any source and by card confirmation, stratified by household wealth quintile, place of residence, and region. Survey-weighted estimates and 95% confidence intervals were calculated using Taylor series linearisation.
Card-confirmed full-schedule coverage declined from 76.5% (95% CI: 72.8-80.1%) in 2014 to 71.6% (95% CI: 69.0-74.1%) in 2022. Measles 1 vaccination showed the largest decline among individual antigens (-2.9 points). Although the national documentation gap was relatively small (2.4 points), notable inequities emerged. Coverage was nearly uniform across wealth groups in 2014 (poorest: 78.0%; richest: 74.7%), but by 2022 a 15.9-point disparity was observed (poorest: 64.5%; richest: 80.4%). Regional variation was substantial, ranging from 52.0% in the Northern Region to 85.6% in the Western North Region. When the expanded 2022 immunisation schedule was considered, full-schedule coverage declined further to 68.7%.
Ghana maintained high levels of initial vaccine uptake but experienced declines in full-schedule card-confirmed coverage and a substantial increase in wealth-related inequities between 2014 and 2022. Targeted investments in community outreach and immunisation service delivery, particularly among poorer households and underserved regions, are needed to improve vaccination completion and reduce inequities.
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