Geographic location of health facility and immunization program performance in Hoima district, western Uganda: a health facility level assessment

Nicholas Kwikiriza Magambo,Francis Bajunirwe,Fred Bagenda

doi:10.1186/s12889-020-09859-z

Nicholas Kwikiriza Magambo, Francis Bajunirwe + Show 1 more

Open Access

https://doi.org/10.1186/s12889-020-09859-z

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Abstract

BackgroundGlobally, immunization coverage for childhood vaccines is below the immunization target of achieving at least 90% coverage with the pentavalent vaccine. In Uganda, a recent survey shows 80% of districts had poor immunization program performance. However, there is significant variation in performance within and between districts. We hypothesized that geographic location of a health facility may influence performance of its immunization programs. Therefore, the purpose of this study was to examine whether geographical location of a health facility within a district is associated with performance of the immunization program in Hoima district, western Uganda.MethodsWe conducted a cross sectional study using a mixed methods approach. The main study unit was a health center and we also interviewed health workers in-charge of the facilities and reviewed their health facility records. We reviewed the Uganda Health Management Information System (HMIS) 105 reports of six months to obtain data on immunization program performance. Performance was categorized using World Health Organization’s Reach Every District (RED) criteria and classified as poor if a facility fell in category 3 or 4 and good if 1 or 2. We also conducted key informant interviews with immunization focal persons in the district. We examined the association between dependent and independent variables using Fisher’s exact test.ResultsWe collected data at 49 health facilities. Most of these facilities (55.1%) had poor immunization program performance. Proximal location to the central district headquarters was significantly associated with poor immunization program performance (p < 0.05). Attitudes of health workers in the more urban areas, differences in strategies for outreach site selection and community mobilization in the rural and urban areas were suggested as possible explanations.ConclusionsProximal location to the urban setting near district headquarters was strongly associated with poor immunization program performance. To be able to reach larger numbers of children for vaccination, interventions to improve performance should target health facilities in urban settings.

Highlights

Immunization coverage for childhood vaccines is below the immunization target of achieving at least 90% coverage with the pentavalent vaccine
Measurements Data to assess immunization program performance were obtained by reviewing Health Management Information System (HMIS) 105 reports in the District Health Information System version 2 (DHIS2) that spanned a period of six months from January to June 2017 and we reviewed these reports to assess immunization program performance
Health worker attitude The key informants indicated that the health facilities located closer to the district headquarters might put up a poor performance because the health workers there reside in the town, away from their work stations and are more likely to commit less time to immunization activities like outreaches compared to their more rural counterparts

Summary

Introduction

Immunization coverage for childhood vaccines is below the immunization target of achieving at least 90% coverage with the pentavalent vaccine. In Uganda, a recent survey shows 80% of districts had poor immunization program performance. We hypothesized that geographic location of a health facility may influence performance of its immunization programs. The purpose of this study was to examine whether geographical location of a health facility within a district is associated with performance of the immunization program in Hoima district, western Uganda. According to the World Health Organization (WHO), immunization coverage for childhood vaccines is still below the optimum target of achieving 90% or more for coverage with 3 doses of pentavalent vaccine [1, 2]. In Uganda, a WHO report showed 90 out of 112 districts or 80% had poor immunization performance [5]. In only 20% of the districts, at least 80% of the targeted children received all the recommended doses of the lifesaving childhood vaccines

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