FACTORS CONTRIBUTING TO LOW IMMUNIZATION COVERAGE IN
KAKOBA DIVISION - MBARARA MUNICIPALITY,
MBARARA DISTRICT
A RESEARCH REPORT SUBMITED TO
UGANDA NURSES AND MIDWIVES EXAMINATIONS BOARD
IN PARTIAL FULFILLMENT OF THE REQUIREMENTS
FOR THE AWARD OF THE DIPLOMA IN NURSING SCIENCES
BY
KICONCO EVAS
N15/U011/DNE/016
APRIL, 2017
Factors contributing to low immunization coverage
i
ABSTRACT
Immunization is one of the major public health interventions to avoid childhood
illnesses and mortality. Globally, there are 30 million children who are not routinely
immunized every year and 1.5 million children under five years of age die each year
from vaccine preventable diseases.
The purpose of the study was to establish factors contributing to low immunization
coverage in Kakoba Division - Mbarara Municipality, Mbarara District. Cross-
sectional and descriptive study which employed a quantitative approach of data
collection was used and the study was conducted at Kakoba Health Centre III in
Kakoba Division. The researcher used convenient sampling method to select samples.
Only 65 parents/caretakers with children who attended Maternal Child Health at
Kakoba Health Centre III in Kakoba Division. The findings showed that a majority 29
(45%) of the participants said there are others factors like poor mobilization,
postponding dates and few health workers which hinders immunization services while
a few 4 (6%) sail low knowledge of the health workers. majority 56 (86%) of the
participants said fear of the side effects of the vaccine because it make the child sick
compared to only 1 (2%) who had no response, 52 (80%) of the participants revealed
that lack of awareness by care givers may result to low immunization service utilization
while only 4 (6%) were not sure of that. Factors like poor mobilization, postponding
dates, fear of side effects of the vaccine and lack of awareness by caregivers contribute
to low immunization coverage.
Factors contributing to low immunization coverage
iii
AUTHORIZATION
Unpublished research report submitted to the Kampala International University-
Western Campus, School of Nursing and deposited in the library, is open for
inspection, but is to be used with due regard to the right of the author. The author and
Kampala International University Western Campus, School of Nursing can grant
privilege of loan or photocopy to accredited borrowers provided credit is given in
subsequent written or published work.
Author: Kiconco Evas
Signature………………..…………….. Date……………….…….…………….
School of Nursing of Kampala International University-Western Campus
P.O.Box 71, Bushenyi, Uganda
Supervisor: Mr. Namara Gordon
Signature …….….…………..……... Date ………….………..………………
Dean School of Nursing, Kampala International University-Western Campus
Ms. Kabanyoro Annet
Signature ……………………………… Date ………………………………………
Factors contributing to low immunization coverage
iv
DEDICATION
I dedicate this research work to my guardian Mr and Mrs. Kyomuhendo Gad, Mr
Gordon, Mr. Arinaitwe Peter and Ainomugisha Judex who through their tireless
effort supported me throughout my studies.
This research work will be dedicated to my almighty God who has enabled me to reach
this far to him be the glory and to my beloved parents and siblings for their wonderful
guidance and support.
Finally this book is dedicated to the entire classmates and friends of Kampala
International University.
Factors contributing to low immunization coverage
v
ACKNOWLEDGEMENT
It is with assistance of various people that this study was successfully completed.
Special thanks go to guardian Mr. and Mrs. Kyomuhendo Gad, Mr. Arinaitwe
Peter and Mr. Ainomugisha Judex for their prayer and financial support throughout
my studies.
My acknowledgement is further extended to Mr. Namara Gordon who patiently
supervised the study and corrected every error to ensure perfection.
Finally, sincere appreciation to the secretary, Ahimbisibwe Jovitah who patiently
typed this research report with correction of errors making it standard work.
Factors contributing to low immunization coverage
vi
TABLE OF CONTENTS
ABSTRACT ................................................................................................................... i
COPYRIGHT ................................................................................................................ ii
AUTHORIZATION ..................................................................................................... iii
DEDICATION ............................................................................................................. iv
ACKNOWLEDGEMENT ............................................................................................ v
TABLE OF CONTENTS ............................................................................................. vi
LIST OF FIGURES ...................................................................................................... x
LIST OF TABLES ....................................................................................................... xi
LIST OF ABBREVIATIONS ..................................................................................... xii
OPERATIONAL DEFINITIONS .............................................................................. xiii
CHAPTER ONE: INTRODUCTION ........................................................................... 1
1.0 Introduction ............................................................................................................. 1
1.1 Background of the study ......................................................................................... 1
1.2 Problem statement ................................................................................................... 3
1.3 Purpose of the study ................................................................................................ 3
1.4 Study objectives ...................................................................................................... 4
1.4.1 Broad objective .................................................................................................... 4
1.4.2 Specific objectives ............................................................................................... 4
1.5 Research questions .................................................................................................. 4
1.6 Justification of the study ......................................................................................... 4
1.6.1 Nursing Practice ................................................................................................... 5
1.6.2 Nursing Education ............................................................................................... 5
Factors contributing to low immunization coverage
vii
1.6.3 Nursing Research ................................................................................................. 5
CHAPTER TWO: LITERATURE REVIEW ............................................................... 6
2.0 Introduction ............................................................................................................. 6
2.1 Heath system related factors contributing to low immunization coverage ............. 6
2.2 Community related factors contributing to low immunization coverage ............... 9
3.3 Summary of the literature review ......................................................................... 11
CHAPTER THREE: METHODOLOGY ................................................................... 12
3.1 Introduction ........................................................................................................... 12
3.2 Study design and rationale .................................................................................... 13
3.3 Study setting and rationale .................................................................................... 13
3.4 Study population ................................................................................................... 14
3.4.1 Sample size determination ................................................................................. 14
3.4.2 Sampling procedure ........................................................................................... 15
3.5 Eligibility criteria .................................................................................................. 15
3.5.1 Inclusion criteria ................................................................................................ 15
3.5.2 Exclusion criteria ............................................................................................... 16
3.6 Study variables ...................................................................................................... 16
3.6.1 Dependent variable ............................................................................................ 16
3.6.2 Independent variables ........................................................................................ 16
3.6.3 Confounding variables ....................................................................................... 16
3.7 Research instrument .............................................................................................. 16
3.8 Data collection procedures .................................................................................... 17
3.8.1 Data management............................................................................................... 17
Factors contributing to low immunization coverage
viii
3.8.2 Data analysis and presentation ........................................................................... 17
3.9 Ethical considerations ........................................................................................... 18
3.10 Limitations of the study ...................................................................................... 18
3.11 Dissemination of results ...................................................................................... 18
CHAPTER FOUR: RESULTS ................................................................................... 19
