Barriers to effective uptake and provision of immunization in a rural district in Uganda

Abstract

Introduction Hoima, one of the largest districts in mid- western Uganda, has persistently performed poorly with low immunization coverage, high immunization drop outs rates and repeated outbreaks of vaccine preventable diseases especially measles. The objectives of this study were to evaluate the state of immunization services and to identify the gaps in immunization health systems that contribute to low uptake and completion of immunization schedules in Hoima District. Methods This was a cross sectional mixed methods study, utilizing both qualitative and quantitative approaches. A situation analysis of the immunization services was carried out using in-depth interviews with vaccinators, focus group discussions and key informant interviews with ethno-videography. Secondary data was sourced from records at headquarters and vaccination centres within Hoima District. The quantitative component utilized cluster random sampling with sample size estimated using the World Health Organization’s 30 cluster sampling technique. Results A total of 311 caretaker/child pairs were included in the study. Immunization completion among children of age at least 12 months was 95% for BCG, 96% for OPV0, 93% for DPT1, 84.5% for DPT2, 81% for DPT3 and 65.5% for measles vaccines. Access to immunization centres is difficult due to poor road terrain, which affects effectiveness of outreach program, support supervision, mentorship and timely delivery of immunization program support supplies especially refrigerator gas and vaccines. Some facilities are under-equipped to effectively support the program. Adverse Events Following Immunization (AEFI) identification, reporting and management is poorly understood. Conclusion Immunization services in Hoima District require urgent improvement in the following areas: vaccine supply, expanding service delivery points, more health workers, transport and tailored mechanisms to ensure adequate communication between health workers and caretakers.

Barriers to vaccine uptake in the fishing and island communities of Uganda: a qualitative study

“…These include the opportunity cost of seeking vaccines versus making a living, distance and/or cost to health facility, availability of service provider, awareness of the importance of using vaccination services and knowledge of availability of services. In this regard, our findings are consistent with previous studies analysing barriers in utilizing vaccination services [8][9][10]14].…”

“…Barriers to vaccine uptake and the provision of services are often intertwined and well documented. These include limited vaccine supply, number of health centres and workers, service deliver points, and transport to and from health centres [8][9][10]. Recent research has focused on the barriers and motivators to the uptake of vaccines in resource-constrained and remote locations including among others intent of the mother, community access, cost, number of clients at health centre, unfriendly workers and staffing [9,10], and yet less attention is given to the role of structural factors/enablers to uptake of vaccination among island and landing sites communities.…”

Barriers to Childhood Immunization in Sub-Saharan Africa: A Systematic Review

“…We split results into three sectionsparental barriers, health system barriers, and providers' barriers. 8 studies examined allparental/caretakers, health systems and providers' barriers [3,11,13,16,43,45,48,52]; 21 studies examined parental/caretakers and health system barriers [1, 2, 14, 15, 18-19, 22-23, 25, 29, 31-33, 35, 38, 44, 47, 49-51, 53]; 18 studies only looked at parental//caretakers barriers [7, 12, 17, 20-21, 24, 26-28, 34, 36-37, 39, 42, 46, 54] and one study examined parental and providers' barriers.…”

“…stated that "low parental knowledge of immunization and/or lack of access to information about childhood immunization could be an important contributor to the high burden of unimmunized children in sub-Saharan Africa". Four studies [3,13,25,26], noted that a child born to a mother with little or no knowledge of vaccination may not complete the required vaccine series. Two articles reported that delay on vaccine birth doses is associated to maternal education [18,20].…”

Geographic location of health facility and immunization program performance in Hoima district, western Uganda, a facility level assessment

“…The DPT3 coverage for the rural district of Hoima on the shores of Lake Albert in Uganda was recently reported to be 19%, way below the national level. [16] Therefore, the aim of this study was to examine whether geographic distribution of health facilities in uences immunization program performance by health facilities in this rural district of western Uganda.…”