Determinant Of Childhood Immunization Dropout Rates

Abstract

Routine childhood immunization is one of the most effective public health interventions for preventing vaccine-preventable diseases, reducing child morbidity and mortality, and strengthening population immunity. However, children who begin vaccination but fail to complete the recommended schedule remain vulnerable to measles, diphtheria, pertussis, tetanus, polio, hepatitis B, Haemophilus influenzae type b, rotavirus and other preventable conditions. Immunization dropout is a sensitive indicator of continuity of care and programme follow-up. The present thesis was undertaken to assess determinants of childhood immunization dropout rates among children aged 12-23 months, with special attention to maternal education, socioeconomic status, birth order, migration, distance from session site, antenatal care, institutional delivery, immunization card retention, caregiver knowledge, reminder systems and health-service barriers. An analytical community-based cross-sectional study approach was used. The study population included caregivers of children aged 12-23 months from selected urban, peri-urban and rural field practice areas. Data were collected using a structured questionnaire, immunization card review, maternal and child protection card verification and health-system assessment. Data were analysed using frequencies, percentages, chi-square tests, odds ratios and multivariable logistic regression. A p value less than 0.05 was considered statistically significant. Among 300 children included in the analysis, 84 children were classified as dropout and 216 children had completed age-appropriate immunization. The overall dropout proportion was 28.0%. Higher dropout was observed among children of mothers with no formal or primary education, low socioeconomic status, higher birth order, rural or peri-urban residence, distance more than 5 km from session site, fewer than four antenatal visits, home delivery, unavailability of MCP card, low caregiver knowledge, absence of ASHA/ANM reminders, vaccine session cancellation, fear of adverse events and recent migration.