Abstract:

This study investigates the underlying factors contributing to vaccine reluctance among parents in rural communities within South Sudan’s Greater Upper Nile Region, aligning with Sustainable Development Goal 3, which emphasizes reducing child mortality through expanded immunization coverage. Despite global advancements, vaccine hesitancy persists in under-resourced settings. A cross-sectional study involving 375 parents or caregivers across Bor South, Malakal, and Rubkona counties employed a mixed-methods approach, combining structured surveys, desk reviews, Focus Group Discussions (FGDs) with 24 participants, and in-depth interviews (IDIs) with 12 healthcare providers. The research examined key determinants of hesitancy, including socio-economic status, cultural beliefs, knowledge gaps, and the influence of healthcare providers. Findings showed that 69.9% of children were fully vaccinated, while 30.1% were partially or entirely unvaccinated, with primary barriers being financial constraints (74.7%), transportation difficulties (51.7%), and long distances to health facilities (47.7%). Concerns about vaccine safety (86.4%) and lack of awareness (42.1%) also played a significant role. Encouragingly, 96.2% of respondents expressed openness to new vaccines, and 82.7% indicated that support or incentives would improve uptake. In conclusion, while vaccine acceptance is generally high, systemic and informational challenges hinder full coverage, underscoring the need for culturally sensitive, community-based interventions to enhance immunization rates among children in the region.

References:

[1].   Sankaranarayanan, S., Jayaraman, A., & Gopichandran, V., 2019, Assessment of vaccine hesitancy among parents of children between 1 and 5 years of age at a tertiary care hospital in Chennai. Indian Journal of Community Medicine, 44(4), 394–396. https://doi.org/10.4103/ijcm.IJCM_220_18

[2].   Greenwood, B., 2014, The contribution of vaccination to global health: Past, present, and future. Philosophical Transactions of the Royal Society B: Biological Sciences, 369(1645), 20130433. https://doi.org/10.1098/rstb.2013.0433

[3].   Agarwal, A. K., Sengar, A., Preeti, G., & Gupta, R., 2019, A study on vaccine hesitancy among mothers and caregivers during the MR vaccine campaign. National Journal of Community Medicine, 10(11), 605.

[4].   Goss, R. O., 1990, Economic policies and seaports: Strategies for port authorities. Maritime Policy and Management, 17(4), 273–287.

[5].   Mbabazi, W., Lako, A. K., Ngemera, D., Laku, R., Yehia, M., & Nshakira, N., 2013, Maiden immunization coverage survey in the Republic of South Sudan: A cross-sectional study providing baselines for future performance measurement. The Pan African Medical Journal, 16. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4033584/

[6].   Udoh, K., 2022, COVID-19 vaccine hesitancy in South Sudan: What lessons can be learned from Angola’s success story? American Journal of Health Promotion, 36(3), 579–581. https://doi.org/10.1177/08901171211070955

[7].   Lazarus, J. V., Wyka, K., White, T. M., Picchio, C. A., Gostin, L. O., Larson, H. J., Rabin, K., Ratzan, S. C., Kamarulzaman, A., & El-Mohandes, A., 2023, A survey of COVID-19 vaccine acceptance across 23 countries in 2022. Nature Medicine, 29(2), 366–375. https://doi.org/10.1038/s41591-022-02185-4

[8].   Gram, L., Soremekun, S., ten Asbroek, A., Manu, A., O'Leary, M., Hill, Z., Danso, S., Amenga-Etego, S., Owusu-Agyei, S., & Kirkwood, B. R., 2014, Socio-economic determinants and inequities in coverage and timeliness of early childhood immunization in rural Ghana. Tropical Medicine and International Health, 19(7), 802–811. https://doi.org/10.1111/tmi.12324

[9].   The Economic Value of Vaccination: Why Prevention is Wealth. 2015. Journal of Market Access and Health Policy, 3. https://doi.org/10.3402/jmahp.v3.29414

[10].  Appell, M. W., 1985, The multihandicapped child with congenital rubella: Impact on family and community. Reviews of Infectious Diseases, 7(Suppl 1), S17–S21. https://doi.org/10.1093/clinids/7.supplement_1.s17

[11].  Okwaraji, Y. B., Mulholland, K., Schellenberg, J., et al., 2012, The association between travel time to health facilities and childhood vaccine coverage in rural Ethiopia: A community based cross-sectional study. BMC Public Health, 12, 476. https://doi.org/10.1186/1471-2458-12-476

[12].  Shearer, J. C., Nava, O., Prosser, W., et al., 2023, Uncovering the drivers of childhood immunization inequality with caregivers, community members and health system stakeholders: Results from a human-centered design study in DRC, Mozambique and Nigeria. Vaccines (Basel), 11(3), 689. https://doi.org/10.3390/vaccines11030689

[13].  Sialubanje, C., Mukumbuta, N., Ng'andu, M., et al., 2022, Perspectives on the COVID-19 vaccine uptake: A qualitative study of community members and health workers in Zambia. BMJ Open, 12(11), e058028. https://doi.org/10.1136/bmjopen-2021-058028

[14].  Cooper, S., & Wiysonge, C. S., 2023, Towards a more critical public health understanding of vaccine hesitancy: Key insights from a decade of research. Vaccines (Basel), 11(7), 1155. https://doi.org/10.3390/vaccines11071155

[15].  Li, A. J., Tabu, C., Shendale, S., et al., 2020, Qualitative insights into reasons for missed opportunities for vaccination in Kenyan health facilities. PLOS One, 15(3), e0230783. https://doi.org/10.1371/journal.pone.0230783