4.1 Introduction ........................................................................................................... 19
4.2 Bio-demographic data of the participants ............................................................. 19
4.3 Health system related factors contributing to low Immunization coverage ......... 21
4.4 Community related factors contributing to low immunization coverage ............. 24
CHAPTER FIVE: DISCUSSION, CONCLUSION AND RECOMMENDATION .. 27
5.1 Introduction ........................................................................................................... 27
5.2 Discussion of the findings ..................................................................................... 27
5.2.1 Bio-demographic data ........................................................................................ 27
5.2.2 Heath system related factors contributing to low immunization coverage ........ 28
5.2.3 Community related factors contributing to low immunization coverage .......... 31
5.3 Conclusion ............................................................................................................ 33
5.4 Recommendations ................................................................................................. 34
5.6 Implications to nursing practice ............................................................................ 34
REFERENCES ........................................................................................................... 35
APPENDICES ............................................................................................................ 39
Appendix I: Participant Consent Form ....................................................................... 39
Appendix II: Questionnaire ......................................................................................... 40
Appendix III: Letter of Authorization ......................................................................... 45
Factors contributing to low immunization coverage
ix
Appendix IV: Map of Uganda showing location of Mbarara District ........................ 46
Appendix V: Map of Mbarara District showing location of Kakoba Division ........... 47
Factors contributing to low immunization coverage
x
LIST OF FIGURES
Figure 1: A bar graph showing type of health facility near respondent’s home ......... 21
Figure 2: A bar graph showing participant’s place where the last born child was
delivered ...................................................................................................................... 22
Figure 3: A pie chart showing numbers of time should a child be immunized according
to the Uganda immunization schedule ........................................................................ 23
Factors contributing to low immunization coverage
xi
LIST OF TABLES
Table 1: Show bio-demographic data of the study participants .................................. 19
Table 2: Show participants’ nearest health facility distances from home .................. 21
Table 3: Showing participants’ time spend waiting for immunization services at the
clinic ............................................................................................................................ 22
Table 4: Showing responses of participants whose last born children were born from
health facility .............................................................................................................. 23
Table 5: Showing major factors hindering immunization in health facility ............... 24
Table 6: Show community related factors contributing to low immunization ........... 24
Factors contributing to low immunization coverage
xii
LIST OF ABBREVIATIONS
AMREF African Medical and Research Foundation
BCG Bacillus Calmette Guerin
DPT Diphtheria Pertussis Tetanus
EPI Expanded Programme on Immunization
MCH Maternal Child Health
MOH Ministry of Health
OPV Oral Polio Vaccine
UNEPI Uganda National Expanded Programme on Immunization
UNICEF United Nations Children’s Fund
WHO World Health Organization
Factors contributing to low immunization coverage
xiii
OPERATIONAL DEFINITIONS
Immunity; is the ability for the body to resist and fight infections that is resistance
possessed by the body to infectious diseases, foreign tissues non toxic substances and
other antigen.
Immunization; is the process or act of creating immunity by artificial means, that is,
by introducing modified attenuated vaccine.
Immunize; means conferring immunity to an individual.
Vaccination; refers to the introduction of vaccine into the body to provide immunity
to a specific disease.
Vaccine; a suspicion of killed or attenuated organisms (viruses, bacteria etc)
administered for protection or treatment of infectious diseases.
Factors contributing to low immunization coverage
1
CHAPTER ONE: INTRODUCTION
1.0 Introduction
This chapter dealt with background of the study, problem statement, and purpose of
study, study objectives, research questions and justification for the study.
1.1 Background of the study
Immunization is one of the major public health interventions to avoid childhood
illnesses and mortality. Without the same, more than five million children would die
each year and many more fall ill (Arooj, 2015). The re-emerging vaccine preventable
diseases like measles and polio calls for the need for new approach, if the country is to
achieve Millennium Development Goals (MDGs) for universal access to health care
and reduction in child mortality (WHO, 2012).
About 23.2 million children remained unvaccinated of which 15.3 million (65%) are
from eight countries in Africa (Elizabeth et al., 2015). African Medical and Research
Foundation (AMREF) reported that low immunization coverage exposes large
proportion of children to infectious diseases and disease outbreaks mainly come from
pockets of low immunization areas such as remote places or islands, urban slums, or in
certain population groups such as ethnic and racial minorities (Koskei et al., 2014).
According to the WHO/UNICEF (2008), Nigeria accounts for more than 50% of new
polio cases globally largely associated with socio-cultural factors which limit
utilization of immunization services. In Kenya, the Expanded Program of
Immunization (EPI) which changed to Division of Vaccine and Immunization (DVI)
Factors contributing to low immunization coverage
2
has been in operation since 1980s largely follows WHO guidelines for vaccinating
children however; the national coverage was 59% for urban children and even lowers
coverage in rural areas in 2008/2009 report (Kenya Demographic and Health Survey,
2009). This is far from WHO standards of 90% immunization coverage for urban areas
and 80% for rural areas, WHO reported that complete immunization coverage in Kenya
currently stands at 71% (Kenya Demographic and Health Survey, 2009).
According to the Ugandan National Expanded Programme on Immunisation (UNEPI),
a child is considered fully vaccinated if it has received one dose of BCG (given at birth),
4 doses of polio vaccines (given at birth, 6 weeks, 10 weeks and 14 weeks), 3 doses of
Diphtheria Pertussis and Tetanus (DPT), Hepatitis B, Haemophilus influenza type b
vaccine (given at 6 weeks, 10 weeks and 14 weeks), and 1 dose of the measles vaccine
(given at 9 months) (Clark, 2008). Despite the overall, less than half (45.6%) of all
children in Uganda received all vaccines within the recommended time ranges (Babirye
et al., 2012)
In Western Uganda particularly Mbarara district has one of the most health promotion
measures for children to ensure that their immunization status is up to date, but this still
lags behind in many communities especially Kokoba Division, for children who are
immunized are drastically dropping compared to the partially immunized (UNEPI,
2010). The study was to establish factors contributing to low immunization coverage
in Kakoba Division - Mbarara Municipality, Mbarara District.
Factors contributing to low immunization coverage
3
1.2 Problem Statement
Globally, there are 30 million children who are not routinely immunized every year
and 1.5 million children under five years of age die each year from vaccine preventable
diseases namely measles, whooping cough (Pertussis), Hemophilus influenza type B
(HIB) and Tetanus (WHO, 2012). The mortality rates for under-fives has significantly
remained high in African countries with rates above 180 deaths per 1000 live births
compared to global average of 72 due to poor immunization utilization (Elizabeth et
al., 2015).
In Uganda the goal of immunizing children against the six childhood immunizable
diseases responsible for child mortality and morbidity targeted by UNEPI is indeed a
noble one however, it is not an easy task to achieve (UNEPI, 2010). According to MOH
(2009), immunization report revealed that 63% of children less than 1 year had not
completed the immunization schedule by the end of the year 2008 in Uganda.
Although educational and community based programs have been developed aiming at
improving the immunization coverage to the National target, the immunization
coverage in most parts of Mbarara like Kakoba Division in particular has remained low
MOH (2009). Little or none of the information about factors contributing to low
immunization coverage in Kakoba Division is known, hence a reason for this study.
1.3 Purpose of the study
The purpose of the study was to establish factors contributing to low immunization
coverage in Kakoba Division - Mbarara Municipality, Mbarara District.
Factors contributing to low immunization coverage
4
1.4 Study objectives
1.4.1 Broad objective
To establish factors contributing to low immunization coverage in Kakoba Division -
Mbarara Municipality, Mbarara District.
1.4.2 Specific objectives
i. To assess health system related factors contributing to low immunization
coverage in Kakoba division - Mbarara Municipality, Mbarara District.
ii. To identify community related factors contributing to low immunization
coverage in Kakoba Division - Mbarara Municipality, Mbarara District.
