The perceptions of mothers and caregivers about the factors affecting low uptake of measles immunisation among children under 5 years in the Nangana District, Namibia
Immunisation is considered to be amongst the most successful and cost-effective disease prevention interventions available. The Expanded Programme on Immunisation (EPI) in Namibia was established in 1990 to ensure that the immunisation of children takes place within the prescribed age frame. However, continued measles outbreaks, particularly in the Kavango region, are evidence of poor EPI progress, with vaccination coverage being below80% per district. The reasons for the low uptake of measles immunisation in the Nyangana district in the Kavango region are not clearly understood. The aim of this study was, therefore, to investigate the perception of mothers/caregivers of factors that impact on the uptake of measles immunisation in the Nyangana Health District, with a view to improving measles immunisation coverage. Methodology: A qualitative exploratory study design was used to collect data from the study participants. In-depth interviews were conducted with 10 mothers of children under 5 years of age, for both children who received, and those who did not receive measles vaccination. Data was audio-taped and transcribed verbatim. The recorded interviews were translated from the Gciriku language to English. Data was analysed through the use of the Thematic Content Analysis approach. The transcribed interviews and narratives from the research assistant’s notes were organised into codes, sub-themes and main themes. In the final phase, themes were integrated and interpreted, by identifying facilitating factors for those who took their children for immunisation, and barriers for those who did not take theirs. The researcher facilitated assistance to children who did not receive their measles dose, to receive it. Ethical requirements were adhered to throughout the research study process. Results: The study showed that mothers had both positive and negative perceptions about immunisation. The findings revealed that information, and past experience of measles ,irrespective of the level of education, support from a spouse or family members, availabilityof services and convenience of time schedules, increased the uptake of immunisation on thepart of mothers/caregivers. However, it also emerged that supply-side factors, such as lack of information sharing between health care providers and mothers, hindered effective communication. Additionally, inconvenient time schedules and time constraints, staffshortages, health care providers’ attitudes, inaccurate data being kept of children immunisedat other health facilities, inadequate outreach services and perceived lack of supervision in the health facilties all contributed to the low uptake of immunisation. Demand-side factors that affected the uptake of immunisation included: socio-economic constraints that led to an inability to pay transport costs to access immunisation services; lack of support from a spouse; other family members and other support structures in the community also impacted on immunisation uptake, despite the reported awareness and willingness to use immunisation services. Conclusions and recommendations: The study concludes that the relationship between health care providers and mothers/caregivers, and support from other social structures, should be good, in order to motivate mothers to use immunisation services. The study recommends that the following aspects be addressed, as they have the potential to improve the low uptake of measles immunisation: patient/provider relationship, information sharing, and supervision in the health facility, access to services, availability of outreach services, improved data tracking and active involvement of all stakeholders. Laziness was overwhelmingly offered as an explanation for missing measles immunisation, although there are suggestions that there might be underlying causes for what is perceived as laziness, which require further exploration, especially in terms of socio-cultural barriers to immunisation. It is recommended that an in-depth look at the perceptions of health care providers and key informants should be conducted to search for further understanding of contributing factors.