Tools Influencing Access to and Utilization of Pentavalent-3 Immunization Services in Africa: A Scoping Review.

Introduction Background Immunisation will continue to stand as one of the most effective public health interventions, reducing morbidity and mortality associated with vaccine-preventable diseases. Global evidence will demonstrate that routine immunisation has prevented an estimated 2–3 million child deaths annually (WHO, 2020). However, despite these achievements, disparities in vaccination coverage will persist, especially in low- and middle-income countries (LMICs), where systemic challenges and inequities will undermine universal access. Issues such as delayed uptake, incomplete vaccination schedules, and missed opportunities for immunisation will remain prevalent, particularly in sub-Saharan Africa (Oleribe et al., 2019). These gaps will continue to pose a threat to the attainment of Sustainable Development Goal (SDG) 3.2, which seeks to end preventable deaths of newborns and children under five by 2030. Globally, coverage of the third dose of diphtheria–tetanus–pertussis (DTP3), a proxy for immunisation performance, will remain suboptimal in several regions, with Africa recording some of the lowest rates (WHO & UNICEF, 2022). The persistence of outbreaks of measles, polio and other vaccine-preventable diseases will further reveal weaknesses in immunisation systems. Determinants such as maternal education, socio-economic status, cultural beliefs, geographical access, vaccine supply and healthcare worker attitudes will be consistently identified in the literature as barriers and facilitators to vaccination uptake (Brown et al., 2021; Galles et al., 2021). In Ghana, the Expanded Programme on Immunisation (EPI) will continue to achieve notable progress in reducing childhood morbidity and mortality. However, universal coverage will not yet be realised, as gaps will persist particularly in rural and peri-urban communities. Evidence will suggest that barriers such as caregiver perceptions, health system delays, vaccine stockouts, transportation difficulties and institutional inefficiencies will constrain optimal utilisation of immunisation services for children under five (Adokiya et al., 2017). The uptake of the third dose of the pentavalent vaccine (Penta-3) will particularly reflect these inequalities, making it a crucial area of inquiry for policy and practice. To address these challenges, this scoping review will be undertaken to map and summarise documented tools that have been designed and implemented to influence access to and utilisation of Penta-3 immunisation services in Africa. It will seek to consolidate findings from diverse health system contexts, identify existing evidence gaps, and highlight priority areas for intervention. By generating a comprehensive overview of such tools, the review will provide insights that could strengthen immunisation strategies, with relevance to Ghana and other African settings. The aim will be to examine tools that enhance mothers’ and caregivers’ access to Penta-3 services and support their sustained utilisation. Findings will be positioned to serve as a practical evidence base for policymakers, programme implementers and researchers, guiding the design of targeted, context-specific strategies that promote equity in immunisation coverage. Ultimately, the review will align with global health commitments, including SDG 3.2, which prioritises reductions in child mortality, and SDG 10, which targets reduced inequalities in access to essential services