Immunisation Decision-Making and Barriers to Vaccine Uptake among Children Under-5 in Low-Resource Settings

BackgroundSince the turn of the millennium, childhood immunisation against preventable infectious diseases in sub-Saharan Africa (SSA) has experienced unprecedented growth. However, immunisation coverage remains a fundamental challenge in the region, which still has the highest under-five mortality rate in the world, due to wide-ranging drivers that have complicated interventions. Low immunisation coverage will continue to plague the region unless the knowledge-gaps associated with childhood immunisation decision-making are identified, studied, measured and addressed. Therefore, the aim of this study is to assess the factors that influence immunisation decision-making among caregivers of children under-5 years old, and to understand the behaviours that shape these influences. MethodsThe study used qualitative methods such as focus group discussions. Participants were caregivers of children under-5 years old in Nigeria. Simplified cluster sampling approach was used to select caregivers in four geographical clusters. A minimum of seven caregivers from each cluster were purposively included. Data were analysed deductively using meta-aggregation approach. ResultsThe study findings show that caregivers immunisation decision-making are mainly motivated by: inadequate knowledge about childhood immunisation, especially the conflict between vaccine-preventable and non-vaccine-preventable diseases; masculinity (attitudes of fathers or men can help or hinder immunisation); the gender of child (the perception of weaker versus stronger sex); misinformation about immunisation, especially the perception that it is family planning through the backdoor). Other influences include exploitation of caregivers by healthcare workers; incessant stock-outs of vaccines leading to complacent behaviour associated with vaccine hesitancy; ineffective communication about immunisation schedule and poor reminder systems; religious beliefs; poor attitudes of healthcare workers and more. ConclusionThe factors that influence immunisation decision-making in low-resource settings and the motivations that shape these behaviours are largely psychological, sociocultural, behavioural, health system and structural. Designing interventions that address the root causes of gender inequity must start with the attitudes of men and the socio-cultural practices that enable them. Furthermore, the sandwich model for addressing vaccine misinformation can be effective in countering myths and conspiracies about vaccines.