1.5 Research questions
i. What are the health systems related factors contributing to low immunization
coverage in Kakoba division - Mbarara Municipality, Mbarara District?
ii. What community related factors contributing to low immunization coverage in
Kakoba Division - Mbarara Municipality, Mbarara District?
1.6 Justification of the study
Immunization is a lifesaving and cost-effective medical intervention which reduces
childhood morbidity and mortality from diseases (Arooj, 2015). When a person is
immunized against the preventable diseases, he/she is protected against them but the
chances of acquiring the infection are likely to decrease very much if only a small
proportion of new born children receive the vaccine (WHO, 2012).
Factors contributing to low immunization coverage
5
1.6.1 Nursing Practice
This study was designed to come up with information that would help stakeholders
determine the contributing factors to low immunization coverage in Kakoba Division -
Mbarara Municipality, Mbarara District so as to lay strategies to reverse the trend.
1.6.2 Nursing Education
On the other hand the study would contribute to the existing knowledge on
immunization that would influence the health workers and community members on
social marketing and utilization of government programs.
1.6.3 Nursing Research
Similarly the generated information may be utilized by nursing researchers as part of
the literature and some of the recommendations serving as a basis for further research.
Factors contributing to low immunization coverage
6
CHAPTER TWO: LITERATURE REVIEW
2.0 Introduction
In this chapter, the researcher has focused on the information available from other
research reports, journals, textbooks, internet and resourceful persons about factors
contributing to low immunization coverage in relation to the study objectives.
2.1 Heath system related factors contributing to low immunization coverage
Health system determinants of receipt of immunization completion are complex and
interwoven. A study done on reasons for incomplete vaccination and factors for missed
opportunities among rural Nigerian children identified several reasons affecting
childhood immunization such as parents’ objection, disagreement or concern about
immunization safety (38.8%), long distance walking (17.5%) and long waiting time at
health facilities (15.2%) are the most common reasons for incomplete vaccination/
immunization (Abdulraheem et al., 2011). This showed that parental belief about
immunization safety is the major reason for incomplete immunizations among Nigerian
children (Abdulraheem et al., 2011).
Nevertheless, Health institution born children were 7.5 times more likely to be
vaccinated and 4.4 times more likely to complete vaccination than home born children,
which is consistent with studies from other places (Jagrati et al., 2008). In addition,
Children born in health institution were (95%) times likely to be fully vaccinated than
those who born a home after adjustment for another variable. This mean most children
Factors contributing to low immunization coverage
7
who are born from home missed to be immunized for at birth dose such as BCG and
Polio 0 (Jagrati et al., 2008).
A study done by Koskei et al. (2014), showed that all respondents had heard about the
importance of immunization, they were found to have poor health seeking behavior. In
addition, 35.76% reported that they always attended medical appointment for
her/himself and for the child while 49.70% of the respondents admitted failing to attend
clinic appointment because they did not understand the explanation well due to
language barriers between providers and their clients. Most of them understood pokot
language (mother tongue) and Kiswahili (Koskei et al., 2014).
Furthermore, a study conducted in Urban Dili District of Ethiopia by Amin (2013),
found that lack of access to immunization services contributed to low immunization
coverage as results of negative health workers’ attitudes and the manner in which they
treated mothers on aspects of service organization and inadequate supply of vaccines.
Health facility is another factor which contributed to full immunization of the child.
Different studies showed the importance of availability and accessibility of health
facility in immunization coverage (Rup, 2008). Families nearer to the health facility
are more likely to complete the immunization than those far from it. Cross sectional
study done in India, Assam district showed that immunization status of the children
was significantly higher where the distance of the health centre was less than 2
kilometer compared with those residing in remote inaccessible areas with a distance of
greater than 5 kilometer to the health centre (Rup, 2008).
Factors contributing to low immunization coverage
8
According to Omolo (2007), study reported that the emerging challenge is how to
change the behaviour of the health workers since the incinerators are not being used by
some health workers for various reasons, it is clear that health workers’ attitudes can
significantly influence mothers’ attendance. Therefore, improving staff attitudes and
greater community mobilization will be the key approaches to increasing the
immunization coverage in Siaya District, Kenya (Omolo, 2007).
Another study conducted by Chinyama (2013), in Ethiopia Sesheke District to
determine the factors that had influenced low measles immunization coverage found
out that lack of health worker training, broken cold chain equipment, inadequate
supervision and shortage of staff had contributed to low immunization coverage in
Sesheke district, despite the available effective vaccines.
Nevertheless, a study conducted on the assessment of Expanded Programme on
Immunization Service Utilization in Sekyere West District of Ashanti Region, Ghana
revealed that most of the reasons (low vaccines supply, inadequate knowledge of health
workers and limited understanding of vaccinations among caregivers linked to low
vaccine uptake) with 57.1% pointed to be the obstacles to access to immunization
services and missed opportunities and the prominent amongst the reasons being
postponement until another time and other reasons given were, mother being too busy,
family problem including illness of mother, child-ill not brought and time of
immunization inconvenient (Isaac, 2010).
Factors contributing to low immunization coverage
9
2.2 Community related factors contributing to low immunization coverage
The Parents/caretakers, who disagree or are concerned about immunization, are
significantly more likely to have low educational level and to have children who are
completely unimmunized (Hemoke, 2009). Children not fully immunized due to illness
or access reasons are likely to have started the immunization schedule, up to 38.8% of
the study parents/caretakers do not immunize their children because they object,
disagree or are concerned about immunization safety and side effects (Abdulraheem et
al., 2011).
According to Abdulraheem et al. (2011), identified the reasons for partial immunization
and factors that contributed to missed opportunities for immunization in children less
than one year of age in a rural area in Awe, Nasarawa State, Nigeria that less than half
(37.2%) of the mothers completed routine immunization schedules for their children
by the age of 9 months because of parents objection, disagreement or concern about
immunization safety (38.8%), long distance walking (17.5) and long waiting time at
the health facility (15.2%), (Repeated material could be deleted).
A study on child immunization coverage in 700 households in the slum areas of
Rajshahi City Corporation Bangladesh, it was found that full immunization was higher
(92.3%) in the higher ages (24+ months) than the age 12-23 months (89.5%), the high
coverage in the higher ages of 24+ months was attributed to demographic and socio-
economic factors such as mother's education, husband occupation and family’s
monthly income (Rafiqul, Mahfuzar & Mosfequr, 2007).
Factors contributing to low immunization coverage
10
In addition, the study found that the place of delivery and exposure to mass media had
highly significant effects on child immunization. In other words, the mothers who were
exposed to any mass media were more likely to have their children immunized
compared to the mothers who were not exposed to any mass media (Rafiqul, Mahfuzar
& Mosfequr, 2007).
In a study by Nath et al. (2007), on determinants of immunization coverage in 510
children aged 12-23 months in urban slums of Lucknow district, India, it was reported
that only 44% of the children were fully immunized. Incomplete immunization and
unimmunized status of the children were associated with domestic violence and low
socio-economic status which constrained the poor parents to take their children for
repeated visits to complete immunization schedules (Nath et al., 2007).
