What are the barriers and facilitators of on-time measles vaccination in Uganda?

Abstract

Measles is a highly contagious, vaccine-preventable disease, and on-time vaccination is essential for achieving the full benefit of measles-containing vaccines. In recent years, Uganda has experienced measles outbreaks in both urban and rural areas. Investigating the prevalence of and risk factors associated with delayed measles vaccination is an important step toward addressing vaccination barriers and improving on-time measles vaccination coverage. This dissertation characterizes factors associated with on-time measles vaccination in Uganda, defined as vaccination at nine months of age.For manuscript 1 and 2, we conducted a population-based, door-to-door survey of 999 mothers living in Kampala, Uganda. The survey included questions on mothers’ use of their child’s vaccination document, experience seeking vaccination for their child, and the child’s date of measles vaccination. In manuscript 1, we characterized mothers’ retention and use of their child’s vaccination document and evaluated the association between use of the document and achieving on-time measles vaccination for their child. In manuscript 2, we described and characterized potential transportation-related barriers to vaccination and evaluated the association between these barriers and mothers’ ability to achieve on-time measles vaccination for their child. Lastly, for manuscript 3, we used data from the 2016 Uganda Demographic and Health Survey to assess the relationship between mothers’ perceived barriers to healthcare and their ability to achieve on-time measles vaccination for their child. This was evaluated overall, and by urban/rural status. Demographic factors of the mother and child and certain barriers to healthcare were associated with failure to achieve on-time measles vaccination. Overall, our findings contribute to the understanding of the specific factors that influence on-time measles vaccination in this setting. This informs the design of interventions to improve the timing of childhood vaccinations in the future.