factors contributing to low immunization coverage …

FACTORS CONTRIBUTING TO LOW IMMUNIZATION COVERAGE IN

KAKOBA DIVISION - MBARARA MUNICIPALITY,

MBARARA DISTRICT

A RESEARCH REPORT SUBMITED TO

UGANDA NURSES AND MIDWIVES EXAMINATIONS BOARD

IN PARTIAL FULFILLMENT OF THE REQUIREMENTS

FOR THE AWARD OF THE DIPLOMA IN NURSING SCIENCES

BY

KICONCO EVAS

N15/U011/DNE/016

APRIL, 2017

Factors contributing to low immunization coverage

i

ABSTRACT

Immunization is one of the major public health interventions to avoid childhood

illnesses and mortality. Globally, there are 30 million children who are not routinely

immunized every year and 1.5 million children under five years of age die each year

from vaccine preventable diseases.

The purpose of the study was to establish factors contributing to low immunization

coverage in Kakoba Division - Mbarara Municipality, Mbarara District. Cross-

sectional and descriptive study which employed a quantitative approach of data

collection was used and the study was conducted at Kakoba Health Centre III in

Kakoba Division. The researcher used convenient sampling method to select samples.

Only 65 parents/caretakers with children who attended Maternal Child Health at

Kakoba Health Centre III in Kakoba Division. The findings showed that a majority 29

(45%) of the participants said there are others factors like poor mobilization,

postponding dates and few health workers which hinders immunization services while

a few 4 (6%) sail low knowledge of the health workers. majority 56 (86%) of the

participants said fear of the side effects of the vaccine because it make the child sick

compared to only 1 (2%) who had no response, 52 (80%) of the participants revealed

that lack of awareness by care givers may result to low immunization service utilization

while only 4 (6%) were not sure of that. Factors like poor mobilization, postponding

dates, fear of side effects of the vaccine and lack of awareness by caregivers contribute

to low immunization coverage.


ii

COPYRIGHT

Copyright©2017 by Kiconco Evas


iii

AUTHORIZATION

Unpublished research report submitted to the Kampala International University-

Western Campus, School of Nursing and deposited in the library, is open for

inspection, but is to be used with due regard to the right of the author. The author and

Kampala International University Western Campus, School of Nursing can grant

privilege of loan or photocopy to accredited borrowers provided credit is given in

subsequent written or published work.

Author: Kiconco Evas

Signature………………..…………….. Date……………….…….…………….

School of Nursing of Kampala International University-Western Campus

P.O.Box 71, Bushenyi, Uganda

Supervisor: Mr. Namara Gordon

Signature …….….…………..……... Date ………….………..………………

Dean School of Nursing, Kampala International University-Western Campus

Ms. Kabanyoro Annet

Signature ……………………………… Date ………………………………………


iv

DEDICATION

I dedicate this research work to my guardian Mr and Mrs. Kyomuhendo Gad, Mr

Gordon, Mr. Arinaitwe Peter and Ainomugisha Judex who through their tireless

effort supported me throughout my studies.

This research work will be dedicated to my almighty God who has enabled me to reach

this far to him be the glory and to my beloved parents and siblings for their wonderful

guidance and support.

Finally this book is dedicated to the entire classmates and friends of Kampala

International University.


v

ACKNOWLEDGEMENT

It is with assistance of various people that this study was successfully completed.

Special thanks go to guardian Mr. and Mrs. Kyomuhendo Gad, Mr. Arinaitwe

Peter and Mr. Ainomugisha Judex for their prayer and financial support throughout

my studies.

My acknowledgement is further extended to Mr. Namara Gordon who patiently

supervised the study and corrected every error to ensure perfection.

Finally, sincere appreciation to the secretary, Ahimbisibwe Jovitah who patiently

typed this research report with correction of errors making it standard work.


vi

TABLE OF CONTENTS

ABSTRACT ................................................................................................................... i

COPYRIGHT ................................................................................................................ ii

AUTHORIZATION ..................................................................................................... iii

DEDICATION ............................................................................................................. iv

ACKNOWLEDGEMENT ............................................................................................ v

TABLE OF CONTENTS ............................................................................................. vi

LIST OF FIGURES ...................................................................................................... x

LIST OF TABLES ....................................................................................................... xi

LIST OF ABBREVIATIONS ..................................................................................... xii

OPERATIONAL DEFINITIONS .............................................................................. xiii

CHAPTER ONE: INTRODUCTION ........................................................................... 1

1.0 Introduction ............................................................................................................. 1

1.1 Background of the study ......................................................................................... 1

1.2 Problem statement ................................................................................................... 3

1.3 Purpose of the study ................................................................................................ 3

1.4 Study objectives ...................................................................................................... 4

1.4.1 Broad objective .................................................................................................... 4

1.4.2 Specific objectives ............................................................................................... 4

1.5 Research questions .................................................................................................. 4

1.6 Justification of the study ......................................................................................... 4

1.6.1 Nursing Practice ................................................................................................... 5

1.6.2 Nursing Education ............................................................................................... 5


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1.6.3 Nursing Research ................................................................................................. 5

CHAPTER TWO: LITERATURE REVIEW ............................................................... 6

2.0 Introduction ............................................................................................................. 6

2.1 Heath system related factors contributing to low immunization coverage ............. 6

2.2 Community related factors contributing to low immunization coverage ............... 9

3.3 Summary of the literature review ......................................................................... 11

CHAPTER THREE: METHODOLOGY ................................................................... 12

3.1 Introduction ........................................................................................................... 12

3.2 Study design and rationale .................................................................................... 13

3.3 Study setting and rationale .................................................................................... 13

3.4 Study population ................................................................................................... 14

3.4.1 Sample size determination ................................................................................. 14

3.4.2 Sampling procedure ........................................................................................... 15

3.5 Eligibility criteria .................................................................................................. 15

3.5.1 Inclusion criteria ................................................................................................ 15

3.5.2 Exclusion criteria ............................................................................................... 16

3.6 Study variables ...................................................................................................... 16

3.6.1 Dependent variable ............................................................................................ 16

3.6.2 Independent variables ........................................................................................ 16

3.6.3 Confounding variables ....................................................................................... 16

3.7 Research instrument .............................................................................................. 16

3.8 Data collection procedures .................................................................................... 17

3.8.1 Data management............................................................................................... 17


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3.8.2 Data analysis and presentation ........................................................................... 17

3.9 Ethical considerations ........................................................................................... 18

3.10 Limitations of the study ...................................................................................... 18

3.11 Dissemination of results ...................................................................................... 18

CHAPTER FOUR: RESULTS ................................................................................... 19

4.1 Introduction ........................................................................................................... 19

