Abstract
BackgroundChildhood vaccination is an important public health intervention but there is limited information on coverage, trends, and determinants of vaccination completion in Uganda at the regional level. We examined trends in regional vaccination coverage and established the determinants of vaccination completion among children aged 12-23 months in Uganda.MethodsWe analyzed data from the women’s questionnaire for the 1995-2016 Uganda Demographic Health Survey (UDHS). Vaccine completion was defined as having received a dose of Bacillus-Calmette Guerin (BCG) vaccine; three doses of diphtheria, pertussis, and tetanus (DPT) vaccine; three doses of oral polio vaccine (OPV) (excluding OPV given at birth); and one dose of measles vaccine. We performed Chi-square tests to compare vaccination completion by socio-demographic factors stratified by 10 sub-regions: Eastern, East Central, Central 1, Central 2, Kampala, Karamoja, North, Western, West Nile, and Southwest. We performed logistic regression analysis for each of the regions to identify factors associated with vaccination completion at 5% level of statistical significance.ResultsOverall vaccination completion was 48.6% (95%CI, 47.2, 50.1) and ranged from 17.3% in Central 1 to 65.9% in Southwest. Vaccination completion rates declined significantly by 10.4% (95% confidence interval (CI), − 16.1, − 4.6) between 1995 and 2000, and increased significantly by 10.0% (95% CI, 4.6, 15.4) between 2000 and 2006, and by 5.4% (95% CI, 0.2, 10.6) between 2006 and 2011. Maternal education (secondary or higher level), receipt of tetanus toxoid (TT) during pregnancy, and possession of a child health card were associated with vaccination completion across all the sub-regions. Other factors like place of residence, religious affiliation, household wealth, maternal age, childbirth order, size of child at birth, and place of delivery were associated with vaccination completion but differed between the 10 sub-regions.ConclusionBesides considerable regional variations, the vaccination completion rate among children aged 12-23 months in Uganda remains suboptimal despite the availability of vaccines. Maternal education, receipt of TT, and possession of a child health card are associated with a higher likelihood of vaccination completion among children aged 12-23 months in all the regions of Uganda. Interventions to improve the utilization of vaccination services in Uganda should consider these factors.
Highlights
Childhood vaccination is an important public health intervention but there is limited information on coverage, trends, and determinants of vaccination completion in Uganda at the regional level
We aim to describe the regional trends in vaccination coverage and to identify the determinants of vaccination completion at the regional level among children aged 12-23 months in Uganda using data from Demographic Health Surveys datasets from 1995 to 2016
The proportions ranged from 28.2% in East-Central sub-region to 64.2% in Southwest sub-region in 1995; from 17.3% in Central 1 sub-region to 47.6% in Southwest sub-region in 2000; from 38.9% (95%Confidence interval (CI), 30.7, 47.9) in East-Central to 52.7% (95%CI, 41.6, 63.4) in Western sub-region in 2006; from 38.6% (95%CI, 29.4, 48.7) in East-Central to 67.5%, (95%CI, 54.4, 78.3) in Kampala in 2011; and from 45.0% (95%CI, 35.8, 54.5) in East-Central to 65.9% (95%CI, 59.1, 72.1) in Southwest in 2016 (Table 1), Karamoja subregion was excluded due to small sample size
Summary
Childhood vaccination is an important public health intervention but there is limited information on coverage, trends, and determinants of vaccination completion in Uganda at the regional level. Despite interventions to improve vaccination coverage and the subsequent achievements gained in the last 5 years (2008-2014), the third dose coverage of the diphtheria, pertussis, and tetanus (DPT3) vaccine in sub-Saharan Africa (SSA) has plateaued at 72% [2]. Coverage, and vaccination completion in Uganda, UNEPI has instituted several vaccination strategies such as community-based outreaches, home-based vaccination, child day plus, and mass immunization campaigns that have been employed over the years. Despite these strategies, vaccination coverage in Uganda has remained relatively low over the past years. DPT-3 and the first dose of measles vaccine coverage have stagnated at 79 and 80%, respectively [3]
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