Factors Affecting Compliance of Childhood Routine Immunization and Dropout Rate

Volume 3, Issue 2, February – 2018 International Journal of Innovative Science and Research Technology
ISSN No:-2456 –2165
Factors Affecting Compliance of Childhood Routine

Immunization and Dropout Rate in KABUYANDA
Town Council – ISINGIRO District
Fred. Oyesigye (MPH)
Makerere University School of Public Health, Kampala –Uganda
Uganda FETP, Graduation 2017
Abstract:-Routine immunisation remains the cost effective I. INTRODUCTION

approach in preventing childhood illnesses. However
immunisation compliance and dropout rate remains a Routine immunisation remains the cost effective approach of
challenge worldwide. Compliance refers to a child getting preventing childhood illnesses. However compliance to
vaccinated according to schedule recommended by routine immunisation and dropout rate remains a challenge
government, and dropout rate the difference between the problem Worldwide. A child fully immunised,
Initial and last vaccine administered (USAID 2003). (BCG mothers/caretakers need to be compliant and follow a
-Measles). This Study looked at complianceof childhood scheduled return date for immunisation. Therefore
routine immunisation and dropout rate in Kabuyanda Compliance to routine immunisation is when a child is
Town Council which remained high at 47% in 2014 vaccinated according to the government recommended
(Kabuyanda HCIV Records Office 2014) instead of Schedule, an infant should receive doses of antigens of BCG
national target of <18%, for BCG and Measles ≤ 10% for at birth or first contact and OPV0 at birth or within 14 days
DPTHep+Hib1- DPTHep+Hib3, (UBOS 2013) A cross after delivery, OPV1and DPTHEP+Hib1 at 6weeks, OPV2
sectional study was done, 384 respondents of children 1 to and DPTHEP+Hib2 at 10 weeks, OPV3 and DPTHEP+Hib3
24months were interviewed using structured at 14 weeks and Measles at 9monthsand Uganda National
questionnaires administered by simple systematic Expanded Program on Immunisation (UNEPI) goal is to have
sampling at household. Bivariate analysis on outcome 1 all children immunised before their first birth day, while
Compliant, 2 Not Compliant was done, tested using odds dropout rate is the difference between the initial vaccine
ratio and Pearson’s Chi-Square (x²). Factors significant at administered (BCG or DPTHEP+Hib1) and the last vaccine
P value ≤0.05 with plausible association were again administered ( DPTHEP+Hib3 or Measles), however in
analyzed at Multivariate level to obtain adjusted Odds Uganda dropout rate of less than 10% for DPTHEP+Hib1-
Ratio for factors affecting compliance to routine DPTHEP+Hib3 and 18% for BCG/Measles is
immunisation and dropout rate, “ time taken to get acceptable.(USAID 2003).
services” OR=1.99 (95%CI=1.02-3.89), “distance to
immunization centre” OR=2.28 (95%CI=1.02-2.36) came Globally over 240,000 children are dying of vaccine
out as factors responsible. Mother’snegligence and preventable diseases, (Tuberculosis, Polio, Measles,
engagement duties, Sick children at the time of Diphtheria, Whooping Cough, Tetanus, Hepatitis B and
immunisation and forgetting a returndate werecredible Haemophilius Influenza type B) with a high dropout rate of
causes that hindered compliance and increased dropout DPTHEP+HIb3 antigen, indicating poor continuity of routine
rate, mothers who waited 1hr were50% more likely to be immunisation in rural Health Centres (Bbaale E. 2013).
compliant than mothers waiting for 3hrs+. Mothers
residing in a distance 0.5 Km were 2.6 times likely to be While in Sub Saharan Africa, 4.4 million children died from
complaint compared to mothers residing far from a child hood vaccine-preventable diseases in 2008 (Bbaale E.
facility. Therefore there is need to improve on time spent 2013) while 57.8% of children aged 12-23Months in Osun
with mothers, create more outreaches to reduce on State of Nigeria, were fully Immunised far below the World
distance to immunisation services and intensify health Health Organisation and National target of 80% and dropout
education to communities, carry out more studies to rate of BCG to Measles and DPTHEP+HIb1/ DPTHEP+HIb3
strengthen these findings. were higher than Expected≤18%, ≤10% respectively
(Elizabeth .B et al 2013).
Keywords:-Compliance, Dropout Rate, BCG,
DPTHep+Hib&Measles Vaccine, Full Immunisation In Uganda 652,711 Children between 2007-2009 were not
Immunised against DPTHEP+HIb3 and Measles respectively
IJISRT18FB124 www.ijisrt.com 606