In a survey to describe the immunization coverage in a rural part of north India with a
sample of 747 children, it was found out that 94.8 % (708 of 747) eligible children were
immunized and had received the required doses of the primary schedule vaccines
(Singh 2007). The coverage found only 39 (5.2%) of the eligible children had not
completed immunization schedule for BCG, DPT, Polio and Measles due to temporary
or permanent migration of the children or family to the village or went back to the
parents’ home or divorce or the child was adopted by relative (Singh 2007).
In Bangladesh the study showed that programmatic factors are linked to drop out from
immunization. In the same study found lack of information about schedule of session
and non holding of session according to schedules were commonly cited reasons for
dropouts and other reasons identified were no idea about doses, vaccinator did not
Factors contributing to low immunization coverage
11
inform about subsequent doses, refusal by health professionals due to lost card or
vaccine exhausted (Abdul et al., 2010).
Knowledge on the benefit of immunization is also an important reason for the
defaulting and non immunization. For instance in southern of Ethiopia Wanago Woreda
mothers who had poor knowledge about the benefit of vaccines were 6 times more
likely to have defaulted than mothers who had good knowledge, also mothers who had
negative perception towards health institution support were 2.3 times more likely to
have defaulter children than mothers with positive attitude (Tadesse, 2009).
A base line survey done in Ethiopia in 2008 by core group polio project indicated that,
a reason for not immunization were, health workers did not come and give vaccine at
the village (28.2%) followed by lack of awareness about vaccination (25.9%), absence
of health facility in the locality (19.1%), vaccination is of no use (7.7%), and
vaccination hurts children (5.0%) (Bisrat and Worku, 2008). Also reasons for
defaulting are reported absenteeism of vaccinators (23.8%), vaccination time is
inconvenient (18.7%), lack of awareness on importance of vaccination (15.2%) and
vaccination site is far away (10.9%), not knowing whether to come back for second
and third vaccination (9.8%) are the main reason identified (Bisrat and Worku, 2008).
3.3 Summary of the literature review
Several reasons affecting childhood immunization such as parents’ objection,
disagreement or concern about immunization safety, long distance walking, long
waiting time at health facilities are the most common reasons for incomplete
Factors contributing to low immunization coverage
12
vaccination/ immunization. Health institution born children were 7.5 times more likely
to be vaccinated and 4.4 times more likely to complete vaccination than home born
children. Lack of access to immunization services contributed to low immunization
coverage as results of negative health workers’ attitudes. Socio-economic factors such
as mother's education, husband occupation and family’s monthly income. Lack of
awareness on the importance of immunization.
CHAPTER THREE: METHODOLOGY
3.1 Introduction
This chapter presents the research methodology which is the detailed procedure of the
study. The chapter comprises of the following sections: study design and rationale,
Factors contributing to low immunization coverage
13
study setting and rationale, population, sample size determination, sampling procedure,
inclusion criteria, study variables, research instruments, data collection procedures,
data management, data analysis and presentation, ethical considerations, limitations of
the study and dissemination of results.
3.2 Study design and rationale
The cross-sectional and descriptive study was conducted which employed a
quantitative approach of data collection to provided information about factors
contributing to low immunization coverage in Kakoba Division-Mbarara Municipality,
Mbarara District. Descriptive, cross sectional and quantitative research because it
involved the systematic collection of numerical information often under conditions of
considerable control and the analysis of that information was by use statistical
procedure.
3.3 Study setting and rationale
This study was conducted at Kakoba Health Centre III in Kakoba Division-Mbarara
Municipality, Mbarara District which is located in the central area of Mbarara District,
western Uganda. It is a public health centre established in 1940 offering general health
care with capacity of 13 beds. Kakoba Division is the major division in Mbarara
municipal, administrative, and commercial center of Mbarara District and the site of
the district headquarters, approximately 265 kilometer south west of Kampala,
Uganda’s largest capital city. Kakoba Health Centre III was considered because of it
being at the centre of Kakoba Division and it would capture the majority of the
Factors contributing to low immunization coverage
14
population from different parts of the division which the researcher wanted to obtained
data from.
3.4 Study population
The study considered parents/caretakers with children who attended Maternal Child
Health (MCH) at Kakoba Health Centre III in Kakoba Division during the time of the
study. This population was considered because it would give appropriate information
for accuracy of the study about immunization.
3.4.1 Sample size determination
A sample size of participants was calculated using Sloven Formula (1962), which state
as 𝑛 = (𝑁
1+𝑁(𝑒)2)
Where; n =desired sample size,
e= Degree of error acceptable at 5% = 0.05
N = population of desired characteristics which these population were
parents/caretakers of children who attended Maternal Child Health at Kakoba Health
Centre III in Kakoba Division. According to the Kakoba Health Centre III quarterly
data report from the immunization register book (January 2017), showed that 78
parents/caretakers with children attended the MCH for immunization schedules
therefore, N was 78.
Implied that, 95% was the confidence level and 5% was the acceptable limit of error
Factors contributing to low immunization coverage
15
𝑛 = (78
1 + 78 (0.052))
n = 65.3 participants (respondents)
Therefore, the sample size considered n = 65 participants (parents/caretakers with
children who attended Maternal Child Health at Kakoba Health Centre III in Kakoba
Division) were used in the study.
3.4.2 Sampling procedure
The researcher considered a convenient sampling method. In this sampling technique
participants were selected basing on their convenient accessibility and proximity to the
researcher. This sampling method was considered because the technique was faster,
easy and cost effective in recruiting the population with desired characteristics in the
study.
3.5 Eligibility criteria
3.5.1 Inclusion criteria
The study considered only parents/caretakers with children who attended Maternal
Child Health at Kakoba Health Centre III in Kakoba Division who were mentally
stabled and were able to participate voluntarily and freely consented during the time of
study.
Factors contributing to low immunization coverage
16
3.5.2 Exclusion criteria
The study excludes the parents/caretakers with children who attended Maternal Child
Health at Kakoba Health Centre III in Kakoba Division who did not consent to
participate in the study and those who were mentally ill or very sick.
3.6 Study variables
3.6.1 Dependent variable
Low immunization coverage in Kakoba division - Mbarara Municipality, Mbarara
District.
3.6.2 Independent variables
Health system related factors contributing to low immunization coverage in Kakoba
division - Mbarara Municipality, Mbarara District.
Community related factors contributing to low immunization coverage in Kakoba
Division - Mbarara Municipality, Mbarara District.
3.6.3 Confounding variables
The study considered the following confounding variables to support the study these
are; age, tribe, religion, marital status, education and occupation.
3.7 Research instrument
A self administered questionnaire with closed, open and structured questions was used.
The instrument had 3 sections; Section A was to collect biodata information, section
B was to access for health system related factors while section C was to access for
Factors contributing to low immunization coverage
17
community related factors contributing to low immunization coverage in Kakoba
Division - Mbarara Municipality, Mbarara District.
For reliability and validity, questionnaires were pretested on tenth of the sample size
outside the study area in Ishaka Division. The questionnaire was then revised and
content adjustments made accordingly for completeness, clarity, consistency and
uniformity.
3.8 Data collection procedures
The researcher got an introductory letter from the school of nursing which was used to
introduce herself. There after she introduced the purpose of the study as specifically for
research ethics to have them consent in order to allow researcher carry out the study in
the respective jurisdiction. The health centre in charge introduced the researcher to the
sampled participants so as to build confidence in the respondents.
