Title : In-depth reasons for the high proportion of zero-dose children in underserved populations of Ethiopia: Results from a qualitative study
Abstract:
Background: Increasing attention is being given to reach children who fail to receive routine vaccinations, commonly designated as zero-dose children. A comprehensive understanding of the supply- and demand-side barriers is essential to inform zero-dose strategies in high-burden countries and achieve global immunization goals.
Objectives: This qualitative study aimed to identify the barriers for reaching zero-dose and under-immunized children and what and explore gender affects access to vaccination services for children in Ethiopia. Data was collected between March-June 2022 using key informant interviews and focus group discussions with participants in underserved settings.
Results: The high proportion of zero-dose children was correlated with inadequate information being provided by health workers, irregularities in service provision, suboptimal staff motivation, high staff turnover, closure and inaccessibility of health facilities, lack of functional health posts, service provision limited to selected days or hours, and gender norms viewing females as responsible for childcare. Demand-side barriers included religious beliefs, cultural norms, fear of vaccine side effects, and lack of awareness and sustained interventions.
Conclusion: Recommendations to increase vaccination coverage include strengthening health systems such as services integration, human resources capacity building, increasing incentives for health staff, integrating vaccination services, bolstering the EPI budget especially from the government side, and supporting reliable outreach and static immunization services. Additionally, immunization policy should be revised to include gender considerations including male engagement strategies to improve uptake of immunization services.
Key Words: supply and demand barrier, gender norms, key informant interview, focus group discussion
Audience Takeaway:
- By understanding the various factors health policymakers and practitioners can use this knowledge to develop comprehensive information campaigns that tackle the misconceptions and fears surrounding vaccines while providing accurate, accessible, and culturally sensitive information to caregivers.
- Understanding the diverse range of barriers contributing to the high proportion of zero-dose children is crucial for professionals in their job. By addressing these barriers comprehensively, professionals can ultimately contribute to reducing vaccine-preventable diseases and safeguarding the health and well-being of children.
- The findings highlight the importance of addressing issues such as inadequate information provision, irregularities in service provision, staff motivation, accessibility challenges, gender norms, and demand-side barriers. By incorporating these key findings into their own research or teaching, faculty members can contribute to the collective efforts aimed at improving vaccination coverage and reducing the prevalence of zero-dose children.
- the high proportion of zero-dose children is influenced by both the supply and demand sides of immunization. Addressing this complex issue requires a comprehensive and integrated approach that strengthens the health system, promotes gender equality, and fosters community engagement. By adopting these multifaceted strategies, we can work towards ensuring every child receives the life-saving benefits of vaccination, simplifying the task of designers and making the process more efficient.
- By recognizing and understanding these barriers, interventions can be designed to improve the accuracy of design, providing new information to assist in designing effective interventions. A multidimensional approach that targets health worker training, service provision, staff motivation, gender norms, and demand-side barriers is crucial for achieving comprehensive immunization coverage and ensuring that every child has access to life-saving vaccines.