4.2 Bio-demographic data of the participants ............................................................. 19

4.3 Health system related factors contributing to low Immunization coverage ......... 21

4.4 Community related factors contributing to low immunization coverage ............. 24

CHAPTER FIVE: DISCUSSION, CONCLUSION AND RECOMMENDATION .. 27

5.1 Introduction ........................................................................................................... 27

5.2 Discussion of the findings ..................................................................................... 27

5.2.1 Bio-demographic data ........................................................................................ 27

5.2.2 Heath system related factors contributing to low immunization coverage ........ 28

5.2.3 Community related factors contributing to low immunization coverage .......... 31

5.3 Conclusion ............................................................................................................ 33

5.4 Recommendations ................................................................................................. 34

5.6 Implications to nursing practice ............................................................................ 34

REFERENCES ........................................................................................................... 35

APPENDICES ............................................................................................................ 39

Appendix I: Participant Consent Form ....................................................................... 39

Appendix II: Questionnaire ......................................................................................... 40

Appendix III: Letter of Authorization ......................................................................... 45


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Appendix IV: Map of Uganda showing location of Mbarara District ........................ 46

Appendix V: Map of Mbarara District showing location of Kakoba Division ........... 47


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LIST OF FIGURES

Figure 1: A bar graph showing type of health facility near respondent’s home ......... 21

Figure 2: A bar graph showing participant’s place where the last born child was

delivered ...................................................................................................................... 22

Figure 3: A pie chart showing numbers of time should a child be immunized according

to the Uganda immunization schedule ........................................................................ 23


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LIST OF TABLES

Table 1: Show bio-demographic data of the study participants .................................. 19

Table 2: Show participants’ nearest health facility distances from home .................. 21

Table 3: Showing participants’ time spend waiting for immunization services at the

clinic ............................................................................................................................ 22

Table 4: Showing responses of participants whose last born children were born from

health facility .............................................................................................................. 23

Table 5: Showing major factors hindering immunization in health facility ............... 24

Table 6: Show community related factors contributing to low immunization ........... 24


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LIST OF ABBREVIATIONS

AMREF African Medical and Research Foundation

BCG Bacillus Calmette Guerin

DPT Diphtheria Pertussis Tetanus

EPI Expanded Programme on Immunization

MCH Maternal Child Health

MOH Ministry of Health

OPV Oral Polio Vaccine

UNEPI Uganda National Expanded Programme on Immunization

UNICEF United Nations Children’s Fund

WHO World Health Organization


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OPERATIONAL DEFINITIONS

Immunity; is the ability for the body to resist and fight infections that is resistance

possessed by the body to infectious diseases, foreign tissues non toxic substances and

other antigen.

Immunization; is the process or act of creating immunity by artificial means, that is,

by introducing modified attenuated vaccine.

Immunize; means conferring immunity to an individual.

Vaccination; refers to the introduction of vaccine into the body to provide immunity

to a specific disease.

Vaccine; a suspicion of killed or attenuated organisms (viruses, bacteria etc)

administered for protection or treatment of infectious diseases.


1

CHAPTER ONE: INTRODUCTION

1.0 Introduction

This chapter dealt with background of the study, problem statement, and purpose of

study, study objectives, research questions and justification for the study.

1.1 Background of the study

Immunization is one of the major public health interventions to avoid childhood

illnesses and mortality. Without the same, more than five million children would die

each year and many more fall ill (Arooj, 2015). The re-emerging vaccine preventable

diseases like measles and polio calls for the need for new approach, if the country is to

achieve Millennium Development Goals (MDGs) for universal access to health care

and reduction in child mortality (WHO, 2012).

About 23.2 million children remained unvaccinated of which 15.3 million (65%) are

from eight countries in Africa (Elizabeth et al., 2015). African Medical and Research

Foundation (AMREF) reported that low immunization coverage exposes large

proportion of children to infectious diseases and disease outbreaks mainly come from

pockets of low immunization areas such as remote places or islands, urban slums, or in

certain population groups such as ethnic and racial minorities (Koskei et al., 2014).

According to the WHO/UNICEF (2008), Nigeria accounts for more than 50% of new

polio cases globally largely associated with socio-cultural factors which limit

utilization of immunization services. In Kenya, the Expanded Program of

Immunization (EPI) which changed to Division of Vaccine and Immunization (DVI)


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has been in operation since 1980s largely follows WHO guidelines for vaccinating

children however; the national coverage was 59% for urban children and even lowers

coverage in rural areas in 2008/2009 report (Kenya Demographic and Health Survey,

2009). This is far from WHO standards of 90% immunization coverage for urban areas

and 80% for rural areas, WHO reported that complete immunization coverage in Kenya

currently stands at 71% (Kenya Demographic and Health Survey, 2009).

According to the Ugandan National Expanded Programme on Immunisation (UNEPI),

a child is considered fully vaccinated if it has received one dose of BCG (given at birth),

4 doses of polio vaccines (given at birth, 6 weeks, 10 weeks and 14 weeks), 3 doses of

Diphtheria Pertussis and Tetanus (DPT), Hepatitis B, Haemophilus influenza type b

vaccine (given at 6 weeks, 10 weeks and 14 weeks), and 1 dose of the measles vaccine

(given at 9 months) (Clark, 2008). Despite the overall, less than half (45.6%) of all

children in Uganda received all vaccines within the recommended time ranges (Babirye

et al., 2012)

In Western Uganda particularly Mbarara district has one of the most health promotion

measures for children to ensure that their immunization status is up to date, but this still

lags behind in many communities especially Kokoba Division, for children who are

immunized are drastically dropping compared to the partially immunized (UNEPI,

2010). The study was to establish factors contributing to low immunization coverage

in Kakoba Division - Mbarara Municipality, Mbarara District.


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1.2 Problem Statement

Globally, there are 30 million children who are not routinely immunized every year

and 1.5 million children under five years of age die each year from vaccine preventable

diseases namely measles, whooping cough (Pertussis), Hemophilus influenza type B

(HIB) and Tetanus (WHO, 2012). The mortality rates for under-fives has significantly

remained high in African countries with rates above 180 deaths per 1000 live births

compared to global average of 72 due to poor immunization utilization (Elizabeth et

al., 2015).

In Uganda the goal of immunizing children against the six childhood immunizable

diseases responsible for child mortality and morbidity targeted by UNEPI is indeed a

noble one however, it is not an easy task to achieve (UNEPI, 2010). According to MOH

(2009), immunization report revealed that 63% of children less than 1 year had not

completed the immunization schedule by the end of the year 2008 in Uganda.

Although educational and community based programs have been developed aiming at

improving the immunization coverage to the National target, the immunization

coverage in most parts of Mbarara like Kakoba Division in particular has remained low

MOH (2009). Little or none of the information about factors contributing to low

immunization coverage in Kakoba Division is known, hence a reason for this study.

