Abstract:

Immunization uptake for childhood vaccine-preventable diseases remains low in urban areas of Uganda, leading to repeated outbreaks of diseases like measles, despite easy communication and accessibility to services. The objectives of this study were to establish immunization coverage and to identify the factors that affect the uptake of immunization among the children aged 10 – 23 months in Nansana Municipality, Wakiso District, Uganda. This was a cross-sectional mixed methods study, utilizing both qualitative and quantitative approaches. Assessment of immunization uptake was carried out on 344 parents/guardians of children aged 10–23 months, using simple random sampling on pre-tested structured questionnaires. Data was analyzed using SPSS 20.0 software. Additionally, 2 focus group discussions with parents and key informant interviews with immunization focal persons were also conducted. Immunization coverage was found to be 90.4% for BCG, 89.3% for Penta1, 80.7% for Penta2, 72.5% for Penta3 and 73.9% for measles1. Availability of vaccines (AOR= 33, 95% CI, 1.44 – 792, p=0.03), accessibility to immunization services (AOR = 32, 95% CI, 2.0 – 513, p=0.01) and communication between the parents and health workers about the return dates (AOR = 0.03, 95% CI, 0.01 – 0.83, p=0.03), were the factors that were independently associated with immunization uptake. The coverage rates were higher than the national average, with the health care service-related factors identified as being critical for improving immunization uptake. There is a need for improved vaccine supply and communication about immunization services, which should be designed considering the local context in collaboration with slum-dwelling communities.

References:

[1] World Health Organization, 2021 “World Health Statistics,” World Health Organization, Geneva, Switzerland, https://creativecommons.org/licenses/by-nc-sa/3.0/igo.

[2] Tadesse, H., Deribew, A and Woldie, M, 2009 “Predictors of defaulting from completion of child immunization in south Ethiopia, A case-control study,” BMC Public Health, 9, 4–9, https://doi:10.1186/1471-2458-9-150.3 World Health Organization, 2009 “World Health Statistics,” WHO Library Cataloguing-in-Publication Data Geneva, World Health Organization, Geneva, Switzerland.

[3] Wolfson et al., 2008 “Estimating the costs of achieving the WHO – UNICEF Global Immunization Vision and Strategy, 2006 – 2015,”, https://doi:10.2471/BLT.07.045096.

[4] Rutherford, M. E., Mulholland, K and Hill, P. C, 2010 “How access to health care relates to under-five mortality in sub-Saharan Africa: systematic review,” Trop. Med. Int. Heal., 15(5), 508–519, https://doi:10.1111/j.1365-3156.2010.02497.x.

[5] World Health Organization, 2018 “World health statistics 2018: monitoring health for the SDGs, sustainable development goals. Geneva: World Health Organization,” Geneva, https://creativecommons.org/licenses/by-nc-sa/3.0/igo.

[6] Malande et al., 2019 “Barriers to effective uptake and provision of immunization in a rural district in Uganda,” PLoS One, 14 (2), p. e0212270, https://doi.org/10.1371/journal.pone.0212270.

[7] Uddin, M. J., Saha, N. C., Islam, Z., Khan, I. A., Quaiyum, M. A, and Koehlmoos, T. P, 2012 “Improving low coverage of child immunization in rural hard-to-reach areas of Bangladesh: findings from a project using multiple interventions,” Vaccine, 30 (2),168–179, https://doi.org/10.1016/j.vaccine.2011.11.030.

[8] Bbaale, E, 2013 “Factors influencing childhood immunization in Uganda,” J. Health. Popul. Nutr., vol. 31, no. 1, p. 118, 2013 doi:10.3329/jhpn.v31i1.14756.

[9] Olson, O, and Berry, C, 2020 “Addressing Parental Vaccine Hesitancy towards Childhood Vaccines in the United States: A Systematic Literature Review of Communication Interventions and Strategies,” Vaccine, https://doi.10.3390/vaccines8040590.

[10] Ameen, M, and Mustafi, A, 2013 “Factors Influencing Childhood Immunizations in Bangaladesh,” International Journal of Mathematics and Statistics Studies, vol. 1, no. 3, pp. 55–65, https://www.ea-journals.org.

[11] .Ministry of Health, “Health Annual health Sector Performance Report,” 2019. Ministry of Health: Kampala, Uganda.

[12] O’Brien, K., Lindstrand, O. A, and Nandy, R 2021 “The Immunization Agenda 2030: a vision of global impact, reaching all, grounded in the realities of a changing world,”. http://dx.doi.org/10.2139/ssrn.3830709.

[13] Wakiso District Local Government, HMIS Report 2019 “Wakiso District Health Records” District Health Officer, Wakiso, Uganda.

[14] Tugumisirize, M. E & Tumwine J, 2002 “Missed opportunities and caretaker constraints to childhood vaccination in rural areas of Uganda,” East Afr. Med. J., 79(7), DOI: 10.4314/eamj.v79i7.8837.

[15] Babirye, J. N., Rutebemberwa, E., Kiguli, J., Wamani, H and F. Nuwaha, 2011 “More support for mothers: a qualitative study on factors affecting immunization behaviour in Kampala, Uganda,” BMC Public Health, pp. 1–11: 723. https://doi.org/10.1186/1471-2458-11-723.

[16] Nansana Municipal Council, HMIS Report 2019 “Nansana Municipality Health Records” Municipal Health Office, Nansana, Uganda.

[17] World Health Organization, “World Health Organization Vaccination Coverage Cluster Surveys: Reference Manual,” Geneva, 2015.

