TY - JOUR
T1 - Barriers to effective uptake and provision of immunization in a rural district in Uganda
AU - Malande, Oliver Ombeva
AU - Munube, Deogratias
AU - Afaayo, Rachel Nakatugga
AU - Annet, Kisakye
AU - Bodo, Bongomin
AU - Bakainaga, Andrew
AU - Ayebare, Elizabeth
AU - Njunwamukama, Sam
AU - Mworozi, Edison Arwanire
AU - Musyoki, Andrew Munyalo
N1 - Funding Information:
This study was funded fully by the CDC Small Grants 2017"- Uganda - Research grants for supporting immunization through the WHO country office - Uganda to OOM. All participants in this study (Health care workers, village health teams, DHMTs, focal persons and leaders from Hoima District, Research assistants, Ministry of health Uganda, UNEPI, UPA, ECAVI staff, and the funders/sponsors (WHO Uganda—CDC small grants).
Publisher Copyright:
© 2019 Malande et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Copyright:
Copyright 2019 Elsevier B.V., All rights reserved.
PY - 2019/2/1
Y1 - 2019/2/1
N2 - © 2019 Malande et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Introduction Hoima, one of the largest districts in mid- western Uganda, has persistently performed poorly with low immunization coverage, high immunization drop outs rates and repeated outbreaks of vaccine preventable diseases especially measles. The objectives of this study were to evaluate the state of immunization services and to identify the gaps in immunization health systems that contribute to low uptake and completion of immunization schedules in Hoima District. Methods This was a cross sectional mixed methods study, utilizing both qualitative and quantitative approaches. A situation analysis of the immunization services was carried out using in-depth interviews with vaccinators, focus group discussions and key informant interviews with ethno-videography. Secondary data was sourced from records at headquarters and vaccination centres within Hoima District. The quantitative component utilized cluster random sampling with sample size estimated using the World Health Organization’s 30 cluster sampling technique. Results A total of 311 caretaker/child pairs were included in the study. Immunization completion among children of age at least 12 months was 95% for BCG, 96% for OPV0, 93% for DPT1, 84.5% for DPT2, 81% for DPT3 and 65.5% for measles vaccines. Access to immunization centres is difficult due to poor road terrain, which affects effectiveness of outreach program, support supervision, mentorship and timely delivery of immunization program support supplies especially refrigerator gas and vaccines. Some facilities are under-equipped to effectively support the program. Adverse Events Following Immunization (AEFI) identification, reporting and management is poorly understood. Conclusion Immunization services in Hoima District require urgent improvement in the following areas: vaccine supply, expanding service delivery points, more health workers, transport and tailored mechanisms to ensure adequate communication between health workers and caretakers.
AB - © 2019 Malande et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Introduction Hoima, one of the largest districts in mid- western Uganda, has persistently performed poorly with low immunization coverage, high immunization drop outs rates and repeated outbreaks of vaccine preventable diseases especially measles. The objectives of this study were to evaluate the state of immunization services and to identify the gaps in immunization health systems that contribute to low uptake and completion of immunization schedules in Hoima District. Methods This was a cross sectional mixed methods study, utilizing both qualitative and quantitative approaches. A situation analysis of the immunization services was carried out using in-depth interviews with vaccinators, focus group discussions and key informant interviews with ethno-videography. Secondary data was sourced from records at headquarters and vaccination centres within Hoima District. The quantitative component utilized cluster random sampling with sample size estimated using the World Health Organization’s 30 cluster sampling technique. Results A total of 311 caretaker/child pairs were included in the study. Immunization completion among children of age at least 12 months was 95% for BCG, 96% for OPV0, 93% for DPT1, 84.5% for DPT2, 81% for DPT3 and 65.5% for measles vaccines. Access to immunization centres is difficult due to poor road terrain, which affects effectiveness of outreach program, support supervision, mentorship and timely delivery of immunization program support supplies especially refrigerator gas and vaccines. Some facilities are under-equipped to effectively support the program. Adverse Events Following Immunization (AEFI) identification, reporting and management is poorly understood. Conclusion Immunization services in Hoima District require urgent improvement in the following areas: vaccine supply, expanding service delivery points, more health workers, transport and tailored mechanisms to ensure adequate communication between health workers and caretakers.
UR - http://www.scopus.com/inward/record.url?scp=85061541457&partnerID=8YFLogxK
U2 - 10.1371/journal.pone.0212270
DO - 10.1371/journal.pone.0212270
M3 - Article
C2 - 30763355
SN - 1932-6203
VL - 14
JO - PLoS ONE
JF - PLoS ONE
IS - 2
M1 - e0212270
ER -