The last stretch: Barriers to and facilitators of full immunization among children in Nepal’s Makwanpur District, results from a qualitative study

Abstract

Background Approximately 35% of Nepal’s children have not received all recommended vaccines, and barriers to immunization exist on both the demand- (i.e., access, affordability, acceptance) and supply- (i.e., logistics, infrastructure) sides. Objective This article describes a formative study to understand the barriers to and facilitators of immunization in Makwanpur, Nepal from both the demand- and supply-sides. Methods Through in-depth interviews, key informant interviews, and focus group discussions (N = 76), we assessed knowledge, attitudes, and experiences with immunization; social norms related to immunization; perceptions of local health facilities; and descriptions of client-provider relationships. Data were analyzed using an iterative, grounded theory approach. Results Three major themes emerged, including positive demand of vaccines, lack of mutual trust between service seekers and service providers, and internal and external motivators of vaccine supply. On the demand-side, caregivers reported high levels of immunization-related awareness, knowledge, and acceptance, largely perceived to be due to a generational shift. On the supply-side, providers expressed passion for their work despite lack of support from local authorities and a desire for more training. Between caregivers and providers, lack of mutual trust emerged as a prominent barrier, revealing a cycle of positive service bias. Conclusions We identified mutual trust as a key pathway toward reaching full immunization coverage in Nepal and we recommend future interventions adopt an approach which focuses on removing social barriers (i.e., distrust) and structural barriers (i.e., opening hours, neglected infrastructure) to immunization.

Muslim parents’ beliefs and factors influencing complete immunization of children aged 0–5 years in a Thai rural community: a qualitative study

“…Some mothers who accepted vaccines but had incomplete immunization behavior, have faced resistance from those who had powerful decision-making voices on childhood vaccination in extended families. Another study similarly found that the younger generation of parents in Nepal try to communicate to make independent decisions and support for childhood vaccination within their respective families [ 27 ].…”

Using the Journey to Health and Immunization (JTHI) Framework to Engage Stakeholders in Identifying Behavioral and Social Drivers of Routine Immunization in Nepal

“…Through the Behavioral Science Immunization Network project, the BSC had two primary objectives: (1) document the use of behavioral science tools and approaches in relation to immunization and (2) increase capacity of BSC members to apply behavioral science to immunization. To achieve these objectives, the BSC, in consultation with the Ministry of Health and Population (MOHP), conducted formative research on the social and behavioral drivers of childhood vaccination in select wards in Kathmandu Metropolitan City and Sudurpaschim and Madesh provinces.…”

“…The Government of Nepal has prioritized its immunization program and has a goal of fully vaccinating 95 percent of children aged 12-23 months by 2030 [1,2]. The country's immunization program is considered a success; compared to its peers, Nepal has achieved high and sustained vaccination coverage (80 percent in 2022) [2,3].…”

“…Many studies have examined the socioeconomic determinants of vaccination and the demand-and supply-side barriers and enablers to vaccination in Nepal. However, none of the studies used a specific behavior change model or were related to intervention design [1,[16][17][18][19].…”

Vaccination Status of Children (Under 5 Years) and Parents Perceptions in District Hangu, Khyber Pakhtunkhwa

“…Globally there are 20 million children who have not received the minimum basic vaccination and only 11% have received the full schedule vaccine recommended by World Health Organization (WHO). 9 Multitude of factors are responsible for this low immunization coverage such as weak health systems, isolated rural areas without easy access to health facilities, urban slums and informal settlements, displaced populations during conflicts and wars, lack of information and misconception of immunization, religious misbelieves, and illiteracy operations, In addition, distance from (taluka) health facility and misconception of parents was among the main reasons of not getting the children vaccinated. 10,11 Studies have shown that socio-economic characteristics, lack of awareness, difficult access and managerial issues had connection to poor immunization coverage in Pakistan.…”