1.3 Purpose of the study

The purpose of the study was to establish factors contributing to low immunization

coverage in Kakoba Division - Mbarara Municipality, Mbarara District.


4

1.4 Study objectives

1.4.1 Broad objective

To establish factors contributing to low immunization coverage in Kakoba Division -

Mbarara Municipality, Mbarara District.

1.4.2 Specific objectives

i. To assess health system related factors contributing to low immunization

coverage in Kakoba division - Mbarara Municipality, Mbarara District.

ii. To identify community related factors contributing to low immunization


1.5 Research questions

i. What are the health systems related factors contributing to low immunization

coverage in Kakoba division - Mbarara Municipality, Mbarara District?

ii. What community related factors contributing to low immunization coverage in

Kakoba Division - Mbarara Municipality, Mbarara District?

1.6 Justification of the study

Immunization is a lifesaving and cost-effective medical intervention which reduces

childhood morbidity and mortality from diseases (Arooj, 2015). When a person is

immunized against the preventable diseases, he/she is protected against them but the

chances of acquiring the infection are likely to decrease very much if only a small

proportion of new born children receive the vaccine (WHO, 2012).


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1.6.1 Nursing Practice

This study was designed to come up with information that would help stakeholders

determine the contributing factors to low immunization coverage in Kakoba Division -

Mbarara Municipality, Mbarara District so as to lay strategies to reverse the trend.

1.6.2 Nursing Education

On the other hand the study would contribute to the existing knowledge on

immunization that would influence the health workers and community members on

social marketing and utilization of government programs.

1.6.3 Nursing Research

Similarly the generated information may be utilized by nursing researchers as part of

the literature and some of the recommendations serving as a basis for further research.


6

CHAPTER TWO: LITERATURE REVIEW

2.0 Introduction

In this chapter, the researcher has focused on the information available from other

research reports, journals, textbooks, internet and resourceful persons about factors

contributing to low immunization coverage in relation to the study objectives.

2.1 Heath system related factors contributing to low immunization coverage

Health system determinants of receipt of immunization completion are complex and

interwoven. A study done on reasons for incomplete vaccination and factors for missed

opportunities among rural Nigerian children identified several reasons affecting

childhood immunization such as parents’ objection, disagreement or concern about

immunization safety (38.8%), long distance walking (17.5%) and long waiting time at

health facilities (15.2%) are the most common reasons for incomplete vaccination/

immunization (Abdulraheem et al., 2011). This showed that parental belief about

immunization safety is the major reason for incomplete immunizations among Nigerian

children (Abdulraheem et al., 2011).

Nevertheless, Health institution born children were 7.5 times more likely to be

vaccinated and 4.4 times more likely to complete vaccination than home born children,

which is consistent with studies from other places (Jagrati et al., 2008). In addition,

Children born in health institution were (95%) times likely to be fully vaccinated than

those who born a home after adjustment for another variable. This mean most children


7

who are born from home missed to be immunized for at birth dose such as BCG and

Polio 0 (Jagrati et al., 2008).

A study done by Koskei et al. (2014), showed that all respondents had heard about the

importance of immunization, they were found to have poor health seeking behavior. In

addition, 35.76% reported that they always attended medical appointment for

her/himself and for the child while 49.70% of the respondents admitted failing to attend

clinic appointment because they did not understand the explanation well due to

language barriers between providers and their clients. Most of them understood pokot

language (mother tongue) and Kiswahili (Koskei et al., 2014).

Furthermore, a study conducted in Urban Dili District of Ethiopia by Amin (2013),

found that lack of access to immunization services contributed to low immunization

coverage as results of negative health workers’ attitudes and the manner in which they

treated mothers on aspects of service organization and inadequate supply of vaccines.

Health facility is another factor which contributed to full immunization of the child.

Different studies showed the importance of availability and accessibility of health

facility in immunization coverage (Rup, 2008). Families nearer to the health facility

are more likely to complete the immunization than those far from it. Cross sectional

study done in India, Assam district showed that immunization status of the children

was significantly higher where the distance of the health centre was less than 2

kilometer compared with those residing in remote inaccessible areas with a distance of

greater than 5 kilometer to the health centre (Rup, 2008).


8

According to Omolo (2007), study reported that the emerging challenge is how to

change the behaviour of the health workers since the incinerators are not being used by

some health workers for various reasons, it is clear that health workers’ attitudes can

significantly influence mothers’ attendance. Therefore, improving staff attitudes and

greater community mobilization will be the key approaches to increasing the

immunization coverage in Siaya District, Kenya (Omolo, 2007).

Another study conducted by Chinyama (2013), in Ethiopia Sesheke District to

determine the factors that had influenced low measles immunization coverage found

out that lack of health worker training, broken cold chain equipment, inadequate

supervision and shortage of staff had contributed to low immunization coverage in

Sesheke district, despite the available effective vaccines.

Nevertheless, a study conducted on the assessment of Expanded Programme on

Immunization Service Utilization in Sekyere West District of Ashanti Region, Ghana

revealed that most of the reasons (low vaccines supply, inadequate knowledge of health

workers and limited understanding of vaccinations among caregivers linked to low

vaccine uptake) with 57.1% pointed to be the obstacles to access to immunization

services and missed opportunities and the prominent amongst the reasons being

postponement until another time and other reasons given were, mother being too busy,

family problem including illness of mother, child-ill not brought and time of

immunization inconvenient (Isaac, 2010).


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2.2 Community related factors contributing to low immunization coverage

The Parents/caretakers, who disagree or are concerned about immunization, are

significantly more likely to have low educational level and to have children who are

completely unimmunized (Hemoke, 2009). Children not fully immunized due to illness

or access reasons are likely to have started the immunization schedule, up to 38.8% of

the study parents/caretakers do not immunize their children because they object,

disagree or are concerned about immunization safety and side effects (Abdulraheem et

al., 2011).

According to Abdulraheem et al. (2011), identified the reasons for partial immunization

and factors that contributed to missed opportunities for immunization in children less

than one year of age in a rural area in Awe, Nasarawa State, Nigeria that less than half

(37.2%) of the mothers completed routine immunization schedules for their children

by the age of 9 months because of parents objection, disagreement or concern about

immunization safety (38.8%), long distance walking (17.5) and long waiting time at

the health facility (15.2%), (Repeated material could be deleted).

A study on child immunization coverage in 700 households in the slum areas of

Rajshahi City Corporation Bangladesh, it was found that full immunization was higher

(92.3%) in the higher ages (24+ months) than the age 12-23 months (89.5%), the high

coverage in the higher ages of 24+ months was attributed to demographic and socio-

economic factors such as mother's education, husband occupation and family’s

monthly income (Rafiqul, Mahfuzar & Mosfequr, 2007).


