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

Abstract

Background: Despite global and local initiatives to increase vaccine uptake, timeliness of vaccinations and vaccine uptake remain low among residents of islands and fishing communities in Uganda. Vaccine coverage (all vaccines) among island communities stands at 37.1% compared to 55%, the national level. This qualitative study was conducted to (i) understand key barriers to vaccine uptake among residents of islands and fishing communities of Lake Victoria, Buganda sub-region, Uganda and (ii) identify specific needs of the communities; ahead of implementation of a mobile health intervention to promote vaccine uptake. Methods: Explorator y qualitative. Data were collected through focus group discussions with women of reproductive age and village health teams (VHT) and key informant interviews with the health coordinators and health service providers. Data were analysed through content analysis, by coding pre-established and recurrent themes.Results: Under the barriers, seven themes were identified: Opportunity cost of seeking vaccines versus making a living, Distance/Cost to health facility, Availability of service provider, Attitudes towards vaccines, Decision making regarding the use of vaccines, Knowledge of availability of services, and Attitudes of service providers. Participants suggested strategies to improve uptake: 1) more health education and regular reminders using VHTs, public address systems and mobile technology; 2) bring services closer to people through scheduled vaccination campaigns to reduce on cost of seeking services; and 3) strengthening public-private partnerships in the health sector for delivery of vaccine services. Conclusion: In light of the current barriers to vaccine uptake, innovations to increase the utilisation of vaccination services in remote underserved settings need to be multi-pronged, responding to user, structural and supply-side factors. The use of mobile technology and public-private partnerships for health have the potential to bridge existing vaccine delivery and uptake gaps.