Peer-reviewed article
When coverage is high: rethinking the role of caregiver perceptions in childhood vaccination uptake in Uganda.
Annika K Gunderson, Taeim Kwon, Yohhan Kumarasinghe, Yuanyuan Yan, Joyce Choe et al. ·
Summary
Written by AI, not yet AICS's view · claude-haiku-4-5-20251001This study surveyed nearly 1,700 caregivers of young children in Uganda to understand how their beliefs and experiences with vaccination affect whether children receive full immunization. While overall belief and experience scores did not predict vaccination status, specific beliefs mattered: caregivers who believed vaccines prevent severe disease or protect the community were more likely to fully vaccinate their children, while those who thought children receive too many vaccines were less likely to do so. Personal experience, such as knowing someone affected by a vaccine-preventable disease, also increased the likelihood of full vaccination.
Key points
- Composite caregiver belief and experience scores were not associated with full vaccination status
- Specific beliefs that vaccines prevent severe disease increased odds of full vaccination 2.68 times
- Belief that vaccines protect the community increased odds of full vaccination 1.67 times
- Belief that children receive too many vaccines reduced odds of full vaccination by 40%
- Knowing someone affected by a vaccine-preventable disease increased odds of full vaccination 2.10 times
Limitations
This cross-sectional study cannot establish causation and captures only associations between caregiver beliefs and vaccination status at a single point in time. The findings reflect the situation in Uganda and may not generalize to other contexts with different vaccination coverage levels or demographic characteristics.
Abstract
BACKGROUND: Beliefs of a child's primary caregiver are known to influence immunization uptake. As coverage increases, the characteristics of households with undervaccinated children may be shifting. METHODS: We conducted a cross-sectional survey of households with a child 12-23 months of age. Vaccine status was verified by inspection of immunization cards or caregiver report. Composite scores captured caregiver beliefs and experiences with vaccination. Associations between these measures and vaccination status were evaluated using weighted logistic regression. RESULTS: Caregivers of 1689 children were surveyed. The odds of full vaccination were not associated with composite beliefs (adjusted odds ratio [aOR] 1.04 [95% confidence interval {CI} 0.95 to 1.14]) or experiences scores (aOR 1.04 [95% CI 0.96 to 1.13]). Specific beliefs that vaccines prevent severe disease (aOR 2.68 [95% CI 1.64 to 4.37]) and protect the community (aOR 1.67 [95% CI 1.10 to 2.53]) were positively associated, whereas beliefs that children receive too many vaccines (aOR 0.60 [95% CI 0.44 to 0.83]) were negatively associated with full vaccination. Positive experiences, including knowing someone affected by a vaccine-preventable disease (aOR 2.10 [95% CI 1.47 to 3.00]) were also linked to full vaccination. CONCLUSIONS: Although composite scores were not associated with immunization status, individual beliefs and experiences may still factor into caregiver decisions to vaccinate their children.