3.8.1 Data management
The data collected were compiled, coded and kept the information between the
researcher and the study participants in order to provide consistence, accuracy and
privacy respectively. After data collection, questionnaires were checked daily, for
completeness, clarity, consistency and uniformity by the researcher.
3.8.2 Data analysis and presentation
Data was be analyzed by descriptive statistics using the computer software program
Microsoft office Excel 2007 version. The analyzed data were presented in the form of
tables, pie charts and bar graphs for interpretation and discussion.
Factors contributing to low immunization coverage
18
3.9 Ethical considerations
To ensure acceptability of the student researcher by the community, an introduction
letter was obtained from Kampala International University-Western Campus School of
Nursing science which was addressed to the Kakoba Division Council-Mbarara
Municipality, Mbarara District for permission to allow the researcher to conduct the
research study in the area. Participants were also asked to consent following the study
purpose explanation.
3.10 Limitations of the study
Some respondents were not cooperating with the researcher however, the researcher
would re-explain more to them about the reasons for collecting the data and those who
insisted, the researcher would leave them as per the research ethics and proceed to next
respondent.
3.11 Dissemination of results
The results from this study were disseminated in hard copy
i. Uganda Nurses and Midwives Examination Board as partial requirement of the
award of Diploma in Nursing Sciences
ii. Kampala International University-Western Campus School of Nursing
Sciences
iii. A copy was also kept by the main researcher
Factors contributing to low immunization coverage
19
CHAPTER FOUR: RESULTS
4.1 Introduction
This chapter consists of analyzed data which were established on factors contributing
to low immunization coverage in Kakoba Division - Mbarara Municipality, Mbarara
District. The results presented were based on Bio-demographic data, health system
related factors and community related factors contributing to low immunization
coverage in Kakoba Division - Mbarara Municipality, Mbarara District.
Only sixty five parents/caretakers with children who attended Maternal Child Health
at Kakoba Health Centre III in Kakoba Division and their responses were displayed
inform of tables, pie chart, graphs, frequency and percentages using the computer
software program Microsoft office Excel 2007 seen below.
4.2 Bio-demographic data of the participants
Table 1: Show bio-demographic data of the study participants
Bio-demographic Variables Frequency (n) Percentage/ (%)
Age range 15-24 years 12 18
25-34 years 30 46
35-44 years 18 28
45 years and above 5 8
Total 65 100
Tribe Banyankole 25 38
Bakiga 11 17
Baganda 13 20
Batoro 11 17
Others; Bahima,
Banyoro
5 8
Factors contributing to low immunization coverage
20
Total 65 100
Marital status Single 6 9
Married 29 45
Divorced 4 6
Cohabiting 23 35
Separated 2 3
Widowed 1 2
Total 65 100
Religion Catholics 15 23
Protestants 25 38
Seventh Day Adventist 10 15
Muslims 5 8
Other; Born again 10 15
Total 65 100
Education No formal education 3 5
Primary level 17 26
Secondary 38 58
Tertiary 7 11
Total 65 100
Occupation Housewives 39 60
Self employed 13 20
Civil servants 11 17
Other; businessperson 2 3
Total 65 100
Source: field data, 2017
Results in table 1 above showed that out of 65 participants, a majority 30 (46%) were
of age range 25-34 years and minority 5 (8%) were of 45 years and above.
The highest proportion 25 (38%) of the participants were Banyankole compared to the
lowest 5 (8%) who were other tribes like Bahima and Banyoro.
Majority 29 (45%) of the participants were married while only 1 (2%) widowed.
Most 25 (38%) of the participants were protestants and few 5 (8%) Muslims.
Factors contributing to low immunization coverage
21
From the same table 1, a large proportion 38 (58%) of the participants had secondary
level of education compared to a few 3 (5%) who had no formal education.
Most 39 (60%) of the participants were housewives while few 2 (3%) were of other
occupation like businessperson.
4.3 Health system related factors contributing to low Immunization coverage
Figure 1: A bar graph showing type of health facility near respondent’s home
n= 65
Source: field data, 2017
On the figure 1 above findings show that, majority 27 (42%) of the respondents have
health centre near their home while few 16 (25%) had private clinics near their home.
Table 2: Show participants’ nearest health facility distances from home
Variables Frequency (n) Percentage / (%)
Less than 3 km 19 29
3-6 km 42 65
6 km and above 4 6
Total 65 100
Source: field data, 2017
Table 2 results show that, out of 65 participants, most 42 (65%) nearest health facility
distances were 3-6 km from home while 4 (6%) were 6 km and above from home.
42%
34%
25%
Health centre
Hospital
Private clinic
0% 10% 20% 30% 40% 50%
Factors contributing to low immunization coverage
22
Table 3: Showing participants’ time spend waiting for immunization services at
the clinic
Variables Frequency (n) Percentage / (%)
Less than 1 hour 40 62
1-2 hours 15 23
2 hours and above 10 15
Total 65 100
Source: field data, 2017
Table 3 findings reveal that, out of 65 participants, majority 40 (62%) spend less than
1 hour waiting for immunization services at the clinic while minority 10 (15%) spend
2 hours and above.
Figure 2: A bar graph showing participant’s place where the last born child was
delivered
n=65
Source: field data, 2017
Figure 2 results show that out of 65 participants, majority 59 (91%) their last born children
were born from health facility and minority 6 (9%) were born from home.
9%
91%
0%
20%
40%
60%
80%
100%
Home Health facility
Per
cen
tag
e
Place of delivery
Factors contributing to low immunization coverage
23
Table 4: Showing responses of participants whose last born children were born
from health facility
Variables Responses Frequency (n) Percentage / (%)
Whether participants last
born child was
immunized
Yes 54 92
No 5 8
Total 59 100
How was the health
workers mood during the
time of immunization
Supportive and
friendly
29 49
Rude and abusive 8 14
Other; happy, caring 22 37
Total 59 100
Source: field data, 2017
Table 4 findings show that, out of 59 participants whose last born children were born
from a health facility, a majority 54 (92%) of the participants last born child was
immunized while few 5 (8%) their last born were not immunized.
Meanwhile from the same table 5 findings reveal that a large proportion 29 (49%) of
the participants said the health worker mood was supportive and friendly during the
time of immunization while few 8 (14%) said health worker was rude and abusive.
Figure 3: A pie chart showing numbers of time should a child be immunized
according to the Uganda immunization schedule n= 65
5% 12%
48%
35% Less than 3 times
4 times
5 times
6 times and above
Factors contributing to low immunization coverage
24
Source: field data, 2017
On figure 3 study findings reveal that out of 65 a majority 31 (48%) of the respondents
said a child should be immunized 5 times according to Uganda Immunization schedule
while few 3 (5%) said less than 3 times.
Table 5: Showing major factors hindering immunization in health facility
Variables Frequency (n) Percentage / (%)
Low knowledge level of health workers 4 6
Inadequate supply of vaccines 24 37
Lack of vaccine equipments 8 12
Others; poor mobilization, postponding
dates, few health workers
29 45
Total 65 100
Source: field data, 2017
Table 5 results show that out of 65 a majority 29 (45%) of the participants said others
factors like poor mobilization, postponding dates and few health workers while a few
4 (6%) sail low knowledge of the health workers.
