**1. Introduction**

The World Health Organization (WHO) has addressed immunization inequity, and global efforts to promote vaccine access are encouraged [1]. In 2021, 25 million children worldwide (19%) did not receive basic vaccines, such one or more doses of the Diphtheria-Tetanus-Pertussis vaccine (DTP). This number of undervaccinated children has increased by 5.9 million since 2019. Countries such as Angola, Brazil, the Democratic Republic of Congo, Ethiopia, India, Indonesia, Myanmar, Nigeria, Pakistan, and the Philippines comprise 60% of these children [2].

In Brazil, the National Immunization Program (NIP) was established in 1973, and it is considered an international benchmark due to its scope and performance, offering

**Citation:** de Oliveira Roque e Lima, J.; Pagotto, V.; Rocha, B.S.; Scalize, P.S.; Guimarães, R.A.; de Lima, M.D.; da Silva, L.N.; da Silva Oliveira, M.D.; Moura, W.É.A.; Teles, S.A.; et al. Low Vaccine Coverage and Factors Associated with Incomplete Childhood Immunization in Racial/Ethnic Minorities and Rural Groups, Central Brazil. *Vaccines* **2023**, *11*, 838. https://doi.org/10.3390/ vaccines11040838

Academic Editors: Ahmad Reza Hosseinpoor, M. Carolina Danovaro, Devaki Nambiar, Aaron Wallace and Hope Johnson

Received: 31 January 2023 Revised: 21 March 2023 Accepted: 23 March 2023 Published: 13 April 2023

**Copyright:** © 2023 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https:// creativecommons.org/licenses/by/ 4.0/).

most WHO-recommended vaccines free of charge [3,4]. However, the country still faces challenges in achieving the expected worldwide vaccine coverage [5].

Incomplete childhood vaccination may be associated with demographic, socioeconomic, and policy-related factors [6]. Additionally, gender inequalities, ethnic discrimination, and limited access to health services in remote areas may also affect vaccination coverage [7].

In rural Brazil, significant inequalities are observed regarding urban environments and diverse races, peoples, and cultures. Settlers are rural groups that rely on family agricultural production, demanding agrarian reform [8]. Quilombolas are ethnic groups distributed throughout Brazil, residing in rural or urban areas, predominantly black, with their own historical ties [9]. Settlers and traditional quilombola communities stand out in this scenario, characterized by cultural isolation, popular struggles of resistance, and deprioritization. Little is known about their living and health conditions [10].

To date, there are no data on vaccination coverage for children residing in settlements and quilombola areas in Brazil. Therefore, situational diagnoses regarding access and factors associated with vaccination in vulnerable areas of the country are critical. These data can guide the development of more effective actions, informing decision-making in public policies and promoting universal access to health services.

This study aims to estimate vaccination coverage for the complete basic schedule during the first year (Table 1) and analyze the factors associated with incomplete vaccination in settled and quilombola children in the state of Goiás, Brazil, in response to the gaps in vaccination for children in rural Brazil.
