Childhood immunization coverage and factors associated with low immunization coverage in Hargeisa City, Somaliland.

Abstract

Background: Immunization is only rated second to clean water for interventions that reduce morbidity and mortality following infectious diseases worldwide. In Somalia, routine child immunization coverage among one-year-old children for Diptheria, Tetanus and Pertussis (DTP3) was estimated to be 42% with only 30.5 % of the children in Somaliland receiving the required three doses of DTP by their first birthday. The percentage of children receiving Diphtheria, Tetanus and Pertussis vaccine (DTP) was used as an indicator of how well countries are providing routine immunization services. In Sub Saharan Africa, Somaliland included, the targets for immunization uptake and coverage have not been met, and the main underlying factors in Hargeisa have yet to be described. Objective: To determine the childhood immunization coverage and describe the factors associated with low immunization coverage among children aged 12-23 months in Hargeisa City, Somaliland. Methods: This was a mixed methods community based cross-sectional study employing both quantitative and qualitative data collection methods, conducted between December 2019 to February 2020 in Hargeisa city, Somaliland. Data was collected from 834 caregivers with children aged 12–23 months old. Descriptive statistics was performed, and results of continuous variables were presented in terms of means, standard deviations while Categorical variables were presented in terms of frequency and proportions. Logistic regression analysis was performed to identify factors associated with ―low immunization coverage‖ at bivariate and multivariate levels. A total of 8 key informants (KIs) were interviewed. Data from KIIS was analyzed using a thematic approach, informed by the socioecological model. Results: Of the 804 children, 626 (78.1%), had received full immunization at the time of the study; 697/804 (86.7 %) of children had received up to DPT3 immunization and 46/804(5.7%) had not received any immunization. The factors associated with low immunization included; a caregiver who did not know the number of immunization sessions a child should get p <0.001 (95% AOR 9.24, CI: 4.11, 19.67,), a child who had never visited a health facility previously P= 0.02 (95% AOR 0.46, CI: 0.28, 0.76) a child where caregiver did not have a vaccination card p <0.001 (95% AOR 0.29, CI: 0.18, 0.49) , self-employed care givers, p<0.037 (95% AOR 0.57, CI:0.34,0.97), a caregiver who did not receive postnatal care after delivery, p<0.001 (95% AOR 3.35, CI: 2.17, 5.13), a caregiver who had refused child to be immunized previously, p<0.038 (95% AOR 1.93, CI: 1.04, 3.61), and the residence distance of more than 5km from the immunizing health facility, p<0.001(95% AOR, 1.97CI: 1.15,3.41).Qualitative findings revealed that limited knowledge about immunization and benefits, busy schedule, negative religious beliefs, lack of support from family members, vaccine stock outs and long waiting time were key barriers to immunization completion. Conclusion: This study established that one in every four children over 12 months of age has not completed immunization schedule in Hargeisa, while one in every 20 children has never been immunized at all. The factors contributing to this include: a caregiver who did not know the number of immunization sessions a child should get; a child who had never visited a health facility previously; a caregiver who did not receive postnatal care after delivery; and the residence distance of more than 5km from the immunizing health facility. Recommendations: Caregiver education and community engagement on immunization should be incorporated in all mother and child health centers. The ministry of health in collaboration with its partners should also reinstitute outreach immunization services in Hargeisa city, that will help reduce burden of long distances, and competing responsibilities. health workers should be more vigilant in assessing immunization status of all children who came to the mother and child health centers so that they can get the missed.