4.4 Community related factors contributing to low immunization coverage
Table 6: Show community related factors contributing to low immunization
Variables Frequency,
(n)
Percentage /
(%)
Whether migration of families (change of
residence of families) affects utilization
of immunization services
Yes 36 55
No 22 34
Not sure 7 11
Factors contributing to low immunization coverage
25
Total 65 100
Use of mass media (radio, television and
news papers) is a strong tool for
promotion of immunization utilization of
immunization services
Yes 60 92
No 3 5
Not sure 2 3
Total 65 100
Fear of the side effects of the vaccine
because it make the child sick
Yes 56 86
No 8 12
No response 1 2
Total 65 100
Lack of awareness by care givers may
result to low immunization service
utilization
Yes 52 80
No 9 14
Not sure 4 6
Total 65 100
Whether bad weather conditions affect
the utilization of immunization services
Yes 37 57
No 13 20
Not sure 15 23
Total 65 100
Whether domestic violence may lead to
low immunization service utilization
Yes 25 38
No 11 17
Not sure 29 45
Total 65 100
Whether low level of education lead to
low immunization service up take
Yes 30 46.1
No 23 35.4
I don’t know 12 18.5
Total 65 100.0
Source: field data, 2017
Factors contributing to low immunization coverage
26
According to table 6 findings indicate that, out of 65 participants a majority 36 (55%)
said migration of families migration of families (change of residence of families)
affects utilization of immunization services while few 7 (11%) were not sure.
A large proportion 60 (92%) of the participants said the use of mass media (radio,
television and news papers) is a strong tool for promotion of immunization utilization
of immunization services while minority 2 (3%) were not sure.
A majority 56 (86%) of the participants said fear of the side effects of the vaccine
because it make the child sick compared to only 1 (2%) who had no response.
Majority 52 (80%) revealed that lack of awareness by care givers may result to low
immunization service utilization while only 4 (6%) were not sure of that.
Highest proportion 37 (57%) revealed that bad weather conditions affect utilization of
immunization services compared to 13 (20%) who said it does not affect.
Most 29 (45%) of the participants were not sure that domestic violence may lead to low
immunization service utilization while few 11 (17%) said it does not.
Majority 30 (46.1%) of the participants said low level of education lead to low
immunization service up take while minority 12 (18.5%) did not know.
Factors contributing to low immunization coverage
27
CHAPTER FIVE: DISCUSSION, CONCLUSION AND RECOMMENDATION
5.1 Introduction
The chapter deals with the discussion, conclusion, and recommendations of the study
results and implications to nursing practices about factors contributing to low
immunization coverage in Kakoba Division -Mbarara Municipality, Mbarara District.
5.2 Discussion of the findings
5.2.1 Bio-demographic data
In this study findings found out that out of 65 participants a majority 30 (46%) were of
age range 25-34 years compared to a minority 5 (8%) who were of 45 years and above.
This result implying that in Kakoba Division the reproductive age of the population is
in between 25-34 years.
The highest proportion 25 (38%) of the participants were Banyankole compared to the
lowest 5 (8%) who were other tribes like Bahima and Banyoro. This finding implies
that the study was conducted in Ankole land in western part of Uganda which consist
mainly with Banyankole tribe however other tribes were also found existing.
Majority 29 (45%) of the participants were married while only 1 (2%) widowed. The
married people in most cases are the one who care for the family.
Most 25 (38%) of the participants were protestants and few 5 (8%) Muslims, some
religion affects the health system programs when comes for services delivery however
Protestants religion has no know impacts on most health services utilization.
Factors contributing to low immunization coverage
28
Furthermore, a large proportion 38 (58%) of the participants had secondary level of
education compared to a few 3 (5%) who had no formal education. This findings show
at least most of the participants has attained level of education and thus support Rafiqul,
Mahfuzar & Mosfequr (2007), found that full immunization were attributed to the
demographic and socio-economic factors such as mother’s education, husband
occupation and family's monthly income.
In addition, most 39 (60%) of the participants were housewives while few 2 (3%) were
of other occupation like businessperson. This results was in line with Rafiqul, Mahfuzar
& Mosfequr (2007), found that full immunization were attributed to the demographic
and socio-economic factors such as mother’s education, husband occupation and
family’s monthly income.
5.2.2 Heath system related factors contributing to low immunization coverage
The results found that a majority 27 (42%) of the respondents had health centre near
their home while few 16 (25%) had private clinics near their home. The importance of
availability and accessibility of health facility in contributed to full immunization
coverage of the child, thus the findings support Rup (2008), study done in Assam
district, India found that families nearer to the health facility are more likely to
complete the immunization than those far from it.
In addition, the findings revealed that most 42 (65%) nearest health facility distances
were 3-6 km from home while 4 (6%) were 6 km and above from home. This was in
line with Rup (2008), showed that immunization status of the children was significantly
Factors contributing to low immunization coverage
29
higher where the distance of the health centre was less than 2 kilometer compared with
those residing in remote inaccessible areas with a distance of greater than 5 kilometer
to the health centre.
According to the study findings showed that majority 40 (62%) would spend less than
1 hour waiting for immunization services at the clinic while minority 10 (15%) spend
2 hours and above. In line with Abdulraheem et al. (2011), study done on reasons for
incomplete vaccination and factors for missed opportunities among rural Nigerian
children identified several reasons affecting childhood immunization such as parents’
objection, disagreement or concern about immunization safety (38.8%), long distance
walking (17.5%) and long waiting time at health facilities (15.2%) are the most
common reasons for incomplete vaccination/ immunization.
The study further found that majority 59 (91%) their last born children were born from health
facility and minority 6 (9%) were born from home. This concurs with Jagrati et al. (2008),
found that health institution born children were 7.5 times more likely to be vaccinated
and 4.4 times more likely to complete vaccination than home born children, which is
consistent with studies from other places.
The results further evidenced that out of 59 participants whose last born children were
born from a health facility a majority 54 (92%) of the participants last born child was
immunized while few 5 (8%) their last born were not immunized. This coincide with
Jagrati et al. (2008), that children born in health institution were (95%) times likely to
be fully vaccinated than those who born a home after adjustment for another variable.
Factors contributing to low immunization coverage
30
These mean most children who are born from home missed to be immunized for at birth
dose such as BCG and Polio 0.
The findings further reveal that a large proportion 29 (49%) of the participants said the
health worker mood was supportive and friendly during the time of immunization while
few 8 (14%) said health worker was rude and abusive. This partly agreed with a study
conducted in Urban Dili District of Ethiopia by Amin (2013), found that lack of access
to immunization services contributed to low immunization coverage as results of
negative health workers’ attitudes and the manner in which they treated mothers on
aspects of service organization and inadequate supply of vaccines.
Nevertheless, the study findings revealed that near to half 31 (48%) of the respondents
said a child should be immunized 5 times according to Uganda Immunization schedule
while few 3 (5%) said less than 3 times. These results were independent however; the
researcher had no clear clarification on the number of times children need to be fully
immunized in Uganda this is because there are numbers of immunization taking place
in the researcher’s country currently.
