Immunization coverage and risk factors for high dropout in Rakai district.

Abstract

INTRODUCTION: Worldwide over 27 million children under 1 year remain overlooked by routine immunization services. In Uganda, only 71% of children under-1 year are fully immunized. In Rakai district coverage rates are lower than national averages and the DPT 1-III dropout rate is high at 18% compared to the national target of <10%. Reasons for the high dropout in Rakai are not well documented thus this study. OBJECTIVES: The general objective was to determine the current immunization coverage and the risk factors for drop out in Rakai district. The specific objectives were; • To determine the current immunization coverage amon 12-23 months old children • To determine the dropout rate among 12-23 months old children • To identify risk factors for immunization dropout in rakai district • To identify missed opportunities for immunization in Rakai district and, • To compare the coverage rate and dropout rate obtained from district immunization records to that obtained from a community survey.

METHODS: This was a cross sectional study among caretakers of children 12-23 months of age in Rakai district. Multi stage cluster sampling was done. A total of 528 children were sampled from 66 clusters. A semi structured questionnaire and record review checklists were used to collect the data. Quantitative data was analyzed using Epi info computer package.

RESULTS: Of the 528 children in the study, 38.3% were dropouts, 56.8% were fully immunized, 4.16% were not immunized at all while only 0.75% were on schedule. The crude immunization coverage for BCG, DPT 1, DPT III, OPV III and measles dropout rates were 20% and 29.1% respectively. The significant predictors for dropout at multivariate analysis included young age of child (12-18 years) OR: 2.16 (95%C1:1.49-3.13), occurrence of missed opportunities to immunize OR:2.51 (95%C1:1.45-4.33), obtaining knowledge on immunization from health workers OR: o.67 (95%C1:0.47-0.98) and knowledge on sick child immunization OR:0.85(95%C1:0.74-0.96). CONCLUSION: Immunization coverage is fairly high in Rakai district. The dropout rates are higher than what is considered acceptable and the risk factors for dropout are late age of immunisation, occurance of missed opportunity for immunisation and misconception that sick children should not be immunised. With exception of measles, coverage by survey is higher that administrative coverage in Rakai district. RECOMMENDATION: In order to increase coverage and reduce the dropout rates, the ministry of health should support the Rakai district health team to conduct a health education campaign to provide caretakers with accurate information on immunization and its importance. In addition, screening of all children visiting health facilitates should be done to avoid missed opportunities.