Uptake of measles vaccination services and associated factors among under fives in Temeke district, Dar es salaam region, Tanzania

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.