ISSN No:-2456 –2165
(WHO 2013) with 223218 Unimmunised Children against (1.96) P=Estimated Prevalence of the Problem under Study,
DPTHEP+HIb3, resulting into re-occurrence of vaccine- Q=100%-P or (1-P).
preventable diseases like Measles due to non –compliance of
mothers and care takers (WHO 2012). Our dependent variables were constructed on the outcome
Variable 1 Complaint “if the respondent started the
Kabuyanda Town Council inIsingiro District has the best immunisation, followed the Immunisation schedule and
immunisation Services in the Health Sub District but with completed in 9months, 2 Not Compliant to routine
poor compliance of childhood routine immunisation and high immunisation services (Mothers/ Care takers who started the
Dropout rate of BCG to Measles compared to National Target Immunisation and did not follow the recommended
of <18% immunisation schedule and dropped out). We controlled a
𝑇𝑜𝑡𝑎𝑙𝑛𝑢𝑚𝑏𝑒𝑟𝑜𝑓𝐵𝐶𝐺𝑎𝑛𝑡𝑖𝑔𝑒𝑛−𝑇𝑜𝑡𝑎𝑙𝑛𝑢𝑚𝑏𝑒𝑟𝑜𝑓𝑚𝑒𝑎𝑠𝑙𝑒𝑠𝑎𝑛𝑡𝑖𝑔𝑒𝑛 number of independent variables, guided by previous literature
, 𝑥100 =
𝑇𝑜𝑡𝑎𝑙𝑛𝑢𝑚𝑏𝑒𝑟𝑜𝑓𝐵𝐶𝐺𝑎𝑛𝑡𝑖𝑔𝑒𝑛
949−493
by coding. They included distance, waiting time, missed
x100 = 47% ( Monthly HMIS 105 Reports opportunities, accessibility, and availability of vaccines,
949
Kabuyanda HCIV 2014). rumours, misconceptions, and mother’s sickness, forgetting
return date, social engagement, Sick Child and complication
Kabuyanda Town Councilisorganized in parishes and of previous injections availability of means of transport, few
villages;ithas a population of 6193 and Annual growth of 3% trained immunisers, and lack of bottom- top planning while
with2940 childrenless than one year (Isingiro District Planning confounding variables like age, education, marital status,
office 2013). It hasa min hospital (Kabuyanda Health Centre religion, occupation, poverty, were also considered.
IV). There are Village health teams (VHTs) to mobilise
communities forservices including Maternal and Child Health Tools were validated for completeness and categorized, coded
usingtelephones with tollfree calls, village health teams report datawas exported from Epidata as an excel sheet to StataSE12
weekly to Health Centre in Charges and heads of UNEPI at (64-bit) foranalysis Univariate analysis (one way cross
the Min Hospital all childhood related diseases.Despite the tabulation) was done for frequency distribution. Bivariate
infrastructure and government commitmentto prevent Infant analysison outcome variable 1 Complaint,2 Not Compliant to
childhood diseases through routine immunization (WHO routine immunisation was done, and cross tabulated against
2012),few children aged between 1 to 24 months are brought each independent variable, the association was tested using
for immunization services at Health Centres and Outreaches, odds ratio and Pearson’s Chi-Square (x²) because all variables
resulting into overwhelming number of children not fully were categorical. Factors Significant at P value ≤0.05 with
immunized, therefore compliance and dropout rate remains a plausible association tocompliance or not were again analyzed
health problem in Kabuyanda Town Council, that impinge on at Multivariate level to obtain adjusted Odds Ratio (OR)
social economic status with huge losses on families with sick which determined the associated factors affecting compliance
childrenduring treatment, the study looked at reasons for non- of childhood routine immunisation and dropout rate in
compliance and dropout rate of mothers /caretakers from Kabuyanda Town Council -IsingiroDistrict”. The study
routine immunisation in Kabuyanda Town Council. population based random sample generalised the findings to
many others in the country,self reports on immunisation
II. MATERIALS AND METHODS compliance and dropout rate bycomparing Child Health Cards
with mothers/caretakers information reduced recall
We got approval from Makerere University School of Public bias,which was a key strength to the study.
Health and Ethics Committee and Uganda National Council of
Science and Technology (NCST) to explore factors associated III. RESULTS
with non compliance to routine immunisation and dropout
ratein Kabuyanda Town Council through interviewing A. Social Demographic Factor
Mothers/ Caretakers with Children between 1Months to
24Months at house hold,from four wards of Town council Majority (45.8%) were aged between 26-35 years, completed
(Northern and Central Kabuyanda, Kisyoro andIryango). Primary education (64.3%) therefore illiterate, this could be
apparent cause for not complying with immunisation policies.
It was a cross sectional study, semi structured questionnaires (53.9%) were peasants who earned a leaving through farming.
were administered to 384 respondents for interviewthrough Also mother’s engagement (16.1%) and Negligence (15.6%)
simple systematic sampling. Sample Size was determined by were also sighted as probable causes, because majority
𝑛 = 𝑍 2 PQ/𝛿 2 (Kish Leslie 1965),the outcome of interest was a excused themselves for having a sick children at home (6.3%)
categorical variable reported as a proportion), n= Sample at the very date of immunisation and others forget a return
Size, Z= the Standard Normal Deviate at 95% Confidence date (4.9%) for Immunization Services.

