Abstract
<title>Abstract</title> <p> <bold>Background</bold> : Vaccination remains a critical public health intervention in reducing morbidity and mortality from vaccine-preventable diseases (VPDs). The World Health Organisation (WHO) recommends at least 90% coverage for key childhood vaccines such as Bacillus Calmette–Guérin (BCG), pentavalent vaccine (Penta3), measles–rubella (MR), and yellow fever. However, persistent gaps in vaccine coverage completeness remain in many low- and middle-income settings. In Ghana, the Expanded Programme on Immunisation (EPI) targets children under five years. Rapid urbanization and population mobility in the Greater Accra Region (GAR) present constraints to equitable service delivery. We examined EPI routine immunisation data from the District Health Information Management System 2 (DHIMS2) to assess trends in childhood vaccination coverage and completeness from 2014 to 2023. <bold>Methods:</bold> We extracted vaccination records <bold/> fromDHIMS2 inGAR from 2014–2023 for children aged 0–11 and 12–23 months, including catch-up vaccinations up to 59 months. Coverage was assessed for key vaccines (BCG, OPV1, Penta3, measles-rubella, yellow fever). Descriptive statistics, dropout rates, and geospatial mapping were employed to evaluate trends and district-level performance. Penta 1 and Penta 3 coverage were used as proxies for access and utilisation. <bold>Results:</bold> Age-appropriate completion among children 0–11 months increased from 20.6% (37,728/183,569) in 2016 to 47.1% (95,963/203,856) in 2019, then stabilised between 38.3% and 44.0% (2020–2023). Fully immunised for 12–23 months increased from 51.9% (101,794/195,995) in 2014 to 80.5% (183055/227490) in 2023. Penta3 coverage improved from 67.8% (132,909/ 195,995) to 96.5% (219,426/ 227,490) between 2014 and 2023. By 2023, 45% (13/29) of districts in GAR had achieved the WHO target of 90% coverage for Measles-Rubella 2 (MR2). The Penta 1-Penta 3 dropout rate was -16.8% in 2023. The most significant dip in vaccination coverage was in 2020. <bold>Conclusion:</bold> Despite improvements in overall coverage in GAR, age-appropriate completion of the full immunisation schedule, particularly by 11 months remained suboptimal, with substantial district-level variation. Coverage of vaccines such as MR2 exceeded 100% in some districts, indicating notable data quality issues. Strengthening routine data quality, improving monitoring of age-appropriate vaccination, and targeting underperforming districts are essential to achieving equitable immunisation outcomes. </p>