10

In addition, the study found that the place of delivery and exposure to mass media had

highly significant effects on child immunization. In other words, the mothers who were

exposed to any mass media were more likely to have their children immunized

compared to the mothers who were not exposed to any mass media (Rafiqul, Mahfuzar

& Mosfequr, 2007).

In a study by Nath et al. (2007), on determinants of immunization coverage in 510

children aged 12-23 months in urban slums of Lucknow district, India, it was reported

that only 44% of the children were fully immunized. Incomplete immunization and

unimmunized status of the children were associated with domestic violence and low

socio-economic status which constrained the poor parents to take their children for

repeated visits to complete immunization schedules (Nath et al., 2007).

In a survey to describe the immunization coverage in a rural part of north India with a

sample of 747 children, it was found out that 94.8 % (708 of 747) eligible children were

immunized and had received the required doses of the primary schedule vaccines

(Singh 2007). The coverage found only 39 (5.2%) of the eligible children had not

completed immunization schedule for BCG, DPT, Polio and Measles due to temporary

or permanent migration of the children or family to the village or went back to the

parents’ home or divorce or the child was adopted by relative (Singh 2007).

In Bangladesh the study showed that programmatic factors are linked to drop out from

immunization. In the same study found lack of information about schedule of session

and non holding of session according to schedules were commonly cited reasons for

dropouts and other reasons identified were no idea about doses, vaccinator did not


11

inform about subsequent doses, refusal by health professionals due to lost card or

vaccine exhausted (Abdul et al., 2010).

Knowledge on the benefit of immunization is also an important reason for the

defaulting and non immunization. For instance in southern of Ethiopia Wanago Woreda

mothers who had poor knowledge about the benefit of vaccines were 6 times more

likely to have defaulted than mothers who had good knowledge, also mothers who had

negative perception towards health institution support were 2.3 times more likely to

have defaulter children than mothers with positive attitude (Tadesse, 2009).

A base line survey done in Ethiopia in 2008 by core group polio project indicated that,

a reason for not immunization were, health workers did not come and give vaccine at

the village (28.2%) followed by lack of awareness about vaccination (25.9%), absence

of health facility in the locality (19.1%), vaccination is of no use (7.7%), and

vaccination hurts children (5.0%) (Bisrat and Worku, 2008). Also reasons for

defaulting are reported absenteeism of vaccinators (23.8%), vaccination time is

inconvenient (18.7%), lack of awareness on importance of vaccination (15.2%) and

vaccination site is far away (10.9%), not knowing whether to come back for second

and third vaccination (9.8%) are the main reason identified (Bisrat and Worku, 2008).

3.3 Summary of the literature review

Several reasons affecting childhood immunization such as parents’ objection,

disagreement or concern about immunization safety, long distance walking, long

waiting time at health facilities are the most common reasons for incomplete


12

vaccination/ immunization. Health institution born children were 7.5 times more likely

to be vaccinated and 4.4 times more likely to complete vaccination than home born

children. Lack of access to immunization services contributed to low immunization

coverage as results of negative health workers’ attitudes. Socio-economic factors such

as mother's education, husband occupation and family’s monthly income. Lack of

awareness on the importance of immunization.

CHAPTER THREE: METHODOLOGY

3.1 Introduction

This chapter presents the research methodology which is the detailed procedure of the

study. The chapter comprises of the following sections: study design and rationale,


13

study setting and rationale, population, sample size determination, sampling procedure,

inclusion criteria, study variables, research instruments, data collection procedures,

data management, data analysis and presentation, ethical considerations, limitations of

the study and dissemination of results.

3.2 Study design and rationale

The cross-sectional and descriptive study was conducted which employed a

quantitative approach of data collection to provided information about factors

contributing to low immunization coverage in Kakoba Division-Mbarara Municipality,

Mbarara District. Descriptive, cross sectional and quantitative research because it

involved the systematic collection of numerical information often under conditions of

considerable control and the analysis of that information was by use statistical

procedure.

3.3 Study setting and rationale

This study was conducted at Kakoba Health Centre III in Kakoba Division-Mbarara

Municipality, Mbarara District which is located in the central area of Mbarara District,

western Uganda. It is a public health centre established in 1940 offering general health

care with capacity of 13 beds. Kakoba Division is the major division in Mbarara

municipal, administrative, and commercial center of Mbarara District and the site of

the district headquarters, approximately 265 kilometer south west of Kampala,

Uganda’s largest capital city. Kakoba Health Centre III was considered because of it

being at the centre of Kakoba Division and it would capture the majority of the


14

population from different parts of the division which the researcher wanted to obtained

data from.

3.4 Study population

The study considered parents/caretakers with children who attended Maternal Child

Health (MCH) at Kakoba Health Centre III in Kakoba Division during the time of the

study. This population was considered because it would give appropriate information

for accuracy of the study about immunization.

3.4.1 Sample size determination

A sample size of participants was calculated using Sloven Formula (1962), which state

as 𝑛 = (𝑁

1+𝑁(𝑒)2)

Where; n =desired sample size,

e= Degree of error acceptable at 5% = 0.05

N = population of desired characteristics which these population were

parents/caretakers of children who attended Maternal Child Health at Kakoba Health

Centre III in Kakoba Division. According to the Kakoba Health Centre III quarterly

data report from the immunization register book (January 2017), showed that 78

parents/caretakers with children attended the MCH for immunization schedules

therefore, N was 78.

Implied that, 95% was the confidence level and 5% was the acceptable limit of error


15

𝑛 = (78

1 + 78 (0.052))

n = 65.3 participants (respondents)

Therefore, the sample size considered n = 65 participants (parents/caretakers with

children who attended Maternal Child Health at Kakoba Health Centre III in Kakoba

Division) were used in the study.

3.4.2 Sampling procedure

The researcher considered a convenient sampling method. In this sampling technique

participants were selected basing on their convenient accessibility and proximity to the

researcher. This sampling method was considered because the technique was faster,

easy and cost effective in recruiting the population with desired characteristics in the

study.

3.5 Eligibility criteria

3.5.1 Inclusion criteria

The study considered only parents/caretakers with children who attended Maternal

Child Health at Kakoba Health Centre III in Kakoba Division who were mentally

stabled and were able to participate voluntarily and freely consented during the time of

study.


16

3.5.2 Exclusion criteria

The study excludes the parents/caretakers with children who attended Maternal Child

Health at Kakoba Health Centre III in Kakoba Division who did not consent to

participate in the study and those who were mentally ill or very sick.

3.6 Study variables

3.6.1 Dependent variable

Low immunization coverage in Kakoba division - Mbarara Municipality, Mbarara

District.

3.6.2 Independent variables

Health system related factors contributing to low immunization coverage in Kakoba

division - Mbarara Municipality, Mbarara District.

