Barriers to childhood immunization in sub-Saharan Africa: A systematic review

Abstract

Background: Immunization to prevent infectious diseases is a core strategy to improve childhood health as well as survival. It remains a challenge for some African countries to attain the required childhood immunization coverage. We aim at identifying individual barriers confronting parents/caretakers, providers, and health systems that hinder childhood immunization coverage in Sub-Saharan Africa. Method: This systematic review searched PubMed/MEDLINE, Web of Science and EMBASE. We restricted to published articles in English that focused on childhood immunization barriers in sub-Saharan Africa from January 1988 to December 2019. We excluded studies if: focused on barriers to immunization for children in other regions of the world, studied adult immunization barriers; studies not available on the university library, they were editorial, reports, reviews, supplement, and bulletins. Study designs included were cross-sectional, secondhand data analysis; and case control. Results: Of the 2652 items identified, 48 met inclusion criteria. Parents/caretakers were the most common subjects. Nine articles were of moderate and 39 were of high methodological quality. Nine studies analyzed secondary data; 36 used cross-sectional designs and three employed case control method. Thirty studies reported national immunization coverage of key vaccines for children under one, eighteen did not. When reported, national immunization coverage of childhood vaccines is reported to be low. Parents/caretaker' barriers included lack of knowledge of immunization, distance to access point, financial deprivation, lack of partners support, and distrust in vaccines and immunization programs. Other associated factors for low vaccine rates included the number of offsprings, lifestyle, migration, occupation and parent's forgetfulness, inconvenient time and language barrier. Barriers at health system level cited by healthcare providers included limited human resources and inadequate infrastructures to maintain the cold chain and adequate supply of vaccines. Conclusion: In this review we identified more thoroughly the parents/caretakers' barriers than those of providers and health systems. Factors that influenced decisions to get children vaccinated were mainly their gender, beliefs, socio-culture factors in the communities in which they live. Thus it is vital that immunization programs consider these barriers and address the people and societies in their communities across sub-Saharan Africa.

Decomposing the rural–urban gap in factors associated with childhood immunisation in sub-Saharan Africa: evidence from surveys in 23 countries

“…The key independent variable was residential status, that is, rural or urban area. Based on some immunisation literature, 9 11 13 we selected and controlled for nine (9) covariates grouped into child factors: sex of child, and birth order as well as maternal factors: maternal age, education, wealth quintile, occupation, sex of household head, health insurance subscription status and distance to health facilities. Sex of child was either male or female while birth order ranged from one (1) to six (6) or more.…”

“…Some of these recent studies have reported that lack of knowledge of immunisation, lack of partner support, financial deprivation and distrust in immunisation programmes account for incomplete or non-immunisation. 9–11 Further evidence indicate rural–urban variation in childhood immunisation in some parts of SSA 12 while another study examined rural–urban variations in missed opportunities of immunisation in SSA, 13 and showed an emerging trend in the disparity in favour of urban residents. It is, therefore, not unanticipated that under-5 mortality is higher among rural children compared with urban children in SSA.…”

Public Knowledge and Opinion on Childhood Routine Immunizations in Two Major Cities of Anambra State, Nigeria

“…Findings of this study agree with previous reports on the positive influence of formal education on knowledge of immunization. 30–32 This was supported by the finding that the initial source of information was predominantly formal education settings. This may also be attributed to the fact that individuals who have higher education are more likely to appreciate the basic concepts of vaccination.…”

“…Previously, misconception was identified as the major hindrance to childhood immunization in African settings. 30 , 33 , 34 In 2003, the WHO polio vaccination campaign was boycotted by opinion leaders in three Northern Nigerian states due to misconceptions that the vaccine was contaminated with HIV and could cause sterility. 33 It has also been reported that some parents prefer their children to endure the disease to being vaccinated because they believed that immunity induced by vaccines is less effective than that acquired from natural disease.…”

“… 33 It has also been reported that some parents prefer their children to endure the disease to being vaccinated because they believed that immunity induced by vaccines is less effective than that acquired from natural disease. 30 Therefore, the trend in opinion may contribute to the higher uptake of vaccines in the southeast compared to other geopolitical zones in Nigeria. Hence, the government should intensify efforts on improving the opinion of parents towards childhood immunization in zones currently experiencing low immunization coverage especially in Northern Nigeria.…”