Factors Affecting Immunization Coverage of Children under Five Years in Elashabiyaha District, Lower Shabelle Region, Somalia

ABSTRACT 

Background: Elashabiyaha is one of the largest districts in Lower Shabelle region Somalia who has accommodated one of the most populous Somali IDPs camps. Only 30% of children are immunized against the six major childhood diseases. These are far below the targeted average percentage of 80%. This study was conducted to explore cunent immunization coverage of the children under five years in Elashabiyaha and to assess factors affecting immunization coverage of the child~en under five years in Elashabiyaha district. 

Objectives: The study aimed to assess factors affecting immunization coverage of children under five years in Elashabiyaha district lower Shabelle region Somalia. Methods: A descriptive cross-sectional study was conducted to detem1ine the factors affecting immunization coverage in Elashabiyaha district. Researcher administered questionnaire was used to interview 330 of household heads in Elashabiyaha district. Univariate analysis was done to find out the percentage of the cunent immunization coverage. Bivariate analysis was done to assess the factors affecting immunization coverage .Logistic regression was then used to adjust for the effect of the confounding factors and to make multivaraiate analysis on different significant factors. 

Results: Immunization coverage is 43.8% and there was 2 times more likely for household heads who believe in traditional healers as an altemative not to immunize their children [95% CI 1.315-3.370: p=0.002] than those who reported not believing in traditional healers. And also it was 2 times more likely for household heads who were lacking outreach immunization services not to immunize their children [95% CI 1.082-2.764: p=0.022] than those reported accessing outreach immunization services. Conclusion~ Low immunization coverage at only 43.8% was found. Lack of outreach inununization services, cultural beliefs such as believing that traditional healers are better than inununization services and believing that westems spread diseased through immunization were assessed as factors that were associated with low immunization coverage in the study area. Recommendations: Better understanding of local perceptions and behavior related to immunization, building health education programs upon traditional beliefs and practices and expansion of outreach sites were recommended. The govemment, local, international NGOs and health professionals need to introduce immunization services to the community, make immunization services affordable, available, accessible and all the wrong beliefs and misconceptions need to be eradicated.

TABLE OF CONTENTS

Declaration ............................................................................................................................................. i

Approval ............................................................................................................................................... ii

Dedication ............................................................................................................................................ iii

Acknowledgement ............................................................................................................................... iv

Table of contents ................................................................................................................................... v

List of Appendices ............................................................................................................................. viii

List of Figures ...................................................................................................................................... ix

List of Tables ........................................................................................................................................ x

List of Acronyms ................................................................................................................................ xi

Operational Definitions ....................................................................................................................... xii

Abstract .............................................................................................................................................. xiii

CHAPTER ONE: INTRODUCTION ................................................................................................... 1

1.0 Introduction .................................................................................................................................... 1

1.1 Background .................................................................................................................................... 1

1.1.1 Historical Background ................................................................................................................ I

1.1.2 Theoretical Backgroud ................................................................................................................ J

1.1.3 Conceptual Background ............................................................................................................. 4

1.1.4 Contextual Backgroud ................................................................................................................ 5

1.2 Problem Statement ......................................................................................................................... 6

1.3 Study Objectives ........................................................................................................................... 7

1.3.1 General Objectives ..................................................................................................................... 7

_I .3.2 Specific Objectives ...................................................................................................................... 7

1.4 Research Questions ......................................................................................................................... 7

1.5 Scope of the Study ......................................................................................................................... 8

1.5.1 Content Scope ............................................................................................................................. 8

1.5.2 Geographical Scope .................................................................................................................... 8

1.5.3 Time Scope ................................................................................................................................. 8

1.6 Significance of the study ................................................................................................................ 8

1.7 Conceptual Framework .................................................................................................................. 9

1.8 Explanation ofThe Conceptual framework .................................................................................. 10

CHAPTER TWO: LETERATURE REVIEW .................................................................................... 11

2.0 Introduction ................................................................................................................................... 11

2.1 Immunization Profile of Somalia .................................................................................................. 11

2.2 Immunization Coverage of BCG, DPT,POLIO AND MEALES ................................................ 12

2.3 Accessibility oflmmunization Services and Factors Affecting Immunization services ............. 12

2.4 Culturall Factors Affecting Immunization Coverage ................................................................... 1 3

2.5 Political Factors Affecting Immunization Coverage .................................................................... 1 5

CHAPTER THREE: METHODOLOGY ........................................................................................... 16

3.0 Introduction ................................................................................................................................... 16

3.1 Study Design ................................................................................................................................. 16

3.2 Study Area ................................................................................................................................... 16

3.3 Study Population .......................................................................................................................... 16

3.4 Sample Size Determination ........................................................................................................... 17

3.4.1 Sampling Procedure ................................................................................................................... 17

3.5 Inclusion and Exclusion Criteria ................................................................................................... 18

3.5.1 Inclusion Criteria ....................................................................................................................... 18

3.5.2 Exclusion Criteria ...................................................................................................................... 18

3.6 Study Variables ............................................................................................................................ 18

3.7 Data Collection Tools .................................................................................................................. 18

3.7.1 Data Collection Procedure ......................................................................................................... 19

3.7.2 Data Handling and Storage ........................................................................................................ 1 9

3.7.3 Data Analysis and Presentation ................................................................................................. 19

3.8 Data Quality Control .................................................................................................................... 19

3.9 Ethical Consideration ................................................................................................................... 20

3.9.1 Institutional Consent ................................................................................................................ 20

3.9.2 Informed Consent.. ..................................................................................................................... 20

3.9.3 Community Advisory Groups .................................................................................................... 20

3.10 Study Limitations/Delimitations ................................................................................................. 2()

CHAPTER FOUR: PRESENTATION, ANALYSIS AND INTERPRETATION OF DATA ......... 22

4.0 Introduction ................................................................................................................................... 22

4.1 Socio-d~mographic Charactetistics of the Respondents ............................................................... 22

4.2 Immunization Status of the Child ................................................................................................. 24

4.3 Accessibility of Immunization Servicces ...................................................................................... 24

4.4 Cultural Beliefs of The Community Affecting Immunization Services ....................................... 27

4.5 Political Factors Affecting Immunization Services ...................................................................... 29

4.6 Multivariate Analysis .................................................................................................................... 30

CHAPTER FIVE: DISCUSSION,CONCLUSION AND RECOMMENDATIONS ......................... 32

5.0 Introduction ................................................................................................................................... 32

5.1 Discussion of the Results .............................................................................................................. 32

5.1.1 Immunization Status .................................................................................................................. 32

5.1.2 Accessibility ofimmunization Services And Factors Affecting Immunization Services ......... 32

5.1.3 Cultural Beliefs Affecting Immunization Coverage ................................................................. 33

5.1.4 Political Factors Affecting immunization Coverage ................................................................. 34

5.2 Conclusion ................................................................................................................................... 34

5.2.1 Immunization Coverage ............................................................................................................. 34

5.2.2 Accessibility of immunization services Conclusion .................................................................. 34

5.2.3 Cultural beliefs affecting immunization coverage ..................................................................... 35

5.2.4 Political factors affecting immunization coverage .................................................................... 35

5.3 Recommendations ......................................................................................................................... 35

5.3.1 Accessibility of immunization services ..................................................................................... 35

5.3.2 Cultur,al Factors Affecting Itmnunization Servicces ................................................................. 35

5.3.3 Political Factors Affecting Immunization Services ................................................................... 35

Referrence ........................................................................................................................................... 3 6