Gaps in measles vaccination coverage in Kasese district, Western Uganda: results of a qualitative evaluation

Abstract

Background Despite the availability of a highly effective vaccine, measles remains a substantial public health problem in many countries including Uganda. In this study, conducted between June–August 2020 following a local outbreak, we sought to explore the factors that could affect measles vaccination coverage in rural western Uganda. Methods We conducted a descriptive study using qualitative data collection approaches in the Kasese district. The research team utilized purposive sampling to identify and select participants from the public health sector and district government. We conducted key informant interviews (KII) and one focus group discussion (FGD). Responses were recorded using portable electronic devices with the FGD and KII guide installed. Interviews were conducted at the health centre and district headquarters. Data was coded and analysed using ATLAS.ti version 8 software through deductive thematic analysis to identify key themes. Results Barriers to measles vaccination identified in this study were premised around six themes including: (i) availability of supplies and stock management, (ii) health worker attitudes and workload, (iii) financing of vaccination outreach activities, (iv) effectiveness of duty rosters (i.e., health workers’ working schedules), (v) community beliefs, and (vi) accessibility of healthcare facilities. Respondents reported frequent vaccine supply disruptions, lack of resources to facilitate transportation of health workers to communities for outreach events, and health centre staffing that did not adequately support supplemental vaccination activities. Furthermore, community dependence on traditional medicine as a substitute for vaccines and long distances traveled by caregivers to reach a health facility were mentioned as barriers to vaccination uptake. Conclusions Health system barriers limiting vaccination uptake were primarily logistical in nature and reflect inadequate resourcing of immunization efforts. At the same time, local beliefs favouring traditional medicine remain a persistent cultural barrier. These findings suggest an urgent need for more efficient supply management practices and resourcing of immunization outreaches in order to achieve the Uganda Ministry of Health’s targets for childhood immunization and the prevention of disease outbreaks.

Measles Vaccine Coverage and Disease Outbreaks: A Systematic Review of the Early Impact of COVID-19 in Low and Lower-Middle Income Countries

“…This was particularly evident from local data, which often articulated some of the challenges faced by single hospitals or areas that may be lost by reporting nationally aggregated figures. Cold-chain infrastructure limitations included stock-outs secondary to refrigerated storage space or faulty cold-chain equipment and delayed supply in multiple sub-Saharan African countries [ 28 , 33 ]. Other critical infrastructure challenges were exacerbated during COVID-19, including poor road quality and transport access issues [ 34 , 36 , 60 ] limiting vaccine delivery to sparse rural populations.…”

“…[52] "Faulty fridges impacted storage, lack of transportation and financial renumeration." [28] "Disruptions in global manufacturing and supply chains, border closures, restriction on local mobility." [47] "Lack of fridges in remote health centres."…”

“…[41] "A large number mentioned that stock-outs were common." [28] "UNEPI (Uganda National Expanded Program on Immunization) policy of unpreserved vaccines which must be discarded at the end of the session or 6 h after reconstitution . .…”

“…[47] Travel time '5 "Study also revealed that long distances from the healthcare facility was a barrier to vaccination." [28] Lack of PPE '5 "Patients needed to provide own mask's." [54] "PPE not available for vaccinators for first weeks of COVID lockdown."…”

“…[60] Parents unaware of EPI schedule 3 "Caregivers forgetting about the 9-month appt [for MCV]." [28] "Low awareness about child age-eligible for vaccination, about the side effect of vaccines and measures taken for vaccine side effects in a questionnaire taken by caregivers." [31] COVID-19-related misinformation 3 "WhatsApp voice-note warnings that EPI clinics would vaccinate babies with western developed COVID-19 vaccines."…”