[18] Braun, V, 2014 “What can ‘thematic analysis’ offer health and well-being researchers?” Int J Qualitative Stud Health Well-being, 1, 9–10, http://dx.doi.org/10.3402/qhw.v9.26152.

[19] Nolna, S. K., Bonono, C. R., Moncher, M. N., Bindé, T., Nolna, D and Zogo, P. O, 2018 “Factors influencing the performance of routine immunization in urban areas: A comparative case study of two cities in Cameroon: Douala and Yaounde,” Vaccine, 36 (49), 7549–7555, https://doi.org/10.1016/j.vaccine.2018.10.048.

[20] Tadesse et al., 2017 “Factors and misperceptions of routine childhood immunization service uptake in Ethiopia: findings from a nationwide qualitative study,” Pan Afr. Med. J., 28 (1), http://www.panafrican-med-journal.com/content/article/28/290/full/.

[21] Zewdie, A., Letebo, M and Mekonnen, T, 2016 “Reasons for defaulting from childhood immunization program: a qualitative study from Hadiya zone, Southern Ethiopia,” BMC Public Health, 16(1), 1–9, https://doi.org/10.1186/s12889- 016-3904-1.

[22] Babalola, S, 2011 “Maternal reasons for non-immunization and partial immunization in northern Nigeria,” J. Paediatr. Child Health, 47(5), 276–281. https://doi.org/10.1111/j.1440-1754.2010.01956.x.

[23] Tefera, Y. H., Getachew, K., Assefa, T., Ababu, Y., Simireta, T., Zewdie Birhanu, Z, 2017 “Factors and misperceptions of routine childhood immunization service uptake in Ethiopia: findings from a nationwide qualitative study,” 8688, 1–9, https://doi:10.11604/pamj.2017.28.290.14133.

[24] Tefera, Y. A., Wagner, A. L., and Boulton, M. L, 2018 “Predictors and Barriers to Full Vaccination among Children in Ethiopia,” Vaccines, 6(22)1–11, https://doi.org/10.3390/vaccines6020022.

[25] Mthiyane et al., 2019 “Factors associated with missed and delayed DTP3 vaccination in children aged 12-59 months in two communities in South Africa, 2012-2013,” South African Med. J., 109 (8), 562–569, https://doi.org/10.7196/SAMJ.2019.v109i8.13244.

[26] Obasohan, P. E., Mustapha, M. A., Makada, A., and Obasohan, D. N, 2018 “Evaluating the reasons for partial and non-immunization of children in Wushishi local government area, niger state, Nigeria: methodological comparison,” Afr. J. Reprod. Health, 22 (4), 113–122, 22:113: https://doi.org/10.29063/ajrh2018/v22i4.12.

[27] Ambe, J. P., Omotara, B. A., and Baba, M.M, 2001 “Perceptions, beliefs and practices of mothers in sub-urban and rural areas towards measles and measles vaccination in Northern Nigeria,” Trop. Doct., 31(2), 89–90, https://doi.org/10.1177%2F004947550103100211.

[28] Braka, R. F. L., Asiimwe, D., Soud, F., Makumbi, I and Gust, D, 2012 “A Qualitative Analysis of Vaccine Safety Perceptions and Concerns Among Caretakers in Uganda,” Matern. Child Heal. J., 16, 1045–1052, https://doi.org/10.1007/s10995-011-0826-5.

[29] Miyahara et al., 2016 “Barriers to timely administration of birth dose vaccines in The Gambia, West Africa,” Vaccine, 34 (29) 3335–3341, https://doi.org/10.1016/j.vaccine.2016.05.017.

[30] Mekonnen, A. G., Bayleyegn, A. D., and Ayele, E. T, 2019 “Immunization coverage of 12–23 months old children and its associated factors in Minjar-Shenkora district, Ethiopia: a community-based study,” BMC Pediatr., 19(1):198. https://doi.org/10.1186/s12887-019-1575-7.

[31] Akwataghibe, N.N., Ogunsola, E. A., Broerse, J. E.W., Popoola, O. A., Agbo, A. I and Dieleman, M. A, 2019 “Exploring factors influencing immunization utilization in Nigeria—a mixed-methods study,” Front. Public Health., 7, 392, https://doi.org/10. 3389/fpubh.2019.00392.

[32] Ntenda, P. A. M, 2019 “Factors associated with non-and under-vaccination among children aged 12–23 months in Malawi. A multinomial analysis of the population-based sample,” Pediatr. Neonatol., vol. 60, no. 6, pp. 623–633 19;60(6):623 –33, https://doi.org/10.1016/j.pedneo.2019.03.005.

[33] Wiysonge, C. S., Uthman, O. A., Ndumbe, P.M., and G. D. Hussey, G. D, 2012 “Individual and contextual factors associated with low childhood immunisation coverage in Sub-Saharan Africa: A multilevel analysis,” PLoS One, vol. 7, 5 e37905. https://doi.org/10.1371/journal.pone.0037905.

[34] Kiptoo, E., 2015 “Factors Influencing Low Immunization Coverage Among Children Between 12 - 23 Months in East Pokot, Baringo Country, Kenya,” Int. Journal of. Vaccines., vol. 1, no. 2 https://doi.org/10.15406/ijvv.2015.01.00012.

[35] Bangura, J. B., Xiao, S., Qiu, Ouyang, D. F., and Chen, L, 2020 “Barriers to childhood immunization in sub-Saharan Africa: A systematic review,” BMC Public Health, 20:1108, doi: https://doi.org/10.1186/s12889-020-09169-4.