Barriers to reaching the Zero-Dose and Under Immunized Children in Uganda: a qualitative rapid assessment.

BackgroundDespite great strides made in improving immunization coverage in Uganda, the burden of under-immunized (UI) and zero-dose (ZD) children remains high, increasing the risk of Vaccine Preventable Disease outbreaks. This study explored the barriers to reaching ZD and UI children in selected high-burden communities in Uganda. MethodsThis cross sectional qualitative rapid assessment study was conducted in three high-burden districts--Kasese, Mubende, and Wakiso in Uganda The study received ethical approval, and all participants were consented before interview. Data were collected through key informant interviews with local leaders, district health team members, health workers and village health team members, as well as in-depth interviews with caregivers of children aged 18 weeks to 23 months. The collected data were analyzed thematically with the aid of NVIVO 14 (QSR International). Results are presented in themes and subthemes and supported by verbatim quotations where necessary. ResultsThe study identified a range of demand and supply-side barriers hindering access to immunization for ZD and UI children in Uganda. These barriers are reported under seven themes namely: limited physical access to immunization services; inadequate client-centered immunization services (Long waiting time at health facilities, poor health worker attitudes, immunization-related costs); vaccine stockouts; fear of adverse events following Immunization; limited spousal support; myths and misconceptions related to immunization; and persistent home-based births or deliveries. ConclusionUnderstanding the barriers to immunization uptake among zero-dose and under-immunized children is a critical foundation for strengthening vaccination coverage and reducing the incidence of VPDs in Uganda. This rapid assessment conducted in Kasese, Mubende, and Wakiso districts highlights both demand and supply side challenges that hinder access and utilization of immunization services. Addressing these barriers requires coordinated, multi-sectoral approaches that are both comprehensive and contextually grounded.