Factors associated with non-uptake of measles-rubella vaccine second dose among children under five years in Mtwara district council, Tanzania, 2017

Abstract

Introduction in 2014, Tanzania introduced the combined measles-rubella vaccine in the routine immunization schedule. Two doses of measles-rubella vaccine (MR1 and MR2) are recommended at 9 and 18 months, respectively. In 2015, MR2 coverage among eligible 18-month-old children in Tanzania was only 57%, lower than the WHO-recommended coverage (95%). During the same period Mtwara District Council (MDC) reported a coverage of 52% which is lower than the nation average. We determined factors associated with non-uptake of MR2 among children in MDC Tanzania. Methods we conducted a community-based cross-sectional survey using cluster sampling during January - April 2017 in MDC. Caretakers of children born during January 2014 - January 2015 and residing in MDC for the past three years were recruited. We interviewed participants and reviewed vaccination cards. Logistic regression modeling was employed to identify independent factors associated with uptake of MR2. Results of 1,000 children assessed, 558 (55.8%) were unvaccinated with MR2. Factors independently associated with non-uptake of MR2 included the caretaker being unaware of the ages for MR1 and MR2 administration [aOR=3.50; 95%CI 1.98-6.21; p<0.001], having MR2 vaccination services offered at the local vaccination station fewer than three days per week [aOR=1.50; 95%CI 1.42-5.59; p<0.001], not having the vaccine available during vaccination days [aOR=3.38; 95%CI 1.08-10.61; p<0.01], unwillingness of health workers to open multi-dose vaccine vials for a single child [aOR=3.80; 95% CI 2.12-6.79; p<0.001], and long waiting times for vaccination services [aOR=1.80; 95% CI 1.08-3.00; p<0.01]. Conclusion more than half the children under five years in MDC were not vaccinated with MR2. Lack of caretaker knowledge about appropriate vaccination age, unavailability of vaccine, having insufficient numbers of children waiting to warrant multidose vial use, and long clinic waiting times were associated with MR2 non-uptake. The community should receive education about MR vaccine; we recommend thorough screening of children?s vaccination status at each clinic visit and provision of vaccine whenever possible. Vaccine distribution should be improved in MDC.

Parental concerns and uptake of childhood vaccines in rural Tanzania – a mixed methods study

“…The findings of this study support existing literature on low timely vaccine coverage in children from Southeastern Tanzania [26,27] and describe an underlying, unaddressed, current of vaccine hesitancy. The study highlights missed opportunities for routine immunization, common parental concerns, and the potential role of information access, which, if addressed, may improve childhood vaccination rates, especially in rural areas.…”

“…Both quantitative survey data from the mothers of these children, and qualitative data from FGDs suggest delays in vaccinations, and that convenience, confidence, and to a lesser degree, complacency, may contribute to these delays. Two previous studies in the same area described low timeliness of vaccine uptake in the region but did not examine parental concerns [26,27].…”

“…Based on a study of community vaccine perceptions, Chambongo et al suggested health promotion, community sensitization, and improving provider-patient relationships, as strategies for increasing vaccination coverage among rural Tanzanian children [28]. Similar recommendations on the need to improve caregiver knowledge about vaccines were published by Magodi et al [27].…”

Mother’s Knowledge on HIV, Syphilis, Rubella, and Associated Factors in Northern Tanzania: Implications for MTCT Elimination Strategies

“…Similarly, another study in Ethiopia by Negussie et al found that lack of knowledge of the effectiveness of vaccines was one of the reasons for noncompliance of scheduled vaccines [ 46 ]. Tanzania is lagging behind on its MR2 coverage [ 37 ]. Despite the high first (MR1) coverage of >98%, the repeat vaccine (MR2) coverage is at 84%, below the national target of 90% [ 38 ].…”

“…Among pregnant women, 2.7 to 12% of adverse pregnancy outcomes are attributed to acute rubella infection [ 35 , 36 ]. Risk factors for CRS are low herd immunity, young mothers, lack of rubella seroprevalence screening, not vaccinating all school girls, and low rubella vaccine coverage [ 37 , 38 ]. In the study region, Kilimanjaro, the population HIV prevalence is below the national average [ 14 , 25 , 32 , 33 ].…”