Yellow fever vaccination coverage among nomadic populations in the Savannah region, Ghana: a cross-sectional study following an outbreak

Abstract

Introduction: Yellow fever (YF) remains a major public health concern in Ghana, with periodic outbreaks despite ongoing vaccination efforts. Nomadic populations, due to their mobility and remote settlements, are often underserved by vaccination campaigns, posing challenges to achieving herd immunity. The objective of the study was to estimate yellow fever vaccination coverage among nomadic populations in the Savannah Region of Ghana and compare it with the national average, and identify reasons for non-vaccination to inform future outbreak response strategies.

Methods: a community-based cross-sectional study was conducted among 2,914 individuals from 414 nomadic households across 22 affected communities using a modified WHO vaccination coverage survey. Data were analyzed in Stata version 15. Descriptive statistics and t-tests were used to assess differences in vaccination coverage and associated factors.

Results: overall vaccination coverage was 80.3% (SD = 0.24), significantly lower than the national average of 88% (t(413) = -4.00, p < 0.001)), though within the WHO-recommended threshold for herd immunity. A significant inverse relationship was observed between household size and vaccination coverage (p < 0.001). Most respondents (93.2%) presented vaccination cards for verification, while 4.8% reported verbally. The main reasons for non-vaccination included absence during campaigns, lack of transportation, and limited information about the campaign. Perceptions of vaccine effectiveness were largely positive (67.5%), though 25.1% expressed doubts about efficacy.

Conclusion: yellow fever vaccination coverage among nomadic populations in the Savannah Region, though adequate for herd protection, remains below national targets. Strengthened outreach strategies, tailored health promotion, and targeted catch-up campaigns are essential to sustain high coverage and prevent future outbreaks among mobile and hard-to-reach populations.

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ORCID for Michael Head: orcid.org/0000-0003-1189-0531

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