Abstract:
ABSTRACT
Background: In Tanzania, measles rubella vaccine second dose (MR2) was introduced into routine immunization program in May 2014 and as of 2016, official national coverage for MR2 vaccine was 71% which is low than recommended coverage in WHO- measles rubella elimination strategic plan (≥95%). This reveals that attaining high coverage of MR2 vaccine is still a challenge. There is significant proportion of eligible children not fully protected against measles and rubella disease and factors influencing non-uptake of MR2 have not been explored enough to develop specific interventions to improve vaccination coverage.
Main Objective: To determine factors associated with non-uptake of measles rubella vaccine second dose among children aged 18-36 months in Kinondoni municipality.
Method: A household based cross-sectional study employing quantitative method with a sample size of 527 children aged 18-36 months was undertaken in Kinondoni municipality, Dar es Salaam, Tanzania during the period of May to June 2018. Four stages cluster sampling technique was used to access the study participants. Face to face, interview using structured questions was used to collect data on factors influencing non-uptake and immunization card information to determine the vaccination status of the child. Interviewed responses were analyzed using Statistical Package for Social Scientist (SPSS) for windows version 22.0 (2013) Armonk, New York (NY), USA. Differences between proportions were examined using chi-square test. Bivariate and multivariate analyses were conducted to identify independent factors associated with non-uptake of MR2. Crudes Odds Ratios (COR) and Adjusted Odds Ratios (AOR) and 95% Confidence Intervals (CI) were calculated. Variables showing associations in bivariate logistic regression (p-value ≤ 0.2) were subjected to multiple logistic regression model using backward elimination, dropping the least significant independent variable until all the remaining predictor variables were significant (p-value ≤ 0.05 and 95% CI not including 1.
Results: In this study, 528 children aged 18-36 months were recruited. The proportion of MR2 vaccine non-uptake was 17.0%. Health promotion talk (AOR=2.24, 95% CI= 1.52 – 5.31, P-value =0.02) and awareness on MR2 vaccine (AOR=4.90, 95% CI=1.24 – 19.3, p=0.002) showed statistical significant association with non-uptake of MR2 vaccine.
Conclusion: Seventeen percent of the eligible children were not vaccinated with MR2 vaccine. Inadequate health promotion talks and caretaker’s awareness on MR2 vaccine contributed significantly to the non-uptake of MR2 vaccine. This study recommends for Immunization and Vaccine Development Program (IVD) to ensure that promotional talks on vaccine are conducted at both health facility and community levels focusing on the importance of vaccination and the need to abide to vaccination schedule. In addition, the Program need to strengthen identification of vaccine defaulters when they visit health facility for treatment or preventive services.