Community related factors contributing to low immunization coverage in Kakoba

Division - Mbarara Municipality, Mbarara District.

3.6.3 Confounding variables

The study considered the following confounding variables to support the study these

are; age, tribe, religion, marital status, education and occupation.

3.7 Research instrument

A self administered questionnaire with closed, open and structured questions was used.

The instrument had 3 sections; Section A was to collect biodata information, section

B was to access for health system related factors while section C was to access for


17

community related factors contributing to low immunization coverage in Kakoba

Division - Mbarara Municipality, Mbarara District.

For reliability and validity, questionnaires were pretested on tenth of the sample size

outside the study area in Ishaka Division. The questionnaire was then revised and

content adjustments made accordingly for completeness, clarity, consistency and

uniformity.

3.8 Data collection procedures

The researcher got an introductory letter from the school of nursing which was used to

introduce herself. There after she introduced the purpose of the study as specifically for

research ethics to have them consent in order to allow researcher carry out the study in

the respective jurisdiction. The health centre in charge introduced the researcher to the

sampled participants so as to build confidence in the respondents.

3.8.1 Data management

The data collected were compiled, coded and kept the information between the

researcher and the study participants in order to provide consistence, accuracy and

privacy respectively. After data collection, questionnaires were checked daily, for

completeness, clarity, consistency and uniformity by the researcher.

3.8.2 Data analysis and presentation

Data was be analyzed by descriptive statistics using the computer software program

Microsoft office Excel 2007 version. The analyzed data were presented in the form of

tables, pie charts and bar graphs for interpretation and discussion.


18

3.9 Ethical considerations

To ensure acceptability of the student researcher by the community, an introduction

letter was obtained from Kampala International University-Western Campus School of

Nursing science which was addressed to the Kakoba Division Council-Mbarara

Municipality, Mbarara District for permission to allow the researcher to conduct the

research study in the area. Participants were also asked to consent following the study

purpose explanation.

3.10 Limitations of the study

Some respondents were not cooperating with the researcher however, the researcher

would re-explain more to them about the reasons for collecting the data and those who

insisted, the researcher would leave them as per the research ethics and proceed to next

respondent.

3.11 Dissemination of results

The results from this study were disseminated in hard copy

i. Uganda Nurses and Midwives Examination Board as partial requirement of the

award of Diploma in Nursing Sciences

ii. Kampala International University-Western Campus School of Nursing

Sciences

iii. A copy was also kept by the main researcher


19

CHAPTER FOUR: RESULTS

4.1 Introduction

This chapter consists of analyzed data which were established on factors contributing

to low immunization coverage in Kakoba Division - Mbarara Municipality, Mbarara

District. The results presented were based on Bio-demographic data, health system

related factors and community related factors contributing to low immunization


Only sixty five parents/caretakers with children who attended Maternal Child Health

at Kakoba Health Centre III in Kakoba Division and their responses were displayed

inform of tables, pie chart, graphs, frequency and percentages using the computer

software program Microsoft office Excel 2007 seen below.

4.2 Bio-demographic data of the participants

Table 1: Show bio-demographic data of the study participants

Bio-demographic Variables Frequency (n) Percentage/ (%)

Age range 15-24 years 12 18

25-34 years 30 46

35-44 years 18 28

45 years and above 5 8

Total 65 100

Tribe Banyankole 25 38

Bakiga 11 17

Baganda 13 20

Batoro 11 17

Others; Bahima,

Banyoro

5 8


20

Total 65 100

Marital status Single 6 9

Married 29 45

Divorced 4 6

Cohabiting 23 35

Separated 2 3

Widowed 1 2

Total 65 100

Religion Catholics 15 23

Protestants 25 38

Seventh Day Adventist 10 15

Muslims 5 8

Other; Born again 10 15

Total 65 100

Education No formal education 3 5

Primary level 17 26

Secondary 38 58

Tertiary 7 11

Total 65 100

Occupation Housewives 39 60

Self employed 13 20

Civil servants 11 17

Other; businessperson 2 3

Total 65 100

Source: field data, 2017

Results in table 1 above showed that out of 65 participants, a majority 30 (46%) were

of age range 25-34 years and minority 5 (8%) were of 45 years and above.

The highest proportion 25 (38%) of the participants were Banyankole compared to the

lowest 5 (8%) who were other tribes like Bahima and Banyoro.

Majority 29 (45%) of the participants were married while only 1 (2%) widowed.

Most 25 (38%) of the participants were protestants and few 5 (8%) Muslims.


21

From the same table 1, a large proportion 38 (58%) of the participants had secondary

level of education compared to a few 3 (5%) who had no formal education.

Most 39 (60%) of the participants were housewives while few 2 (3%) were of other

occupation like businessperson.

4.3 Health system related factors contributing to low Immunization coverage

Figure 1: A bar graph showing type of health facility near respondent’s home

n= 65


On the figure 1 above findings show that, majority 27 (42%) of the respondents have

health centre near their home while few 16 (25%) had private clinics near their home.

Table 2: Show participants’ nearest health facility distances from home

Variables Frequency (n) Percentage / (%)

Less than 3 km 19 29

3-6 km 42 65

6 km and above 4 6

Total 65 100


Table 2 results show that, out of 65 participants, most 42 (65%) nearest health facility

distances were 3-6 km from home while 4 (6%) were 6 km and above from home.

42%

34%

25%

Health centre

Hospital

Private clinic

0% 10% 20% 30% 40% 50%


22

Table 3: Showing participants’ time spend waiting for immunization services at

the clinic


Less than 1 hour 40 62

1-2 hours 15 23

2 hours and above 10 15

Total 65 100


Table 3 findings reveal that, out of 65 participants, majority 40 (62%) spend less than

1 hour waiting for immunization services at the clinic while minority 10 (15%) spend

2 hours and above.

Figure 2: A bar graph showing participant’s place where the last born child was

delivered

n=65


Figure 2 results show that out of 65 participants, majority 59 (91%) their last born children

were born from health facility and minority 6 (9%) were born from home.

9%

91%

0%

20%

40%

60%

80%

100%

Home Health facility

Per

cen

tag

e

Place of delivery


23

Table 4: Showing responses of participants whose last born children were born

from health facility

Variables Responses Frequency (n) Percentage / (%)

Whether participants last

born child was

immunized

Yes 54 92

No 5 8

Total 59 100

How was the health

workers mood during the

time of immunization

Supportive and

friendly

29 49

Rude and abusive 8 14

Other; happy, caring 22 37

Total 59 100


Table 4 findings show that, out of 59 participants whose last born children were born

from a health facility, a majority 54 (92%) of the participants last born child was

immunized while few 5 (8%) their last born were not immunized.

