Abstract:
Background: Measles outbreaks have been recurring in Tanzania despite
ongoing efforts in immunization. In May 2011, there was a large Measles
outbreak in the Temeke district, Dar es salaam where a total 588 cases were
reported. The investigation found that a large percentage of underfives had not
received measles vaccination. Although measles vaccination coverage figures
are easily available, information about factors affecting uptake of measles
vaccination services is not easily available. In order to plan and implement
interventions that aim to improve uptake of measles vaccination services,
information on the determinants of measles uptake level such as community,
health facility, household and children factors is needed. This study investigated
the factors associated with the low uptake of vaccination services in Temeke
district.
Methods: A cross-sectional survey was conducted to assess the uptake of
measles vaccination services and associated factors among children aged 12-23
months. Uptake of measles vaccination services was defined as the act of taking
a child for vaccination which shows the level of acceptance of vaccination
services by a caretaker. Uptake of measles vaccination was categorized into two
groups; Low uptake and high uptake of vaccination services. Any child who
had received both routine and supplementary measles vaccines was said to have
high uptake and a child was said to have a low uptake of vaccination services if
he/she had received either routine or supplementary only or neither of the two
vaccines. Household and children determinants of low uptake for measles
services were assessed. Bivariate and multivariate logistic regression were
performed to identify significant determinants of low uptake. Analysis was
done using EpiInfo version 3.5.1.
Results: A total of 295 children aged between 12-23 months were involved in
the study. The mean age was 17 months. A total of 82 out 295 (27.8%) children
had received either routine or supplementary vaccine or neither of the twovaccine i.e had a low uptake of vaccination services. A total of 23 (7.8%) out of
295 children had not received routine measles vaccination while 66 out of 295
(23.4%) children had not received supplementary measles vaccination. The
number of children who neither received routine nor supplementary
vaccinations was 9 out of 295 (3%). Factors which were significantly associated
with low uptake of vaccination services were younger age of the child
(Adjusted Odds Ratio (AOR) 2.11 CI 1.10-4.38), low education level of the
caretaker (AOR 3.36 CI 1.17-9.62), caretaker’s lack of knowledge on the
purpose of supplementary measles vaccine (AOR 2.04 CI 1.06-3.93),
caretaker’s lack of knowledge of the age for routine measles vaccination (AOR
4.71 CI 2.47-8.99), residing in a ward where there are high measles cases (AOR
2.29 CI 1.23- 4.27) and residing in a ward less than 2 years duration (AOR 2.24
CI 1.12-4.48).
Conclusions: The uptake of both routine and supplementary measles vaccine is
below the Tanzania estimated coverage. Household and childhood factors
played a role in determining the uptake of measles vaccination services. There
is a need for the DHMT to revisit the Health education sessions during RCH
services covering vaccine preventable diseases and identify gaps to be
addressed. The team should also find out reasons behind mothers not sending
children for vaccination especially supplementary vaccines.
