Uptake and coverage of DPT3 vaccine among nationals and refugees in Nakivale Refugee Settlement, Isingiro District

Abstract

The uptake and coverage of vaccines are critical components of public health, particularly in refugee and rural settings where populations are vulnerable to infectious diseases. A study was conducted in a resource-limited setting in Nakivale Refugee Settlement in Isingiro District, Uganda, to understand the factors influencing DPT3 (diphtheria, pertussis and tetanus) vaccine uptake among nationals and refugees. Questionnaires were administered and data collected through structured interviews. The study included 399 respondents, mainly female (54.9%), aged 25-34 years (37.6%), mostly Christian (62.7%) with secondary education (45.1%), and nearly half employed (50.1%). Socio-demographic factors significantly associated with population group were sex, age, marital status, education, occupation, religion, and information from religious leaders (p < 0.05). Vaccine coverage showed disparities. Overall DPT3 uptake was 64.4%, below the national target of 90%, with nationals having higher uptake (72.7%) than refugees (62.4%). Participants aged 36-45 years were 71% less likely to receive DPT3 compared to those aged 18-25 (AOR = 0.29, p = 0.004). Married (AOR = 0.19, p < 0.001) and divorced (AOR = 0.03, p < 0.001) participants were significantly less likely to vaccinate than singles. Catholics and other minority religions were 96-97% less likely to uptake DPT3 compared to Anglicans (p < 0.001). Caregivers living 5-10 km and >10 km from health facilities were about 9.7 and 8.8 times more likely to vaccinate than those within 5 km (p < 0.001). Knowledge of polio vaccination increased the likelihood of DPT3 uptake by 11.86 times (p < 0.001), whereas knowledge about TB vaccination was associated with 92% lower likelihood (p < 0.001). Mass media as a source of information increased vaccine uptake likelihood by 8.26 times (p = 0.001), while family members as a source of information reduced uptake by 64% (p = 0.009). Belief that vaccination is disseminated by gender and that vaccines protect against diseases increased uptake by 5.18 and 4.73 times, respectively (p < 0.01). Among refugees, similar patterns were observed about knowledge of polio vaccination (AOR = 5.12, TB vaccination knowledge reducing uptake (AOPR = 0.25), and mass media promoting uptake (AOR = 4.74). Among nationals, knowledge of polio increased DPT3 uptake about 18.42 times (p = 0.008); belief that multiple doses harm children reduced uptake by 93% (p = 0.025); belief engendered by vaccine dissemination increased uptake by 9.84 times (p = 0.044). These results highlight how socio-demographic, knowledge, and belief factors influence DPT3 uptake, with differences between nationals and refugees and areas of targeted intervention.