Meanwhile from the same table 5 findings reveal that a large proportion 29 (49%) of

the participants said the health worker mood was supportive and friendly during the

time of immunization while few 8 (14%) said health worker was rude and abusive.

Figure 3: A pie chart showing numbers of time should a child be immunized

according to the Uganda immunization schedule n= 65

5% 12%

48%

35% Less than 3 times

4 times

5 times

6 times and above


24


On figure 3 study findings reveal that out of 65 a majority 31 (48%) of the respondents

said a child should be immunized 5 times according to Uganda Immunization schedule

while few 3 (5%) said less than 3 times.

Table 5: Showing major factors hindering immunization in health facility


Low knowledge level of health workers 4 6

Inadequate supply of vaccines 24 37

Lack of vaccine equipments 8 12

Others; poor mobilization, postponding

dates, few health workers

29 45

Total 65 100


Table 5 results show that out of 65 a majority 29 (45%) of the participants said others

factors like poor mobilization, postponding dates and few health workers while a few

4 (6%) sail low knowledge of the health workers.

4.4 Community related factors contributing to low immunization coverage

Table 6: Show community related factors contributing to low immunization

Variables Frequency,

(n)

Percentage /

(%)

Whether migration of families (change of

residence of families) affects utilization

of immunization services

Yes 36 55

No 22 34

Not sure 7 11


25

Total 65 100

Use of mass media (radio, television and

news papers) is a strong tool for

promotion of immunization utilization of

immunization services

Yes 60 92

No 3 5

Not sure 2 3

Total 65 100

Fear of the side effects of the vaccine

because it make the child sick

Yes 56 86

No 8 12

No response 1 2

Total 65 100

Lack of awareness by care givers may

result to low immunization service

utilization

Yes 52 80

No 9 14

Not sure 4 6

Total 65 100

Whether bad weather conditions affect

the utilization of immunization services

Yes 37 57

No 13 20

Not sure 15 23

Total 65 100

Whether domestic violence may lead to

low immunization service utilization

Yes 25 38

No 11 17

Not sure 29 45

Total 65 100

Whether low level of education lead to

low immunization service up take

Yes 30 46.1

No 23 35.4

I don’t know 12 18.5

Total 65 100.0



26

According to table 6 findings indicate that, out of 65 participants a majority 36 (55%)

said migration of families migration of families (change of residence of families)

affects utilization of immunization services while few 7 (11%) were not sure.

A large proportion 60 (92%) of the participants said the use of mass media (radio,

television and news papers) is a strong tool for promotion of immunization utilization

of immunization services while minority 2 (3%) were not sure.

A majority 56 (86%) of the participants said fear of the side effects of the vaccine

because it make the child sick compared to only 1 (2%) who had no response.

Majority 52 (80%) revealed that lack of awareness by care givers may result to low

immunization service utilization while only 4 (6%) were not sure of that.

Highest proportion 37 (57%) revealed that bad weather conditions affect utilization of

immunization services compared to 13 (20%) who said it does not affect.

Most 29 (45%) of the participants were not sure that domestic violence may lead to low

immunization service utilization while few 11 (17%) said it does not.

Majority 30 (46.1%) of the participants said low level of education lead to low

immunization service up take while minority 12 (18.5%) did not know.


27

CHAPTER FIVE: DISCUSSION, CONCLUSION AND RECOMMENDATION

5.1 Introduction

The chapter deals with the discussion, conclusion, and recommendations of the study

results and implications to nursing practices about factors contributing to low

immunization coverage in Kakoba Division -Mbarara Municipality, Mbarara District.

5.2 Discussion of the findings

5.2.1 Bio-demographic data

In this study findings found out that out of 65 participants a majority 30 (46%) were of

age range 25-34 years compared to a minority 5 (8%) who were of 45 years and above.

This result implying that in Kakoba Division the reproductive age of the population is

in between 25-34 years.

The highest proportion 25 (38%) of the participants were Banyankole compared to the

lowest 5 (8%) who were other tribes like Bahima and Banyoro. This finding implies

that the study was conducted in Ankole land in western part of Uganda which consist

mainly with Banyankole tribe however other tribes were also found existing.

Majority 29 (45%) of the participants were married while only 1 (2%) widowed. The

married people in most cases are the one who care for the family.

Most 25 (38%) of the participants were protestants and few 5 (8%) Muslims, some

religion affects the health system programs when comes for services delivery however

Protestants religion has no know impacts on most health services utilization.


28

Furthermore, a large proportion 38 (58%) of the participants had secondary level of

education compared to a few 3 (5%) who had no formal education. This findings show

at least most of the participants has attained level of education and thus support Rafiqul,

Mahfuzar & Mosfequr (2007), found that full immunization were attributed to the

demographic and socio-economic factors such as mother’s education, husband

occupation and family's monthly income.

In addition, most 39 (60%) of the participants were housewives while few 2 (3%) were

of other occupation like businessperson. This results was in line with Rafiqul, Mahfuzar

& Mosfequr (2007), found that full immunization were attributed to the demographic

and socio-economic factors such as mother’s education, husband occupation and

family’s monthly income.

5.2.2 Heath system related factors contributing to low immunization coverage

The results found that a majority 27 (42%) of the respondents had health centre near

their home while few 16 (25%) had private clinics near their home. The importance of

availability and accessibility of health facility in contributed to full immunization

coverage of the child, thus the findings support Rup (2008), study done in Assam

district, India found that families nearer to the health facility are more likely to

complete the immunization than those far from it.

In addition, the findings revealed that most 42 (65%) nearest health facility distances

were 3-6 km from home while 4 (6%) were 6 km and above from home. This was in

line with Rup (2008), showed that immunization status of the children was significantly


29

higher where the distance of the health centre was less than 2 kilometer compared with

those residing in remote inaccessible areas with a distance of greater than 5 kilometer

to the health centre.

According to the study findings showed that majority 40 (62%) would spend less than

1 hour waiting for immunization services at the clinic while minority 10 (15%) spend

2 hours and above. In line with Abdulraheem et al. (2011), study done on reasons for

incomplete vaccination and factors for missed opportunities among rural Nigerian

children identified several reasons affecting childhood immunization such as parents’

objection, disagreement or concern about immunization safety (38.8%), long distance

walking (17.5%) and long waiting time at health facilities (15.2%) are the most

common reasons for incomplete vaccination/ immunization.

The study further found that majority 59 (91%) their last born children were born from health

facility and minority 6 (9%) were born from home. This concurs with Jagrati et al. (2008),

found that health institution born children were 7.5 times more likely to be vaccinated

and 4.4 times more likely to complete vaccination than home born children, which is

consistent with studies from other places.