The findings showed that a majority 29 (45%) of the participants said there are others
factors like poor mobilization, postponding dates and few health workers which hinders
immunization services while a few 4 (6%) sail low knowledge of the health workers.
This findings support study conducted by Chinyama (2013), in Ethiopia Sesheke
District to determine the factors that had influenced low measles immunization
coverage found out that lack of health worker training, broken cold chain equipment,
inadequate supervision and shortage of staff had contributed to low immunization
Factors contributing to low immunization coverage
31
coverage in Sesheke district, despite the available effective vaccines. It also concurs
with Isaac (2010), found that most of the reasons (low vaccines supply, inadequate
knowledge of health workers and limited understanding of vaccinations among
caregivers linked to low vaccine uptake) with 57.1% pointed to be the obstacles to
access to immunization services and missed opportunities and the prominent amongst
the reasons being postponement until another time and other reasons given were,
mother being too busy, family problem including illness of mother, child-ill not brought
and time of immunization inconvenient.
5.2.3 Community related factors contributing to low immunization coverage
According to the findings indicated that a majority 36 (55%) said migration of families
migration of families (change of residence of families) affects utilization of
immunization services while few 7 (11%) were not sure. This was in line with Singh
(2007), reported that the coverage found only 39 (5.2%) of the eligible children had not
completed immunization schedule for BCG, DPT, Polio and Measles due to temporary
or permanent migration of the children or family to the village or went back to the
parents’ home or divorce or the child was adopted by relative.
A large proportion over half 60 (92%) of the participants said the use of mass media
(radio, television and news papers) is a strong tool for promotion of immunization
utilization of immunization services while minority 2 (3%) were not sure, it concurs
with Rafiqul, Mahfuzar & Mosfequr (2007), study finding that mothers who were
Factors contributing to low immunization coverage
32
exposed to any mass media were more likely to have their children immunized
compared to the mothers who were not exposed to any mass media.
The findings further indicated that majority 56 (86%) of the participants said fear of
the side effects of the vaccine because it make the child sick compared to only 1 (2%)
who had no response thus support Abdulraheem et al. (2011), children not fully
immunized due to illness or access reasons are likely to have started the immunization
schedule, up to 38.8% of the study parents/caretakers do not immunize their children
because they object, disagree or are concerned about immunization safety and side
effects.
According to the results showed that over 52 (80%) of the participants revealed that
lack of awareness by care givers may result to low immunization service utilization
while only 4 (6%) were not sure of that. Similar to Bisrat and Worku (2008), reasons
for defaulting reported that lack of awareness on the importance of vaccination
(15.2%) and vaccination site is far away (10.9%), not knowing whether to come back
for second and third vaccination (9.8%) are the main reason identified. Also concurs
with Abdul et al. (2010), found lack of information about schedule of session and non
holding of session according to schedules were commonly cited reasons for dropouts
and other reasons identified were no idea about doses, vaccinator did not inform about
subsequent doses, refusal by health professionals due to lost card.
Furthermore, study finding indicated that highest proportion 37 (57%) revealed that
bad weather conditions affect utilization of immunization services compared to 13
(20%) who said it does not affect. This implies that during rainy season
Factors contributing to low immunization coverage
33
mothers/caretakers turn up for immunization may be very low thus hindering the
participation for the immunization schedules.
Nevertheless, most 29 (45%) of the participants were not sure that domestic violence
may lead to low immunization service utilization while few 11 (17%) said it does not.
This result implies that most participants do not know whether domestic violence may
lead to low immunization service utilization. It concurs with Nath et al. (2007),
incomplete immunization and unimmunized status of the children were associated with
domestic violence and low socio-economic status which constrained the poor parents
to take their children for repeated visits to complete immunization schedules.
However, majority 30 (46.1%) of the participants said low level of education lead to
low immunization service up take while minority 12 (18.5%) did not know. It concurs
with Hemoke (2009), reported that the Parents/caretakers, who disagree or are
concerned about immunization, are significantly more likely to have low educational
level and to have children who are completely unimmunized.
5.3 Conclusion
According to the study findings, the cited health related factors contributing to low
immunization coverage in Kakoba Division were; factors like poor mobilization,
postponding dates and few health workers hinders immunization services, inadequate
vaccines and poor attitude of health workers like being rude and abusive which scared
away parents/caretakers.
Factors contributing to low immunization coverage
34
The community related factors includes; fear of the side effects of the vaccine because
it make the child sick, lack of awareness by care givers, bad weather conditions and
level of education lead to low immunization service up take.
5.4 Recommendations
The researcher would like to recommends the following basing on the study results;
The government should provide enough funds to facilitate immunization services in
hard to reach areas.
Increasing awareness campaigns through media advertisements about immunization
services as seen from the findings that majority 60 (92%) of the participants said the
use of mass media (radio, television and news papers) is a strong tool for promotion of
immunization utilization of immunization services, this could help even those who
were not sure to become aware about the services.
Continued health education should be provided to the parents/caretakers about the
importance and the effects of the failure to immunize a child.
5.6 Implications to nursing practice
Nurses need to improve on their characters when carrying out a procedure on a patient.
There high demand on health educating the parents/caretaker about post immunization
side effects.
Factors contributing to low immunization coverage
35
REFERENCES
Abdul, Q., Rukhsana, G., Azharul, I. K., Jasim, U., Meghla, I., Faiz A. (2010).
Programmatic Aspects of Dropouts in Child Vaccination in Bangladesh: Findings
from a Prospective Study. Asia-pasfic Journal of public health 2010;23(1):141-50.
Abdulraheem, I. S., Onajole, A. T., Jimoh, A. A. G., and Oladipo, A. R. (2011).
Reasons for incomplete vaccination and factors for missed opportunities among
rural Nigerian children. Journal of Public Health and Epidemiology Vol. 3(4), pp.
194-203, April 2011.
Amin, R. (2013). Reason for low immunization rates in urban Dili District of Ethiopia;
Global health science and practice: Abstract 2013.
Arooj, S., Ali, S., Baber, N., Abbasi, A., Ali, M. (2013). Socioeconomic factors
effecting polio vaccination in Parkistan Health 5 (5): pg. 892.
Babirye, J.N., Engebretsen, I.M.S., Makumbi, F., Fadnes, L.T., Wamani, H. (2012).
Timeliness of Childhood Vaccinations in Kampala Uganda: A Community-Based
Cross-Sectional Study. PLoS ONE 7(4): e35432. doi:10.1371/journal.pone.00354
32.
Bisrat, F., and Worku, A. (2008). Core group polio project baseline survey, in Ethiopia
2008. (1):8-10.
Clark, A., Sanderson, C. (2009). Timing of children’s vaccinations in 45 low-income
and middle-income countries: an analysis of survey data. Lancet 373: 1543–1549.
Factors contributing to low immunization coverage
36
Elizabeth, K., George, K., Raphael, N., Moses, E. (2015). Factors Influencing Low
Immunization Coverage among Children Between 12 - 23 Months in East Pokot,
Baringo County, Kenya. Int. J. Vaccines Vaccin. 1(2):00 012. DOI:10 .154
06/ijvv.2015.0 1.00012.
Hemoke, T., Amare, D., Mirkuze, W. (2009). Predictors of defaulting from completion
of childhood immunization in south ethopia-Acase control study. BMC Public
Health, 9: 150.
