BCG Vaccination Coverage and Determinants Among Children in Somalia: A Nationwide Survey Study

Background: BCG vaccination is the primary defense against severe childhood tuberculosis, yet data on its uptake in Somalia are limited. Methods: Data from the Somalia Demographic and Health Survey were analyzed, including 2025 children aged 0 to 59 months with vaccination cards. Descriptive statistics estimated national and regional BCG coverage, and 2-level logistic regression assessed individual and community-level determinants. Results: National BCG coverage was 57.3%, ranging from 31% in Nugal to 78% in Mudug. Children with higher birth orders were less likely to be vaccinated. Older children had higher vaccination odds, and maternal tetanus toxoid receipt was positively associated with BCG uptake. Middle-income children were more likely to be vaccinated. Children from rural and urban areas had lower odds than nomadic children. Community-level factors explained 10.9% of the variance. Conclusion: BCG coverage in Somalia is below the WHO's 90% target. Addressing inequities in birth order, maternal health, wealth, and geography is essential.