The results further evidenced that out of 59 participants whose last born children were

born from a health facility a majority 54 (92%) of the participants last born child was

immunized while few 5 (8%) their last born were not immunized. This coincide with

Jagrati et al. (2008), that children born in health institution were (95%) times likely to

be fully vaccinated than those who born a home after adjustment for another variable.


30

These mean most children who are born from home missed to be immunized for at birth

dose such as BCG and Polio 0.

The findings further reveal that a large proportion 29 (49%) of the participants said the

health worker mood was supportive and friendly during the time of immunization while

few 8 (14%) said health worker was rude and abusive. This partly agreed with a study

conducted in Urban Dili District of Ethiopia by Amin (2013), found that lack of access

to immunization services contributed to low immunization coverage as results of

negative health workers’ attitudes and the manner in which they treated mothers on

aspects of service organization and inadequate supply of vaccines.

Nevertheless, the study findings revealed that near to half 31 (48%) of the respondents

said a child should be immunized 5 times according to Uganda Immunization schedule

while few 3 (5%) said less than 3 times. These results were independent however; the

researcher had no clear clarification on the number of times children need to be fully

immunized in Uganda this is because there are numbers of immunization taking place

in the researcher’s country currently.

The findings showed that a majority 29 (45%) of the participants said there are others

factors like poor mobilization, postponding dates and few health workers which hinders

immunization services while a few 4 (6%) sail low knowledge of the health workers.

This findings support study conducted by Chinyama (2013), in Ethiopia Sesheke

District to determine the factors that had influenced low measles immunization

coverage found out that lack of health worker training, broken cold chain equipment,

inadequate supervision and shortage of staff had contributed to low immunization


31

coverage in Sesheke district, despite the available effective vaccines. It also concurs

with Isaac (2010), found that most of the reasons (low vaccines supply, inadequate

knowledge of health workers and limited understanding of vaccinations among

caregivers linked to low vaccine uptake) with 57.1% pointed to be the obstacles to

access to immunization services and missed opportunities and the prominent amongst

the reasons being postponement until another time and other reasons given were,

mother being too busy, family problem including illness of mother, child-ill not brought

and time of immunization inconvenient.

5.2.3 Community related factors contributing to low immunization coverage

According to the findings indicated that a majority 36 (55%) said migration of families

migration of families (change of residence of families) affects utilization of

immunization services while few 7 (11%) were not sure. This was in line with Singh

(2007), reported that the coverage found only 39 (5.2%) of the eligible children had not

completed immunization schedule for BCG, DPT, Polio and Measles due to temporary

or permanent migration of the children or family to the village or went back to the

parents’ home or divorce or the child was adopted by relative.

A large proportion over half 60 (92%) of the participants said the use of mass media

(radio, television and news papers) is a strong tool for promotion of immunization

utilization of immunization services while minority 2 (3%) were not sure, it concurs

with Rafiqul, Mahfuzar & Mosfequr (2007), study finding that mothers who were


32

exposed to any mass media were more likely to have their children immunized

compared to the mothers who were not exposed to any mass media.

The findings further indicated that majority 56 (86%) of the participants said fear of

the side effects of the vaccine because it make the child sick compared to only 1 (2%)

who had no response thus support Abdulraheem et al. (2011), children not fully

immunized due to illness or access reasons are likely to have started the immunization

schedule, up to 38.8% of the study parents/caretakers do not immunize their children

because they object, disagree or are concerned about immunization safety and side

effects.

According to the results showed that over 52 (80%) of the participants revealed that

lack of awareness by care givers may result to low immunization service utilization

while only 4 (6%) were not sure of that. Similar to Bisrat and Worku (2008), reasons

for defaulting reported that lack of awareness on the importance of vaccination

(15.2%) and vaccination site is far away (10.9%), not knowing whether to come back

for second and third vaccination (9.8%) are the main reason identified. Also concurs

with Abdul et al. (2010), found lack of information about schedule of session and non

holding of session according to schedules were commonly cited reasons for dropouts

and other reasons identified were no idea about doses, vaccinator did not inform about

subsequent doses, refusal by health professionals due to lost card.

Furthermore, study finding indicated that highest proportion 37 (57%) revealed that

bad weather conditions affect utilization of immunization services compared to 13

(20%) who said it does not affect. This implies that during rainy season


33

mothers/caretakers turn up for immunization may be very low thus hindering the

participation for the immunization schedules.

Nevertheless, most 29 (45%) of the participants were not sure that domestic violence

may lead to low immunization service utilization while few 11 (17%) said it does not.

This result implies that most participants do not know whether domestic violence may

lead to low immunization service utilization. It concurs with Nath et al. (2007),

incomplete immunization and unimmunized status of the children were associated with

domestic violence and low socio-economic status which constrained the poor parents

to take their children for repeated visits to complete immunization schedules.

However, majority 30 (46.1%) of the participants said low level of education lead to

low immunization service up take while minority 12 (18.5%) did not know. It concurs

with Hemoke (2009), reported that the Parents/caretakers, who disagree or are

concerned about immunization, are significantly more likely to have low educational

level and to have children who are completely unimmunized.

5.3 Conclusion

According to the study findings, the cited health related factors contributing to low

immunization coverage in Kakoba Division were; factors like poor mobilization,

postponding dates and few health workers hinders immunization services, inadequate

vaccines and poor attitude of health workers like being rude and abusive which scared

away parents/caretakers.


34

The community related factors includes; fear of the side effects of the vaccine because

it make the child sick, lack of awareness by care givers, bad weather conditions and

level of education lead to low immunization service up take.

5.4 Recommendations

The researcher would like to recommends the following basing on the study results;

The government should provide enough funds to facilitate immunization services in

hard to reach areas.

Increasing awareness campaigns through media advertisements about immunization

services as seen from the findings that majority 60 (92%) of the participants said the

use of mass media (radio, television and news papers) is a strong tool for promotion of

immunization utilization of immunization services, this could help even those who

were not sure to become aware about the services.

Continued health education should be provided to the parents/caretakers about the

importance and the effects of the failure to immunize a child.

5.6 Implications to nursing practice

Nurses need to improve on their characters when carrying out a procedure on a patient.

There high demand on health educating the parents/caretaker about post immunization

side effects.


35

REFERENCES

Abdul, Q., Rukhsana, G., Azharul, I. K., Jasim, U., Meghla, I., Faiz A. (2010).

Programmatic Aspects of Dropouts in Child Vaccination in Bangladesh: Findings

from a Prospective Study. Asia-pasfic Journal of public health 2010;23(1):141-50.

Abdulraheem, I. S., Onajole, A. T., Jimoh, A. A. G., and Oladipo, A. R. (2011).

Reasons for incomplete vaccination and factors for missed opportunities among

rural Nigerian children. Journal of Public Health and Epidemiology Vol. 3(4), pp.

194-203, April 2011.

