Reasons for defaulting from childhood immunization program: a qualitative study from Hadiya zone, Southern Ethiopia

Abstract

BackgroundReduction of mortality and morbidity from vaccine-preventable diseases in developing countries involves successfully implementing strategies that ensure high coverage and minimize drop-outs and missed opportunities. Achieving maximum coverage, however, has been a challenge due to many reasons, including high rates of defaulters from the program. The objective of this study was to explore the reasons behind defaulting from the immunization program.MethodsA qualitative study was conducted in two districts of Hadiya zone, Southern Ethiopia between November 2014 and April 2015. A total of twenty-six in-depth interviews were held with mothers of defaulted children aged 6-11months old and key informants from the communities, health centers, and health offices. Observations and review of relevant documents were also conducted. Thematic analysis was used to analyze the data.ResultsIn this study, the main reason for defaulting from the immunization was inadequate counseling of mothers that led to a lack of information about vaccination schedules and service arrangements, including in unusual circumstances such as after missed appointment, loss of vaccination card and when the health workers failed to make home visits. Provider-client relationships are poor with mothers reporting fear of mistreatment and lack of cooperation from service providers. Contrary to what health workers and managers believe, mothers were knowledgeable about the benefits of vaccination. The high workload on mothers compounded by the lack of support from male partners was also found to contribute to the problem. Health system factors that contributed to the problem were poorly arranged and coordinated immunization services, vaccine and supplies stock outs, and lack of viable defaulter tracking systems in the health facilities.ConclusionsThe main reasons for defaulting from the immunization program are poor counseling of mothers, unsupportive provider-client relationships, poor immunization service arrangements, and lack of systems for tracking defaulters. Efforts to reduce defaulter rates from the immunization program need to focus on improving counseling of mothers and strengthening the health systems, especially with regards to service arrangements and tracking of defaulters.

Coverage, Opportunity, and Challenges of Expanded Program on Immunization among 12–23-Month-Old Children in Woldia Town, Northeast Ethiopia, 2018

“…ese reasons were, 2.3% of caregivers reported that the reason for not completing child vaccination was lack of awareness about completing vaccination schedule and same 2.3% not knowing whether to come back for the second and third vaccination, 2.1% reported fear of side effect, 1.8% reported vaccination time is inconvenient, and same 1.8% because of no vaccination at health facility at the time of vaccination day. Most of the reasons given by the care givers have similarity with the reasons provided by other caregivers on other similar studies [20,25,26,27].…”

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.…”

“…Targeted resources may motivate and enable staff deployed in remote areas for effective outreach activities to maximize coverage of immunization. Poor arrangement and coordination of immunization seasons at health center level was noted [16,38,43,45] a review (conducted in sub-Saharan countries) focus on children and youth noted that, chaotic and uncoordinated services can cause delays and increase costs for beneficiaries [62]. A coordinated National Immunization Program can rationalize services, thus improve immunization uptake and regulating healthcare providers.…”

Evaluation of factors, associated with defaulting routine immunization in children

“…3 The essential requirements for childhood immunization to achieve the desired impact in public health are coverage of immunization services to as many vaccine preventable diseases as possible, maintaining vaccine potency through cold chain and achieving high immunization coverage. 4 Increasing immunization coverage involves two key elements: increasing access to immunization services and reducing dropout rates. While health systems in developing countries seem to improve access to immunization services steadily, the overall change in coverage remains suboptimal.…”