Missed Opportunities for Measles Vaccination among Children Aged 9-59 Months During 2017 Measles Supplementary Immunization Activity in Lilongwe District, Malawi.

Abstract

Background: In Lilongwe District, and for the duration between 2013 and 2017, the measles immunization coverage had stagnated between 65% and 71%. In June 2017, a measles Supplementary Immunization Activity (SIA) was implemented to boost this coverage. The vaccination coverage attained following this SIA was not known because a post vaccination coverage survey was not conducted. This study was conducted to assess the missed opportunities for measles vaccination (MOV) among eligible children during the June 2017 measles SIA in Lilongwe District, Malawi. Methods: A cross-sectional survey using mixed methods was conducted. Caretakers of children who were eligible for the 2017 measles SIA were sampled from 24 households from each of the 20 villages sampled from 4 of the 22 constituencies in Lilongwe District. A child was taken to have been vaccinated if the caretaker gave a true description of when and where the child was vaccinated. Key Informant Interviews (KIIs) were conducted with a sample of planners and health care workers who were involved in the implementation of the 2017 measles SIA. Modified Poisson regression was used to examine the association between MOV and child, caretaker and household related factors. A thematic analysis of transcripts from KIIs was also conducted to explore health system factors associated with MOV. Results: A total of 476 children and their caretakers were surveyed. Their median age was 52.0 months [95% CI 51.0 – 55.9]. Overall, 41.2% [95% CI 36.8 – 45.7] of the children included in the study were not vaccinated during the SIA. Low birth order, non-vaccination during routine, low level of education among caretakers, unemployment of the household head, younger household head, provision of insufficient information by health authorities about the 2017 measles SIA were significantly associated with MOV among eligible children during the 2017 measles SIA. Qualitative findings revealed strong beliefs against vaccinations, wrong perceptions about the SIA (from caretakers‘ perspectives), poor delivery of health education, logistical and human resource challenges as factors associated with non-vaccination. Conclusion: The magnitude of MOV among eligible children was very high due to individual and health care related factors. There is need to educate caretakers on the importance of vaccinating every child irrespective of birth order; efforts are needed to optimize routine immunization program and community mobilization should be intensified as part of SIA activities.