Amin, R. (2013). Reason for low immunization rates in urban Dili District of Ethiopia;

Global health science and practice: Abstract 2013.

Arooj, S., Ali, S., Baber, N., Abbasi, A., Ali, M. (2013). Socioeconomic factors

effecting polio vaccination in Parkistan Health 5 (5): pg. 892.

Babirye, J.N., Engebretsen, I.M.S., Makumbi, F., Fadnes, L.T., Wamani, H. (2012).

Timeliness of Childhood Vaccinations in Kampala Uganda: A Community-Based

Cross-Sectional Study. PLoS ONE 7(4): e35432. doi:10.1371/journal.pone.00354

32.

Bisrat, F., and Worku, A. (2008). Core group polio project baseline survey, in Ethiopia

2008. (1):8-10.

Clark, A., Sanderson, C. (2009). Timing of children’s vaccinations in 45 low-income

and middle-income countries: an analysis of survey data. Lancet 373: 1543–1549.


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Elizabeth, K., George, K., Raphael, N., Moses, E. (2015). Factors Influencing Low

Immunization Coverage among Children Between 12 - 23 Months in East Pokot,

Baringo County, Kenya. Int. J. Vaccines Vaccin. 1(2):00 012. DOI:10 .154

06/ijvv.2015.0 1.00012.

Hemoke, T., Amare, D., Mirkuze, W. (2009). Predictors of defaulting from completion

of childhood immunization in south ethopia-Acase control study. BMC Public

Health, 9: 150.

Isaac, B. (2010). Assessment of Expanded Programme on Immunization Service

Utilization in Sekyere West District of Ashanti Region, Ghana. A Dissertation

Submitted To The School Of Research And Graduate Studies, Kwame Nkrumah

University of Science And Technology, Kumasi – Ghana. Pg 70-78.

Jagrati, V.J., Caroline, D.S., Ilesh, V.J., Gunnar, B. (2008). Risk factors for incomplete

vaccination and missed opportunity for immunization in rural Mozambique. BMC

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pg.136-140.

Koskei Alfred, Simiyu Tabu, Paul Kisia Malalu, Irene Marete, Robert Too, Koskei K.

Peter, Constance Tenge (2014). Utilization of Essential Immunization Services

among Children under Five Years Old in Kacheliba Division, Pokot County,

Kenya. Science Journal of Public Health. Vol. 2, No. 6, 2014, pp. 617-623. doi:

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Ministry of Health (2009). Annual Health Development Report for Uganda,

2008/2009. Kampala, Ministry of Health.

Nath, B., Singh, V., Awasthi, S.,Bhushan, V., Kumar, V, & Singh, S.K. (2007).

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39

APPENDICES

Appendix I: Participant Consent Form

I am Kiconco Evas, a student of Kampala International University pursuing diploma

in nursing sciences. I am conducting a study of “factors contributing to low

immunization coverage in Kakoba Division-Mbarara Municipality, Mbarara District”.

I would like to ask you in order to obtain the information about the mentioned study

above. This survey is anonymous and confidential. Your participation in this study is

strictly voluntary and will in no way affect your relationship with the midwives. To

help protect confidentially, I will be making use of identification code only on the data

form and this will be handled by myself and will be stored away. If there is any unclear

information, you may ask for further clarification.

Declaration of the participant:

I have understood the purpose of the study and consent voluntarily to participate as a

subject in this study. I also understand that the information to be provided will be

confidential.

Participan

t

Signature or thumb print Date

………………………………………

….

……………………………

.


40

Researche

r

Signature Date

………………………………………

….

……………………………

Appendix II: Questionnaire

Topic: Factors Contributing to Low Immunization Coverage in Kakoba Division-

Mbarara Municipality, Mbarara District.

INSTRUCTIONS:

Assured of confidentiality of information being collected

The respondents should tick the most appropriate.

SECTION A: BIO-DEMOGRAPHIC DATA

1. Age range (in year) of the respondent;

15-24

24-34

35-44

45 and above

2. Tribe;

Munyankole

Mukiga

Muganda


41

Mutoro

Other specify ……………………………………………………..

3. Marital status;

Single

Married

Divorced

Cohabiting

Separated

Widowed

4. Religion;

Catholic

Protestant

Seventh Day Adventist (SDA)

Muslim

Other specify………….………………………………………………

5. Education;

No formal education

Primary level

Secondary level


42

Tertiary level

6. Occupation;

House wife

Self employed

Civil servants

Other specify ………………………………………………………

SECTION B: HEALTH SYSTEM RELATED FACTORS CONTRIBUTING TO

LOW IMMUNIZATION COVERAGE

7. Which health facility is near to you?

Health center Hospital Private clinic

8. What is the nearest health facility distance from your home?

Less than 3 km 3-6 km 6 km and above

9. How much time do you spend waiting for immunization services from the clinic?

Less than 1 hour 1-2 hours 2 hours and above

10. Where did you deliver your last born child from?

Home Health facility

11. If from the health facility on question 10, was the child immunized?

Yes No

12. If yes to question 11, were you told about next immunization date appointment?

Yes No


43

13. If yes to question 11, what was the health workers mood during the time of

immunization?

Was supportive and friendly Rude and abusive

Other specify………………………………………………………………

14. Does the health facility where you take your children for immunization have

enough vaccines for the major immunizable diseases?

Yes No I don’t know

15. How many times your children have to be immunized for complete dose according

to Uganda immunization schedule?

Less than 3 times 4 times

5 times 6 times and above

16. According to your understanding, what could be the major factor hindering

immunization coverage in the health system?

Low knowledge level of the health workers

Inadequate supply of vaccines

Lack of vaccines equipment for maintenance

Other specify ………………………………………………………...........

SECTION C: COMMUNITY RELATED FACTORS CONTRIBUTING TO

LOW IMMUNIZATION COVERAGE


44

17. Does migration of families (change of residence of families) affects utilization of

immunization services?

Yes No Not sure

18. The use of mass media (radio, television and news papers) is a strong tool for

promotion of immunization utilization of immunization services.

Yes No Not sure

19. Fear of the side effects of the vaccine because it make the child sick

Yes No No response

20. Lack of awareness by care givers may result to low immunization service

utilization.

Yes No Not sure

21. Bad weather conditions affect the utilization of immunization services

Yes No Not sure

22. Domestic violence may lead to low immunization service utilization

Yes No Not sure

23. Does low level of education lead to low immunization service up take?

Yes No I don’t know

Thanks for your positive response


45

Appendix III: Letter of Authorization


46

Appendix IV: Map of Uganda showing location of Mbarara District


47

Appendix V: Map of Mbarara District showing location of Kakoba Division

KEY

Area of the study district

KEY

Area of Kakoba Division

factors contributing to low immunization coverage …

Documents