Abstract
BackgroundOverall, 1.8 million children fail to receive the 3-dose series for diphtheria, tetanus and pertussis each year in the Democratic Republic of the Congo (DRC). Currently, an emergency plan targeting 9 provinces including Kinshasa, the capital of the DRC, is launched to reinforce routine immunization. Mont Ngafula II was the only health district that experienced high vaccination dropout rates for nearly five consecutive years. This study aimed to identify factors predicting high immunization dropout rates among children aged 12-23 months in the Mont Ngafula II health district.MethodsA cross-sectional household survey was conducted among 418 children in June-July 2019 using a two-stage sampling design. Socio-demographic and perception data were collected through a structured interviewer-administered questionnaire. The distribution of 2017-2018 immunization coverage and dropout rate was extracted from the local health district authority and mapped. Logistic random effects regression models were used to identify predictors of high vaccination dropout rates.ResultsOf the 14 health areas in the Mont Ngafula II health district, four reported high vaccine coverage, only one recorded low vaccine coverage, and three reported both low vaccine coverage and high dropout rate. In the final multivariate logistic random effects regression model, the predictors of immunization dropout among children aged 12-23 months were: living in rural areas, unavailability of seats, non-compliance with the order of arrival during vaccination in health facilities, and lack of a reminder system on days before the scheduled vaccination.ConclusionsOur results advocate for prioritizing targeted interventions and programs to strengthen interpersonal communication between immunization service providers and users during vaccination in health facilities and to implement an SMS reminder system on days before the scheduled vaccination.
Highlights
Overall, 1.8 million children fail to receive the 3-dose series for diphtheria, tetanus and pertussis each year in the Democratic Republic of the Congo (DRC)
This study showed that half of the health areas in the Mont Ngafula II health district had high dropout rates
Unavailability of seats and non-compliance with the order of arrival during vaccination in health facilities, and the absence of a reminder system on days before the scheduled vaccination were the predictors of high vaccination dropout rates among children aged 12-23 months
Summary
1.8 million children fail to receive the 3-dose series for diphtheria, tetanus and pertussis each year in the Democratic Republic of the Congo (DRC). This study aimed to identify factors predicting high immunization dropout rates among children aged 12-23 months in the Mont Ngafula II health district. Considered a key indicator of immunization program performance [4, 5], the third dose of vaccine against diphtheria, tetanus and pertussis (DTP3) has not been administered to 19.7 million children worldwide in their first year of life in 2019 [6]. In the DRC, 1.8 million children fail to receive the three-dose DTP series each year despite improvements in national DTP3 coverage from 25% to 1999 to 81% in 2018 through the partnership with the Vaccine Alliance [8]. Poliomyelitis, yellow fever, and measles outbreaks have been reported across the country over the last ten years [11,12,13,14,15]
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