Peer-reviewed article
Coverage and Drivers to Reaching the Last Child With Vaccination in Urban Settings: A Mixed-Methods Study in Kampala, Uganda
Carol Kamya, Faith Namugaya, Charles Opio, Paul Katamba, Emily Carnahan et al. ·
Summary
Written by AI, not yet AICS's view · claude-haiku-4-5-20251001This study examined vaccination coverage and its drivers among children aged 12-36 months in Kampala, Uganda. While 96% of children received their first vaccination dose, only 41% were fully vaccinated and just 27% received vaccines on time. Parents' understanding of vaccination benefits was the main driver of complete vaccination, while barriers included poor information about vaccines, stock-outs, long waiting times, and hidden costs. The findings show that vaccination services need better social mobilization tailored to urban settings with diverse, mobile populations.
Key points
- Only 41.4% of children aged 12-36 months were fully vaccinated, with a 17.3% dropout rate from first to third DPT dose
- Access to vaccination services was high (96% received first dose), but utilization declined significantly over time
- Parents' appreciation of vaccination benefits was the strongest driver of complete vaccination coverage
- Main barriers to vaccination were inadequate information about vaccines and their schedule, vaccine stock-outs, long waiting times, and hidden vaccination costs
- Vaccination coverage was inequitable, affecting both slum and non-slum areas in the urban setting
Limitations
The study was conducted in Kampala city only, so findings may not generalise to rural Uganda or other urban settings. The study identifies barriers and drivers but does not test interventions to address them, so it cannot establish what solutions would be most effective.
Abstract
BACKGROUND: Limited evidence exists regarding the drivers of vaccination coverage and equity in Kampala city, despite frequent measles outbreaks, inequities in vaccination coverage, and the decline in vaccination coverage rates. This study was designed to determine vaccine coverage among children aged 12-36 months and to understand its demand-side drivers. METHODS: We utilized a mixed-methods parallel convergent study design. A household survey was conducted to quantify the drivers of vaccine coverage among households with children aged 12-36 months. We employed a multistage sampling approach to select households, using a primary sampling unit of an enumeration area. We conducted 30 key informant interviews, 7 focus group discussions, and 6 in-depth interviews with representatives from the immunization program, health workers, and parents residing in areas with low vaccine coverage. RESULTS: Of the 590 enrolled children, 340 (57.6%) were partially vaccinated, 244 (41.4%) were fully vaccinated and had received all the recommended vaccinations, and 6 (1.0%) had never received any vaccine. Of the 244 with all recommended vaccinations, only 65 (26.6%) received their vaccines on time. Access to vaccination services was high (first dose of diphtheria, pertussis, and tetanus [DPT1] coverage of 96%), but utilization decreased over time, as shown by a dropout rate of 17.3% from the first to third dose of DPT. The main driver of complete vaccination was the parents' appreciation of the benefits of vaccination. Among partially vaccinated children, the barriers to vaccination were inadequate information about vaccination (its benefits and schedule), vaccine stock-outs, long waiting times to receive vaccination services, and hidden vaccination costs. CONCLUSION: Vaccination needs to be targeted to all children irrespective of whether they reside in slum areas or nonslum areas, as most are under-vaccinated. Social mobilization and communication efforts should be tailored to the complexities of urban settings characterized by transient and diverse populations with different cultures.