Barriers to Childhood Immunization in Sub-Saharan Africa: A Systematic Review

Abstract

Background Immunization to prevent infectious diseases is a core strategy to improve childhood health as well as survival. It remains a challenge for some African countries to attain the required childhood immunization coverage. We aim at identifying individual barriers confronting parents/caretakers, providers, and health systems that hinder childhood immunization coverage in Sub-Saharan Africa.Method This systematic review searched PubMed/MEDLINE, Web of Science and EMBASE. We restricted to published articles in English that focused on childhood immunization barriers in Sub-Saharan Africa from January 1988 to February 2019. We excluded studies if: focused on barriers to immunization for children in other regions of the world, studied adult immunization barriers; studies not available on the university library, they were editorial, reports, reviews, supplement, and bulletins. Study designs included were cross-sectional, second-hand data analysis; and case control. ResultsOf the 2,538 items identified, 40 met inclusion criteria. Parents/caretakers were the most common subjects. Eight articles were of moderate and 32 were of high methodological quality. Seven studies analyzed secondary data; 30 used cross-sectional designs and three employed case control method. Twenty-five studies reported national immunization coverage of key vaccines for children under one, fifteen did not. When reported, national immunization coverages of childhood vaccines were reported to be low. Parents/caretaker's barriers included lack of knowledge of immunization, distance to access point, financial deprivation, lack of partners support, and distrust in vaccines and immunization programs. Other associated factors for low vaccine rates included the number of offsprings, life style, migration and occupation. Barriers at health system level cited by healthcare providers included limited human resources and inadequate infrastructures to maintain the cold chain and adequate supply of vaccines.Conclusion In this review we identified more thoroughly the parents/caretakers' barriers than those of providers and health systems. Factors that influenced decisions to get children vaccinated were mainly their gender, beliefs, socio-economic and socio-culture factors in the communities in which they live. Thus it is vital that immunization programs consider these barriers and address the people 3 and societies in their communities across Sub-Saharan Africa. BackgroundImmunization is a protective measure against infectious diseases [1]. Childhood immunization remains one of the most high impact public health interventions, by reducing infectious diseasesrelated morbidly and mortality of children at a low cost [2]. It is a core child survival strategy and is demonstrated to avert more than 1·2 million child deaths each year [3,4]. It is a key strategy towards attaining Sustainable Development Goal number 3, namely the reduction of under-five mortality to less than 25/1000 live births by 2013 [5]. Despite these gains, vaccine-preventable diseases remain a...

Covid-19 Vaccine Hesitancy in Northern Nigeria

“…Despite the adult population involved in this study, a surprising 28.7% of the study participants indicated that their decision to take the Covid-19 vaccines is dependent upon the guidance of their parents. This strong influence of parents on vaccine uptake by their wards have been supported by findings from several other studies at different parts of the world (27)(28)(29)(30).…”