Isaac, B. (2010). Assessment of Expanded Programme on Immunization Service
Utilization in Sekyere West District of Ashanti Region, Ghana. A Dissertation
Submitted To The School Of Research And Graduate Studies, Kwame Nkrumah
University of Science And Technology, Kumasi – Ghana. Pg 70-78.
Jagrati, V.J., Caroline, D.S., Ilesh, V.J., Gunnar, B. (2008). Risk factors for incomplete
vaccination and missed opportunity for immunization in rural Mozambique. BMC
Public Health 2008; 8 (161).
Kenya Demographic and Health Survey (2008/2009): Maternal and Child Health,
pg.136-140.
Koskei Alfred, Simiyu Tabu, Paul Kisia Malalu, Irene Marete, Robert Too, Koskei K.
Peter, Constance Tenge (2014). Utilization of Essential Immunization Services
among Children under Five Years Old in Kacheliba Division, Pokot County,
Kenya. Science Journal of Public Health. Vol. 2, No. 6, 2014, pp. 617-623. doi:
10.11648/j.sjph.20140206.29.
Factors contributing to low immunization coverage
37
Ministry of Health (2009). Annual Health Development Report for Uganda,
2008/2009. Kampala, Ministry of Health.
Nath, B., Singh, V., Awasthi, S.,Bhushan, V., Kumar, V, & Singh, S.K. (2007).
Determinants of immunization coverage among 12-23 months old children in urban
slums of Lucknow district, India. Indian Journal Medicine, 61(11)598-606.
Omolo, R. O. (2007). Improving Immunization Coverage in Siaya District, Kenya,
2006: A case for innovative strategies. Science Journal of Public Health. Vol. 1,
No. 3, 2007, pp. 17-23. doi: 10.11648/j.sjph.20070206.29.
Rafiqul, I., Mahfuzar, R., & Mosfequr, R. (2007). Immunization Coverage Among
Slum Children: A Case Study of Rajshahi City Corporation. The Middle East
Journal of Family Medicine, 5 (6).
Rup, K.P., Manash, P.B., Jagadish, M. (2008). Factors Associated with Immunization
Coverage of Children in Assam, India: Over the First Year of Life. Journal of
Tropical Paediatrics 2008; 52 (4):249-52.
Singh, A. (2007). Record-based Immunization Coverage Assessment in Rural North
India. The Internet Journal of Third World Medicine, 4 (1) 1.
Tadesse, H., Deribew, A., Woldie, M. (2009). Predictors of defaulting from completion
of child immunization in south Ethiopia, May 2008 – A case control study. BMC
Public Health 2009;9 (150).
United Nations Children’s Education Fund (2010). State of world’s Children, 2010.
Available at: http://www.unicef: Accessed on 30th January 2017.
Factors contributing to low immunization coverage
38
World Health Organization (2012). Review of Global Immunization Vision and
Strategy 2006-2015, WHO Geneva.
World Health Organization and United Nations Children’s Education Funds (2008):
Review of National Immunization coverage 1980-2007. WHO/UNICEF Geneva.
Factors contributing to low immunization coverage
39
APPENDICES
Appendix I: Participant Consent Form
I am Kiconco Evas, a student of Kampala International University pursuing diploma
in nursing sciences. I am conducting a study of “factors contributing to low
immunization coverage in Kakoba Division-Mbarara Municipality, Mbarara District”.
I would like to ask you in order to obtain the information about the mentioned study
above. This survey is anonymous and confidential. Your participation in this study is
strictly voluntary and will in no way affect your relationship with the midwives. To
help protect confidentially, I will be making use of identification code only on the data
form and this will be handled by myself and will be stored away. If there is any unclear
information, you may ask for further clarification.
Declaration of the participant:
I have understood the purpose of the study and consent voluntarily to participate as a
subject in this study. I also understand that the information to be provided will be
confidential.
Participan
t
Signature or thumb print Date
………………………………………
….
……………………………
.
Factors contributing to low immunization coverage
40
Researche
r
Signature Date
………………………………………
….
……………………………
Appendix II: Questionnaire
Topic: Factors Contributing to Low Immunization Coverage in Kakoba Division-
Mbarara Municipality, Mbarara District.
INSTRUCTIONS:
Assured of confidentiality of information being collected
The respondents should tick the most appropriate.
SECTION A: BIO-DEMOGRAPHIC DATA
1. Age range (in year) of the respondent;
15-24
24-34
35-44
45 and above
2. Tribe;
Munyankole
Mukiga
Muganda
Factors contributing to low immunization coverage
41
Mutoro
Other specify ……………………………………………………..
3. Marital status;
Single
Married
Divorced
Cohabiting
Separated
Widowed
4. Religion;
Catholic
Protestant
Seventh Day Adventist (SDA)
Muslim
Other specify………….………………………………………………
5. Education;
No formal education
Primary level
Secondary level
Factors contributing to low immunization coverage
42
Tertiary level
6. Occupation;
House wife
Self employed
Civil servants
Other specify ………………………………………………………
SECTION B: HEALTH SYSTEM RELATED FACTORS CONTRIBUTING TO
LOW IMMUNIZATION COVERAGE
7. Which health facility is near to you?
Health center Hospital Private clinic
8. What is the nearest health facility distance from your home?
Less than 3 km 3-6 km 6 km and above
9. How much time do you spend waiting for immunization services from the clinic?
Less than 1 hour 1-2 hours 2 hours and above
10. Where did you deliver your last born child from?
Home Health facility
11. If from the health facility on question 10, was the child immunized?
Yes No
12. If yes to question 11, were you told about next immunization date appointment?
Yes No
Factors contributing to low immunization coverage
43
13. If yes to question 11, what was the health workers mood during the time of
immunization?
Was supportive and friendly Rude and abusive
Other specify………………………………………………………………
14. Does the health facility where you take your children for immunization have
enough vaccines for the major immunizable diseases?
Yes No I don’t know
15. How many times your children have to be immunized for complete dose according
to Uganda immunization schedule?
Less than 3 times 4 times
5 times 6 times and above
16. According to your understanding, what could be the major factor hindering
immunization coverage in the health system?
Low knowledge level of the health workers
Inadequate supply of vaccines
Lack of vaccines equipment for maintenance
Other specify ………………………………………………………...........
SECTION C: COMMUNITY RELATED FACTORS CONTRIBUTING TO
LOW IMMUNIZATION COVERAGE
Factors contributing to low immunization coverage
44
17. Does migration of families (change of residence of families) affects utilization of
immunization services?
Yes No Not sure
18. The use of mass media (radio, television and news papers) is a strong tool for
promotion of immunization utilization of immunization services.
Yes No Not sure
19. Fear of the side effects of the vaccine because it make the child sick
Yes No No response
20. Lack of awareness by care givers may result to low immunization service
utilization.
Yes No Not sure
21. Bad weather conditions affect the utilization of immunization services
Yes No Not sure
22. Domestic violence may lead to low immunization service utilization
Yes No Not sure
23. Does low level of education lead to low immunization service up take?
Yes No I don’t know
Thanks for your positive response
Factors contributing to low immunization coverage
46
Appendix IV: Map of Uganda showing location of Mbarara District
Top Related