Peer-reviewed article
Dropout from the pentavalent vaccine series among children aged 12-23 months in the Central African Republic: prevalence, associated factors, and caregiver-reported barriers.
Daniel Katuashi Ishoso, Emmanuel Fandema, Nicole A Hoff, Dalau Mukadi Nkamba, Sydney Merritt et al. ·
Summary
Written by AI, not yet AICS's view · claude-haiku-4-5-20251001This study examined why children in the Central African Republic stop receiving their pentavalent vaccine doses before completing the full series. Among over 4,000 children aged 12-23 months who had started vaccination, about one-third did not complete all three doses. The main barriers were distance to clinics, vaccine shortages, lack of time, and gaps in knowledge about vaccination schedules. Poverty indicators like lack of television and missing birth registration were linked to higher dropout rates.
Key points
- 34.5% of children who started the pentavalent vaccine series failed to complete all three doses
- Distance to vaccination sites (30.9%) and vaccine stockouts (14.0%) were the most commonly reported access barriers
- Caregiver time constraints (29.7%) and lack of knowledge about vaccination schedules (27.3%) were major household and information barriers
- Households without television had nearly 3 times higher odds of vaccine dropout; children without birth registration had 1.56 times higher odds
- Caregivers engaged in agriculture had 3.45 times higher odds of dropout
Limitations
The study relies partly on caregiver recall and home-based records rather than verified health facility data, which may introduce misclassification. The cross-sectional design captures associations but cannot establish causation or explain the mechanisms linking household characteristics to dropout behaviour.
Abstract
BACKGROUND: Routine childhood immunization in the Central African Republic (CAR) is inconsistent due to reasons including political instability and service disruptions. This study assessed dropout between the first and third pentavalent doses among children aged 12-23 months who had received Penta 1, identified associated risk factors, and explored caregiver-reported barriers. Additional dropout indicators within this cohort-specifically from Penta 1 to Penta2, from Penta2 to Penta 3, and from Penta 3 to measles-were also examined to support contextual interpretation. METHODS: We conducted a cross-sectional household survey from December 2023 to March 2024, based on a nationally representative sample covering all seven health regions and 35 districts of the CAR. This secondary analysis focused on dropout between key vaccine doses among children aged 12-23 months and was conducted using Stata 17. Data were collected through structured interviews with caregivers, with vaccination status primarily verified using home-based records; when unavailable, health facility data or caregiver recall were used. Survey-weighted logistic regression models were used to identify factors associated with vaccine dropout. Reasons for non-vaccination were analyzed thematically using the adapted WHO BeSD framework. RESULTS: Among 4121 children aged 12-23 months who had received Penta 1, the national prevalence of dropout between the first and third doses of the pentavalent vaccine was 34.5% (95% CI: 32.4-36.6). Additionally, among these children, we observed 17.0% dropout from Penta 1 to Penta2, 17.5% from Penta2 to Penta 3, and 15.8% from Penta 3 to the measles-containing vaccine. Higher odds of dropout between Penta 1 and Penta 3 were associated with households lacking television (aOR: 2.98; 95% CI:1.88-4.72), absence of birth registration (aOR:1.56; 95% CI:1.26-1.94) and caregivers engaged in agricultural activities (aOR:3.45; 95% CI:1.85-6.44). Primary reported reasons for non-vaccination included access barriers such as distance to the vaccination site (30.9%) and vaccine stockouts (14.0%), contextual and household challenges like caregiver time constraints (29.7%) and family-related problems (10.8%), information gaps including lack of knowledge about the vaccination schedule (27.3%), and motivational concerns such as fear of side effects (10.4%) and distrust in vaccines (2.9%). CONCLUSION: In the CAR, 34.5% of children who receive the first pentavalent dose fail to complete the three dose vaccination series. Improving follow-up and adapting services to overcome local barriers is essential to increase rates of complete immunization.
Findings the Hub has extracted
Each claim below is labelled by its type of design and links back to this report.
- Intervention
- Routine childhood immunization with pentavalent vaccine administered in three doses; this study identifies barriers to completion and associated risk factors
- Population
- Children aged 12-23 months in the Central African Republic who had received at least the first pentavalent dose (n=4,121)
Key finding
34.5% dropout between first and third pentavalent doses (95% CI: 32.4-36.6)