[16].  Mokaya, E. N., Atem, N. A., Awzenio, G., et al., 2024, Lessons from the COVID-19 pandemic response implementation: A case study of South Sudan and Sierra Leone. Global Health: Science and Practice, 12(Suppl 1), e2300180. https://doi.org/10.9745/GHSP-D-23-00180

[17].  Ozawa, S., Yemeke, T. T., Evans, D. R., et al., 2016, Financing of immunization programs by user fees and financial incentives: A systematic review. Vaccine, 34(43), 5206–5212. https://doi.org/10.1016/j.vaccine.2016.08.032

[18].  Smith, P. J., Humiston, S. G., Parnell, T., et al., 2010, The association between intentional delay of vaccine administration and timely childhood vaccination coverage. Public Health Reports, 125(4), 534–541. https://doi.org/10.1177/003335491012500408

[19].  Bajwa, U., Gastaldo, D., Di Ruggiero, E., & Knorr, L., 2018, The health of workers in the global gig economy. Global Health, 14(1), 124. https://doi.org/10.1186/s12992-018-0444-8

[20].  Khubchandani, J., et al., 2021, COVID-19 vaccination hesitancy in the United States: A rapid national assessment. Journal of Community Health, 46(2), 270–277.

[21].  Gamble, V. N., 1997, Under the shadow of Tuskegee: African Americans and health care. American Journal of Public Health, 87(11), 1773–1778.

[22].  Deml, M. J., & Githaiga, J. N., 2022, Determinants of COVID-19 vaccine hesitancy and uptake in sub-Saharan Africa: A scoping review. BMJ Open, 12(11), e066615. https://doi.org/10.1136/bmjopen-2022-066615

[23].  Choi, Y., & Fox, A. M., 2022, Mistrust in public health institutions is a stronger predictor of vaccine hesitancy and uptake than trust in Trump. Social Science & Medicine, 314, 115440. https://doi.org/10.1016/j.socscimed.2022.115440

[24].  Loftus, R., Sahm, L. J., & Fleming, A., 2021, A qualitative study of the views of healthcare professionals on providing vaccine information to patients. International Journal of Clinical Pharmacy, 43(6), 1683–1692. https://doi.org/10.1007/s11096-021-01299-y

[25].  Holford, D., Anderson, E. C., Biswas, A. et al., 2024, Healthcare professionals’ perceptions of challenges in vaccine communication and training needs: A qualitative study. BMC Primary Care, 25, 264. https://doi.org/10.1186/s12875-024-02509-y

[26].  Lin, C., Mullen, J., Smith, D., et al., 2021, Healthcare providers' vaccine perceptions, hesitancy, and recommendation to patients: A systematic review. Vaccines (Basel), 9(7), 713. https://doi.org/10.3390/vaccines9070713

[27].  Ahmad, M., Akande, A., & Majid, U., 2022, Health care provider trust in vaccination: A systematic review and qualitative meta-synthesis. European Journal of Public Health, 32(2), 207–213. https://doi.org/10.1093/eurpub/ckab209

[28].  Gagneur, A., 2020, Motivational interviewing: A powerful tool to address vaccine hesitancy. Canada Communicable Disease Report, 46(4), 93–97. https://doi.org/10.14745/ccdr.v46i04a06

[29].  Setia, M. S., 2016, Methodology series module 3: Cross-sectional studies. Indian Journal of Dermatology, 61(3), 261–264.

[30].  South Sudan National Bureau of Statistics, SSNBS.

[31].  South Sudan District Health Information System 2, SSDHIS2.

[32].  Etikan, I., Musa, S. A., & Alkassim, R. S., 2016, Comparison of convenience sampling and purposive sampling. American Journal of Theoretical and Applied Statistics, 5(1), 1–4.

[33].  Stewart, D. W., Shamdasani, P. N., & Rook, D. W., 2007, Focus Groups: Theory and Practice (2nd ed.).

[34].  Bangura, J. B., Xiao, S., Qiu, D., Ouyang, F., & Chen, L., 2020, Barriers to childhood immunization in sub-Saharan Africa: A systematic review. BMC Public Health, 20, 1–5. https://doi.org/10.1186/s12889-020-09169-4

[35].  Fenta, S. M., & Fenta, H. M., 2021, Individual and community-level determinants of childhood vaccination in Ethiopia. Archives of Public Health, 79, 53. https://doi.org/10.1186/s13690-021-00581-9

[36].  Adamu, A. A., Essoh, T. A., Adeyanju, G. C., et al., 2021, Drivers of hesitancy towards recommended childhood vaccines in African settings: A scoping review of literature from Kenya, Malawi, and Ethiopia. Expert Review of Vaccines, 20(6), 611–621. https://doi.org/10.1080/14760584.2021.1899819

[37].  Dubé, E., Laberge, C., Guay, M., et al., 2013, Vaccine hesitancy: An overview. Human Vaccines & Immunotherapeutics, 9(8), 1763–1773. https://doi.org/10.4161/hv.24657

[38].  Bauch, C. T., Bhattacharyya, S., & Meyers, L. A., 2020, Evaluating the impact of social influence on vaccination decisions. Proceedings of the National Academy of Sciences, 117(12), 6582–6590. https://doi.org/10.1073/pnas.1910835117

Khan, A. A., Mohiuddin, A. F., Abdullah, M., Aliani, R., & Sultan, F., 2023, COVID-19 vaccine hesitancy and attitudes in Pakistan: A cross-sectional phone survey of major urban cities. BMC Public Health, 23, 15905. https://doi.org/10.1186/s12889-023-15905-3