ISSN No:-2456 –2165
Variable Crude OR Adjusted P-Value

OR at 95%CI
Time taken to get services

1 hr vs 3hrs+ 0.50 1.99(1.02-3.89) 0.04*
2-3hrs vs 3hrs+ 0.8 1.29(0.70-2.36) 0.41
Distance to immunization centre
1km vs 0.5 km 2.41 2.28(1.02-5.07) 0.04*
2km+ vs 0.5 km 2.65 0.93(0.59-1.49) 0.77
Period stayed in the area
1-5 years vs 6months 0.87 1.06(0.46-2.44) 0.89
6 years + vs 6 months 0.62 1.51(0.96-2.35) 0.07
Variable Category Immunisation status Un adjusted OR p- Value
N(%)Compliant(n=176) Not (95%CI)
compliant(n=208)
Period stayed in the 6months 13 17 1.0
area 1-6 months
6+years 96 90 0.87 (0.40-1.90) 0.72
67 101 0.62 (0.41-0.95) 0.03*
Distance to the facility 0.5Km 22 11 1.0
1Km 58 70 2.41(1.08-5.39) 0.03*
2Km 96 127 2.65(1.22-5.72) 0.01*
Time taken to get 3hrs + 24 39 1.0
services 2-3hrs 93 121 0.8(0.45-1.42) 0.45
1hr 59 48 0.50(0.26-0.94) 0.03*
Table 1: Showing Bivariate and Multivariate Analysis
Factors affecting Compliance were Time taken to get Services Diphtheria, Whooping Cough, Tetanus, Hepatitis B and
OR=1.99 (95%CI=1.02-3.89) P value=0.04 and distance to Haemophilius Influenza type B) (Ayebo .E et al (2009).
Immunization Centre OR=2.28 (95%CI=1.02-2.36) P Therefore there is aneed to create awarenessamong the
value=0.04, Mothers with a least waiting time (1hr) was 50% population on the benefits of compliance to routine
likely to be Compliant compared to those with the longest immunisation so as to reverse the trend and reduce diseases of
waiting time (3hr +). While Mothers residing at the shortest epidemic potential.
distance 0.5 km were 2.6 times more likely to be complaint
compared to those residing more than a Kilometre away from The study indentified other potential factors, for failing to
the Health facility. complete immunisation in time and subsequently drop out as
“Time taken” to get services,it was observed that
IV. DISCUSSIONS mothers/caretakers with a least waiting time 1hour were likely
to be Compliant, compared to Mothers who waited for
Mother’s compliance to childhood routine immunisationin 3hours+, this indicated that mothers/caretakers who take long,
Kabuyanda Town Council – Isingiro Districtis low,because to get services are demoralised for the next Immunisation
majority of mothers are not compliant (54.2%) compared to return date.
(45.8%) Complaint, the studyattributed it, to illiteracy as
majority had completed primary level,Mother’s engagement Distance to Immunization Centre also influenced compliance,
(16.1%) and Negligence (15.6%), or having a sick child because, mothers residing at a shortest distance 0.5 km were
(6.3%) at the time of Immunisation and forgetting a return 2.6 times more likely to be complaint compared to mothers
date (4.9%) for Immunization Services, dropout rate is also residing more than a Kilometre away from the Health facility
high(47%) compared to the acceptable national average of or Immunisation Outreach, therefore there is need to create
10% and 18% for DPTHEP+Hib1- DPTHEP+Hib3 and more outreaches to extend services to near communities.
BCG/Measles respectively,such observation has been made by
otherscholars in Africa(Abdulraheem I.S et, al (2011). This Return date for immunisation servicesgreatly influenced and
increases incidences of Tuberculosis, Poliomyelitis, Measles, increased dropout rate in Kabuyanda Town Council, because

