Abstract
BackgroundImmunization coverage levels in Guatemala have increased over the last two decades, but national targets of ≥95% have yet to be reached. To determine factors related to undervaccination, Guatemala’s National Immunization Program conducted a user-satisfaction survey of parents and guardians of children aged 0–5 years. Variables evaluated included parental immunization attitudes, preferences, and practices; the impact of immunization campaigns and marketing strategies; and factors inhibiting immunization.MethodsBased on administrative coverage levels and socio-demographic indicators in Guatemala’s 22 geographical departments, five were designated as low-coverage and five as high-coverage areas. Overall, 1194 parents and guardians of children aged 0–5 years were interviewed in these 10 departments. We compared indicators between low- and high-coverage areas and identified risk factors associated with undervaccination.ResultsOf the 1593 children studied, 29 (1.8%) were determined to be unvaccinated, 458 (28.8%) undervaccinated, and 1106 (69.4%) fully vaccinated. In low-coverage areas, children of less educated (no education: RR = 1.49, p = 0.01; primary or less: 1.39, p = 0.009), older (aged >39 years: RR =1.31, p = 0.05), and single (RR = 1.32, p = 0.03) parents were more likely to have incomplete vaccination schedules. Similarly, factors associated with undervaccination in high-coverage areas included the caregiver’s lack of education (none: RR = 1.72, p = 0.0007; primary or less: RR = 1.30, p = 0.05) and single marital status (RR = 1.36, p = 0.03), as well as the child’s birth order (second: RR = 1.68, p = 0.003). Although users generally approved of immunization services, problems in service quality were identified. According to participants, topics such as the risk of adverse events (47.4%) and next vaccination appointments (32.3%) were inconsistently communicated to parents. Additionally, 179 (15.0%) participants reported the inability to vaccinate their child on at least one occasion. Compared to high-coverage areas, participants in low-coverage areas reported poorer service, longer wait times, and greater distances to health centers. In high-coverage areas, participants reported less knowledge about the availability of services.ConclusionsGenerally, immunization barriers in Guatemala are related to problems in accessing and attaining high-quality immunization services rather than to a population that does not adequately value vaccination. We provide recommendations to aid the country in maintaining its achievements and addressing new challenges.
Highlights
Immunization coverage levels in Guatemala have increased over the last two decades, but national targets of ≥95% have yet to be reached
We identify lessons learned that are relevant to ongoing efforts by the Pan American Health Organization (PAHO) to develop a standardized tool for detecting missed opportunities for vaccination in the Americas
Questionnaire Based on a review of the literature on the epidemiology of undervaccinated children, we developed a preliminary version of the questionnaire
Summary
Immunization coverage levels in Guatemala have increased over the last two decades, but national targets of ≥95% have yet to be reached. To determine factors related to undervaccination, Guatemala’s National Immunization Program conducted a user-satisfaction survey of parents and guardians of children aged 0–5 years. Reported third-dose coverage of diphtheria, tetanus, and pertussis vaccine (DPT3) was 85% in 2011, compared to 81% in 2000 and 66% in 1990 [2,3]. Despite these achievements, coverage rates continue to fall short of national targets of ≥95% [3]. In 2012, 25% of districts reported DPT3 coverage
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