Reasons for defaulting from childhood immunization program: a qualitative study from Hadiya zone, Southern Ethiopia

BMC Public Health, Dec 2016

Background Reduction of mortality and morbidity from vaccine-preventable diseases in developing countries involves successfully implementing strategies that ensure high coverage and minimize drop-outs and missed opportunities. Achieving maximum coverage, however, has been a challenge due to many reasons, including high rates of defaulters from the program. The objective of this study was to explore the reasons behind defaulting from the immunization program. Methods A qualitative study was conducted in two districts of Hadiya zone, Southern Ethiopia between November 2014 and April 2015. A total of twenty-six in-depth interviews were held with mothers of defaulted children aged 6-11months old and key informants from the communities, health centers, and health offices. Observations and review of relevant documents were also conducted. Thematic analysis was used to analyze the data. Results In this study, the main reason for defaulting from the immunization was inadequate counseling of mothers that led to a lack of information about vaccination schedules and service arrangements, including in unusual circumstances such as after missed appointment, loss of vaccination card and when the health workers failed to make home visits. Provider-client relationships are poor with mothers reporting fear of mistreatment and lack of cooperation from service providers. Contrary to what health workers and managers believe, mothers were knowledgeable about the benefits of vaccination. The high workload on mothers compounded by the lack of support from male partners was also found to contribute to the problem. Health system factors that contributed to the problem were poorly arranged and coordinated immunization services, vaccine and supplies stock outs, and lack of viable defaulter tracking systems in the health facilities. Conclusions The main reasons for defaulting from the immunization program are poor counseling of mothers, unsupportive provider-client relationships, poor immunization service arrangements, and lack of systems for tracking defaulters. Efforts to reduce defaulter rates from the immunization program need to focus on improving counseling of mothers and strengthening the health systems, especially with regards to service arrangements and tracking of defaulters.

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Reasons for defaulting from childhood immunization program: a qualitative study from Hadiya zone, Southern Ethiopia

Zewdie et al. BMC Public Health Reasons for defaulting from childhood immunization program: a qualitative study from Hadiya zone, Southern Ethiopia Asamnew Zewdie Mekitew Letebo Tinsae Mekonnen Background: Reduction of mortality and morbidity from vaccine-preventable diseases in developing countries involves successfully implementing strategies that ensure high coverage and minimize drop-outs and missed opportunities. Achieving maximum coverage, however, has been a challenge due to many reasons, including high rates of defaulters from the program. The objective of this study was to explore the reasons behind defaulting from the immunization program. Methods: A qualitative study was conducted in two districts of Hadiya zone, Southern Ethiopia between November 2014 and April 2015. A total of twenty-six in-depth interviews were held with mothers of defaulted children aged 6-11months old and key informants from the communities, health centers, and health offices. Observations and review of relevant documents were also conducted. Thematic analysis was used to analyze the data. Results: In this study, the main reason for defaulting from the immunization was inadequate counseling of mothers that led to a lack of information about vaccination schedules and service arrangements, including in unusual circumstances such as after missed appointment, loss of vaccination card and when the health workers failed to make home visits. Provider-client relationships are poor with mothers reporting fear of mistreatment and lack of cooperation from service providers. Contrary to what health workers and managers believe, mothers were knowledgeable about the benefits of vaccination. The high workload on mothers compounded by the lack of support from male partners was also found to contribute to the problem. Health system factors that contributed to the problem were poorly arranged and coordinated immunization services, vaccine and supplies stock outs, and lack of viable defaulter tracking systems in the health facilities. Conclusions: The main reasons for defaulting from the immunization program are poor counseling of mothers, unsupportive provider-client relationships, poor immunization service arrangements, and lack of systems for tracking defaulters. Efforts to reduce defaulter rates from the immunization program need to focus on improving counseling of mothers and strengthening the health systems, especially with regards to service arrangements and tracking of defaulters. Childhood immunization; Defaulter; Ethiopia; Health systems; Tracking - Background Reduction of mortality and morbidities from vaccinepreventable diseases in developing countries involves successfully implementing strategies that ensure high coverage and minimize drop-outs and missed opportunities [1]. Reports by the World Health Organization (WHO) and United Nations Children’s Fund (UNICEF) showed that an estimated two to three million deaths in all age groups are averted each year as a result of vaccinations against diphtheria, tetanus, pertussis, and measles [2]. In general, covering as many diseases as possible, ensuring vaccine potency and achieving high immunization coverage are essential requirements for childhood immunization to have the desired public health impact of decreasing mortality and morbidity, and possibly eliminating some of the vaccine-preventable diseases [1]. These conditions, however, are not usually met in many settings, especially resource-poor countries in sub-Saharan Africa, including Ethiopia [3–5]. As a result, a large number of children in these countries remain at risk for acquiring infectious diseases that can cause serious illness, disability or death [5]. Increasing immunization coverage involves two key elements: increasing access to immunization services and reducing dropout rates. While health systems in developing countries seem to improve access to immunization services steadily, the overall change in coverage remains suboptimal. In Ethiopia, for example, the administrative coverage of immunization showed significant improvement from as low as 42% in the 1990s to more than 88% in 2013, and the country has increased the number of diseases covered by the program from six in 1980 to ten in 2013 [Ethiopian national immunization coverage survey. 2012. Ethiopian Health and Nutrition Research Institute (EHNRI), Unpublished]. Ethiopia, however, falls short of achieving the target 95% of coverage for childhood immunization despite tremendous efforts by the government and its bilateral and multilateral partners. In analyzing the challenges to achieving high coverage in Ethiopia, it is evident that over the years, there have been virtually no achievements in reducing dropout rates. The 2011 Ethiopian Health and Demographic Survey (EDHS) report showed a first to the third dose dropout rate for Diphtheria – Pertussis - Tetanus (DPT) vaccine of 43% [3], indicating the lack of any improvements since 2005 when a similar survey fo (...truncated)


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Asamnew Zewdie, Mekitew Letebo, Tinsae Mekonnen. Reasons for defaulting from childhood immunization program: a qualitative study from Hadiya zone, Southern Ethiopia, BMC Public Health, 2016, pp. 1240, 16, DOI: 10.1186/s12889-016-3904-1