Barriers to Full Immunization Coverage of Under Five Years Children in Benadir Region, Somalia

Abstract

Immunization is an important public health intervention aimed at reducing child mortality and morbidity in line with the fourth goal of the Millennium Development Goals. It is an important means for controlling six vaccine-preventable diseases, namely, Tuberculosis, Diphtheria, Whooping cough, Tetanus, Polio, and Measles. World Health Organization recommends that all children should receive full immunization by the age of two years to boost their immunity. Although immunization coverage has improved significantly over the past four decades, about one-fifth of the world's children still fail to receive full doses of the standard antigens, majority of who are natives of the African region. In Somalia, empirical studies on immunization coverage do not provide detailed information about immunization coverage and key determinants at the community level and within specific groups such as pastoralists. The main objective of this study was to determine barriers to full immunization coverage among under-five year's children within Benadir region. The study applied a cross-sectional survey design, with both quantitative and qualitative methods. Primary data will was sourced from under-five children, service providers in selected health facilities, public health officers and community health workers. A mixture of probability and non-probability sampling procedures were applied to select participants in each category. Fisher's formula for sample size determination from large populations will be used to select a representative sample of the under-five year's children. The study applied a survey questionnaire with both closed and open-ended questions, as well as Focus Group Discussion and Key Informant Interview guides. Both quantitative and qualitative approaches were applied to process, analyze, and interpret the data. Quantitative data techniques will include univariate analyses to produce frequency distributions, percentages, Chi-square (χ 2) statistic, one-way Analysis of Variance, and binary logistic regression. In addition, qualitative data was organized and summarized in line Barriers … Abdirisak et al. 2 with the thematic areas; described, followed by thematic analysis. The study found that children having less than 5 siblings had about 5 times the odds of being fully immunized as those having 15 or more siblings (OR = 5.063; CI = 2.657-9.649); children whose caregivers attended clinic more than thrice during pregnancy had about 11 times the odds of being fully immunized as those whose caregivers attended clinic once (OR = 10.538; CI = 8.412-13.202; while those whose caregivers reported incomes of USD 1500 or more had about 3 times the odds of accessing full immunization as their colleagues whose caregivers indicated income of less than USD 100. Children whose caregivers received support from husbands/partners were about 8 times as likely to access full immunization as those whose caregivers never received such support (OR = 8.207, CI = 6.426-10.465); those whose caregivers negated the belief that 'immunization is a form of family planning' were about 3 times as likely to access full immunization as those whose caregivers affirmed the belief (OR = 2.729; CI = 1.636-4.552); while those whose families had never changed residence (migrated) over the preceding one year period indicated about 7 times the odds of being fully immunized as those whose families migrated more than twice (OR = 7.043; CI = 4.740-10.464).The study concludes that children's immunization status is influenced by factors at the individual, household, community, and health facility levels, which can best be addressed through collaboration between Ministry of Health and development agencies. The study recommends the need to: provide more information on childhood immunization, targeting women of all ages; promote family planning methods, emphasizing birth spacing and smaller family sizes; encourage more women to attend antenatal care clinics, where they can access correct information about childhood immunization. The study further recommends the need to: promote women's economic status to enable them afford costs associated with accessing immunization services; improve male involvement in childhood immunization by creating an information package targeting men of all ages; establish rural maternal and child health centers to reach communities that are far from health facilities with primary healthcare services, including immunization and information. Discover the world's research