Factors and misperceptions of routine childhood immunization service uptake in Ethiopia: findings from a nationwide qualitative study

Abstract

IntroductionWhile the routine childhood immunization program might be affected by several factors, its identification using qualitative evidence of caretakers is generally minimal. This article explores the various factors and misperceptions of routine childhood immunization service uptake in Ethiopia and provides possible recommendations to mitigate them.MethodsIn this study, we used a qualitative multiple case study design collecting primary data from 63 focus group discussions (FGDs) conducted with a purposefully selected sample of children's caretakers (n = 630).ResultsAccording to the results of this study, the use of routine childhood immunization is dependent on four major factors: caretakers' behavior, family characteristics, information and communication and immunization service system. In addition, the participants had some misperceptions about routine childhood immunization. For example, immunization should be taken when the child gets sick and a single dose vaccine is enough for a child. These factors and misperceptions are complex and sometimes context-specific and vary between categories of caretakers.ConclusionOur interpretations suggest that no single factor affects immunization service uptake alone in a unique way. Rather, it is the synergy among the factors that has a collective influence on the childhood immunization system. Therefore, intervention efforts should target these multiple factors simultaneously. Importantly, this study recommends improving the quality of existing childhood immunization services and building awareness among caretakers as crucial components.

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

“…Forty-eight articles met all inclusion criteria for this study; 28 articles were excluded for various reasons. [See supplementary materials 3] Nine articles employed second-hand data analysis [7,12,18,27,37,40,41,47,42]; thirty-six used crosssectional design [1][2][3]11,[13][14][15][16][17]19,[21][22][23][24][25][26][28][29][30][31][32][33][34][35][36][38][39]42,[45][46][48][49][50][51]53,54] and three used case-control study [20,[43][44]. All described studies were conducted on Africa populations (103,655 adults and 76,327 children).…”

“…One critically examined barriers speci c to vaccination doses at birth 0 -1day [18] in the Gambia. Thirty articles reported national immunization coverage [1][2]7,[11][12][13][14][15][16][20][21][22][23][24][25][28][29]32,[34][35][38][39][40][43][44][45][46]49,50,[52][53][54], eighteen did not [3,[17][18][19]22,24,[26][27][30][31]33,[36][37][41][42]47,48,…”

“…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] [18,20]. Misconceptions about childhood immunization were recorded as major hindrance to effective utilization of immunization services in this review [1,2,[11][12][13][14][21][22]29,31,32,48,49] One article [17] reported that some parents believed that the immunity induced by vaccines is less effective than that of the natural disease, and they prefer to endure the diseases than immunization.…”

“…We describe health system barriers as inherent factors that obstruct the process of delivering vaccine and vaccine related services to it bene ciaries. These includes broken cold chain, irregular supplies and distribution of vaccines; limited human resource and infrastructures, and long distances separating health facilities from families [1][2][3]11,13,[14][15][16]19,22,23,25,29,32,35,43,44,[47][48][49][50][51][52]. Vaccine shortages at health facility level and di culties of transporting vaccines were commonly reported to signi cantly hinder immunization services [1-174 3,11,14,16,19,22,23,25,33,43,47,48,52,51].…”

“…Studies [11,13,45,[47][48][49][50]52,53] also revealed that some hard-to-reach areas do not have health facilities nearby to provide childhood immunization. Health workers were reported to covers long distances on outreach services due to inadequate health centers [11,13,15,43]. It was also reported that, caretakers covered long distances to reach immunization centers resulted to non-completion of vaccination series [2,3,13,18,[21][22][23][24][25][26]31,36,38,[40][41][42][43]46].…”