Peer-reviewed article

Barriers to uptake of vaccination among communities in the city of Kigali, 2025.

Amr Magdi Hassan, Asawir Mohammed, Hiba Makki, Hana Makki, Mounkaila Noma et al. · 10 Jul 2026

Abstract

INTRODUCTION: Immunization is a fundamental health component preventing an estimated 2.5 million deaths annually. Despite the documented successes of immunization, disparities of vaccine uptake exist in low- and middle-income countries and across their respective communities. This research assessed the barriers related to recall-based vaccination uptake among communities in Kigali city, the capital of Rwanda. METHODS: A mixed-methods study was implemented on a sample of 210 households and communities across the three districts of the City of Kigali. The quantitative study used a multistage sampling technique according to the WHO Immunization Coverage Survey to select the households from the districts of Kigali city. While the 3 focus group discussions and 6 interviews were implemented in communities not included in the quantitative survey. A thematic analysis was performed on the qualitative data. The quantitative data were analyzed using SPSS 23 and summarized numerically and graphically. Statistical tests performed for association were Chi-square tests and a binary logistic regression was used to establish the relationship between recall-based vaccine uptake and its associated factors. All statistical tests were considered significant when p < 0.05. RESULTS: Quantitative findings of this study reported that all 155 children ≤ 6 years were vaccinated. It also divided the barriers into four main categories: decision barriers, information barriers, accessibility barriers, and challenges in health facilities. A binary logistic regression predicted recall-based vaccine uptake based on 11 explanatory variables. The variables statistically significant were age and household size, with respective p < 0.001, and knowledge of vaccine-preventable diseases with a p-value of 0.038. Qualitatively, FGDs and interviews revealed fear of side effects, denial of vaccination in absence of husbands, long waiting time and poor communication from providers in facilities as factors that discourage attendance for immunization. CONCLUSION: Barriers to recall-based categorization of vaccination frequency were mainly health system-related challenges, including insufficient supplies, costs for pregnant women for first-time vaccinations and denial vaccination in the absence of husbands. These findings call upon Rwandan health authorities and partners to address predictors of vaccination behavior associated with systemic challenges, intentional refusal and enhance immunization service delivery.