Abstract:

In recent years, full childhood routine immunisation coverage has fallen by 5% to levels not seen since 2008; between 2019 and 2021, 67 million children were under-vaccinated. We aimed to identify and describe the determinants of vaccination drop-out from the perspectives of mothers and caregivers. In The Gambia, vaccination coverage has improved from 76% in 2015 to 85% in 2020-21. However, this coverage is still behind the target set by the Global Vaccine Action Plan (GVAP) of 90% and 80% coverages for all antigens at the national and district levels respectively by 2020. These disparities highlight systemic barriers and the need to identify determinants of dropout to guide targeted interventions. The study was conducted in Upper River Region (rural) and West Coast Health Region 2 (semi-urban), selected for their historically high dropout rates (6.1% and 7.5% respectively). We conducted focus group discussions with community stakeholders, including mothers’ clubs and traditional communicators, to gain deeper insights into social and structural influences on vaccination dropout. Findings of the study revealed that caregivers generally possessed adequate awareness of the purpose and benefits of childhood vaccination and widely associated vaccination with disease prevention, child survival and development. Health workers emerged as the most credible and influential source of vaccination information, seconded by community-based actors such as village health workers and local leaders. Interventions should therefore be tailored to address drivers of dropout in communities. Service quality, timeliness and reliability need to be improved, and tailored messaging and awareness creation are needed.

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