ISSN No:-2456 –2165
mothers forget the date they are supposed to return back for information from the vast areasandfinally respondents who
Immunisation Services which was attributed to low education spent their variable time during interview.
levels (64.3%) and failure to read and utilise the information
on the child immunisation card. REFERENCES
V. CONCLUSIONS [1]. Ayebo .E et al (2009) “Timeliness and Completion rate of

immunisation among Nigerian children attending clinical
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and madeconclusions to reduce Dropout rate in Kabuyanda [2]. Bbaale E et al (2006) “Factors for failures to immunize
Town Council .Mother’s compliance to childhood routine within the Expanded with expanded programme on
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respectively (HMIS 105 Reports Kabuyanda HCIV 2014& vaccination on the dynamics of two childhood diseases in
2015). rural Senegal.’’
[5]. Conlan A. Grenfell. B.(2007) ‘’Seasonality and the
Distance travelled by clients to access Immunisation persistence and invasion of measles’’
serviceinfluenced compliance and dropout rate, especially [6]. Ferrari M. et al (2008) ‘’the dynamics of measles in sub-
those in I Kilometre and beyond, which would be solved by Saharan Africa.’’
setting up many immunisation outreaches to shorten the [7]. Hemoke .T. et al (2009) “Predictors of defaulting from
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Ethiopia’’
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[14]. Phimmisane,M (2010) ‘’ Factors affecting
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Compliance with Measles Vaccination in Lao PDR
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Vaccine’’
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[16]. WHO (2008) “Role and impact of sex and gender in
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VI. ACKNOWLEDGEMENTS [17]. WHO (2009) “ State worlds Vaccines and
Immunization” Geneva
We thank all that contributed to the success of this study;
special thanks go to my supervisor Dr, Simon Kasasa.
Makerere University School of Public Health-Kampala-
Uganda, Isingiro District local government for accepting me to
carry out the study,Research Assistants who collected the

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Volume 3, Issue 2, February – 2018 International Journal of Innovative Science and Research Technology

ISSN No:-2456 –2165

Factors Affecting Compliance of Childhood Routine

Abstract:-Routine immunisation remains the cost effective I. INTRODUCTION

IJISRT18FB124 www.ijisrt.com 606

IJISRT18FB124 www.ijisrt.com 607

Variable Crude OR Adjusted P-Value

Time taken to get services

Table 1: Showing Bivariate and Multivariate Analysis

IJISRT18FB124 www.ijisrt.com 608

V. CONCLUSIONS [1]. Ayebo .E et al (2009) “Timeliness and Completion rate of

IJISRT18FB124 www.ijisrt.com 609

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