CHILDHOOD IMMUNIZATION COVERAGE AND FACTORS ASSOCIATED WITH PARTIAL VACCINATION IN JUBA - SOUTH SUDAN

Abstract

Background: Immunization currently averts an estimated 2-3 million deaths every year; however, an estimated 19.5 million infants worldwide are still missing out on basic vaccines. Childhood immunization was institutionalized in South Sudan after signing of the comprehensive peace agreement (CPA) in 2005 and is still a country priority. According to South Sudan demographic and health survey 2010, the estimated coverage of DPT3 was 80%, however this had dropped to 45% in 2016. The current immunisation coverage status particularly in Juba which is relatively stable is not known because of the continuous conflict in the country, population displacement and a breakdown in the public health system. Objective: To assess childhood immunization coverage and the factors associated with partial vaccination among children aged 12-24 months in Juba- South Sudan. Methodology: This was a community based cross-sectional survey with both quantitative and qualitative components. The 624 children 12-24 months who fulfilled the inclusion criteria were enrolled after obtaining consent from the caretakers. The child health card was examined for the immunization status and a standardized questionnaire was administered to capture the demographic data of the children, their caretakers and the factors associated with partial vaccination such as poor road network, long distance to health facility, insecurity and lack of information. Twelve focus group discussions with selected caretakers and 6 key informant interviews with health workers and community leaders were carried out. Results: Of the 624 children 499/624 [(79.9%) (95% CI 77-83%)] had received full vaccination at the time of the study while 104/624 [(16.3%) (95% CI 14-20%)] of the children had received partial vaccination, and 21/624 [(3.8%) (95% CI 2-5%)] had not receive any vaccination. The factors associated with partial vaccination were mother not had any education [(OR 3.09) (CI xiii

1.65-5.76) P value 0.001], having being a resident of IDP camp [(OR 3.84), (95%CI1.78,8.29) and P value 0.001], having no knowledge of all vaccines [(aOR 7.13) (95% CI 1.20-14.33) and P vale 0.001], being in polygamy marriage [(aOR 2.61) (95%CI 1.44-4.75) and P value 0.002], and having being a female headed household [(aOR 2.30) (95% CI 1.20-4.39) and P value 0.012]. Qualitative finding showed that negative attitude of health workers, lack of partner support, and insecurity were among the factors leading to partial vaccination. Conclusion: The childhood immunization coverage in Juba City was 79.9%. The factors associated with partial vaccination were having being female headed household, being a resident of IDP camp, being in polygamy marriage and not knowing all the vaccines. Men involvement in vaccination process, mass health education and policy regarding use of multi-dose vaccines should be considered to scale up vaccination in Juba City.