This secondary analysis of the 2024 Nigeria Demographic and Health Survey (NDHS) assessed socioeconomic inequality in COVID-19 vaccination uptake among women of reproductive age (15–49 years). From 39,050 women recruited, 36,555 responded to the vaccine question and were included (93.6% response). Vaccination uptake was low overall and patterned by socioeconomic position: the least disadvantaged group reported 31.6% uptake, the most disadvantaged 19.2%. A concentration index and curve demonstrated significantly higher vaccination among the least disadvantaged. Decomposition analysis identified key positive contributors to the observed inequality, including higher education, mass media exposure, employment, health insurance coverage, older age (≥30 years), and residence in southern geopolitical zones. The study highlights the need for targeted strategies to reduce socioeconomic barriers and improve equitable coverage.
Vaccination against SARS-CoV-2 has reduced morbidity and mortality from COVID-19, but global and within-country inequities in access and uptake remain concerns, particularly in low- and middle-income countries. Socioeconomic status has been identified as a key determinant of vaccine uptake in Nigeria and sub-Saharan Africa. Nigeria’s large population, uneven health system capacity, high out-of-pocket health financing, and persistent poverty contribute to structural barriers that can disadvantage lower socioeconomic groups.
Women of reproductive age are a key population for equity analyses because gender norms and socioeconomic conditions influence health-seeking behaviour and access to services. Prior evidence from West Africa and Nigeria indicates that socioeconomic disadvantage, rural residence, and sex-specific factors can shape vaccine hesitancy and access. This study therefore examines the distribution and drivers of socioeconomic inequality in COVID-19 vaccination uptake among Nigerian women using concentration indices and decomposition methods to quantify contributor effects.
Data source and sample
The analysis used the 2024 NDHS. Of 39,050 recruited women aged 15–49, 36,555 answered whether they had received a COVID-19 vaccine and were included in the study (93.6% response rate). Data collection occurred between December 1, 2023 and May 7, 2024. Institutional populations (for example, those in hotels, barracks, and prisons) were excluded.
Survey design
The NDHS applied a two-stage stratified sample design with 74 strata derived by disaggregating Nigeria’s 36 states plus the Federal Capital Territory into urban and rural areas. Enumeration areas served as primary sampling units; 1,400 clusters were selected (701 urban, 699 rural). A systematic household selection produced approximately 42,000 households, with GPS coordinates collected. The sampling and field procedures are documented in NDHS reports.
Outcome and analytic approach
The primary outcome was self-reported receipt of any COVID-19 vaccine. Socioeconomic inequality in vaccination uptake was assessed using a concentration index and concentration curve to show whether uptake was disproportionately concentrated among the better-off or worse-off. A socioeconomic decomposition analysis was performed to quantify the contributions of covariates (education, media exposure, employment status, health insurance, age groups, and geopolitical zones among others) to the observed inequality.
Data availability
The analytic dataset and original DHS data are publicly accessible; the article provides a figshare DOI for the extracted analytic dataset and the DHS repository link.
Sample characteristics and uptake
Among the 36,555 women included, COVID-19 vaccination uptake varied across socioeconomic strata. The least disadvantaged women reported the highest uptake at 31.6%, the moderately disadvantaged group reported approximately one-quarter vaccinated, and the most disadvantaged group reported the lowest uptake at 19.2%.
Distribution and inequality measures
The concentration index and accompanying concentration curve demonstrated that COVID-19 vaccination uptake was significantly higher among the least disadvantaged women, indicating a pro‑rich distribution of coverage.
Decomposition findings
The decomposition of the concentration index identified the main positive contributors to the socioeconomic inequality in vaccination uptake. These contributors included: higher education and secondary education attainment; exposure to mass media; being employed; having health insurance coverage; being aged 30 years or older; and residence in the South West, South South and South East geopolitical zones. Each of these factors was associated with higher vaccination uptake and therefore made positive contributions to the observed pro‑rich inequality.
This analysis reveals low overall COVID-19 vaccination uptake among Nigerian women of reproductive age and a clear socioeconomic gradient favoring the least disadvantaged. Education, information access via mass media, employment status, health insurance, older age, and southern regional residence emerged as important drivers of inequality. These findings align with broader evidence that structural determinants and social factors shape vaccine access and uptake in LMIC settings.
The observed patterns suggest both demand-side and supply-side barriers for disadvantaged women. Lower educational attainment and limited media exposure may reduce awareness or acceptance of vaccination, while lack of employment and health insurance may reflect or reinforce logistical and financial barriers. Regional differences indicate that programmatic and health system factors vary across geopolitical zones and can amplify inequities.
Policy implications include the need for targeted outreach and context‑specific measures that prioritize disadvantaged women. Strategies could focus on reducing informational barriers (for example, tailored communication), improving service accessibility, and addressing socioeconomic obstacles that prevent uptake. The study underscores that achieving equitable vaccination coverage requires concerted efforts beyond aggregate national targets.
The study found low and socially unequal COVID-19 vaccination uptake among Nigerian women aged 15–49. Approximately one-third of the least disadvantaged, one-quarter of the moderately disadvantaged, and one-fifth of the most disadvantaged reported receiving a vaccine. Socioeconomic inequality in uptake was driven in part by education, mass media exposure, employment, health insurance, age, and regional location. The author recommends targeted, context-specific policies and interventions to reduce socioeconomic barriers and prioritize disadvantaged women to improve equitable coverage.
The analytic dataset used in this analysis is publicly available via the figshare DOI cited in the article. The original 2024 NDHS data are available from the DHS Program website. The NDHS was implemented by Nigeria’s National Population Commission with support from USAID, ICF, WHO, UNFPA, UNICEF and the Global Fund.
The article reports that the authors received no specific funding for this work. The authors declared no competing interests.