East Africa Centre for Vaccines and Immunization (ECAVI), Kampala, Uganda.
Makerere University, Department of Paediatrics & Child Health, Kampala, Uganda.
PLoS One. 2019 Feb 14;14(2):e0212270. doi: 10.1371/journal.pone.0212270. eCollection 2019.
Hoima, one of the largest districts in mid- western Uganda, has persistently performed poorly with low immunization coverage, high immunization drop outs rates and repeated outbreaks of vaccine preventable diseases especially measles. The objectives of this study were to evaluate the state of immunization services and to identify the gaps in immunization health systems that contribute to low uptake and completion of immunization schedules in Hoima District.
This was a cross sectional mixed methods study, utilizing both qualitative and quantitative approaches. A situation analysis of the immunization services was carried out using in-depth interviews with vaccinators, focus group discussions and key informant interviews with ethno-videography. Secondary data was sourced from records at headquarters and vaccination centres within Hoima District. The quantitative component utilized cluster random sampling with sample size estimated using the World Health Organization's 30 cluster sampling technique.
A total of 311 caretaker/child pairs were included in the study. Immunization completion among children of age at least 12 months was 95% for BCG, 96% for OPV0, 93% for DPT1, 84.5% for DPT2, 81% for DPT3 and 65.5% for measles vaccines. Access to immunization centres is difficult due to poor road terrain, which affects effectiveness of outreach program, support supervision, mentorship and timely delivery of immunization program support supplies especially refrigerator gas and vaccines. Some facilities are under-equipped to effectively support the program. Adverse Events Following Immunization (AEFI) identification, reporting and management is poorly understood.
Immunization services in Hoima District require urgent improvement in the following areas: vaccine supply, expanding service delivery points, more health workers, transport and tailored mechanisms to ensure adequate communication between health workers and caretakers.
霍马是乌干达中西部最大的地区之一，其免疫接种覆盖率一直很低，免疫接种率居高不下，疫苗可预防疾病（尤其是麻疹）反复爆发。本研究旨在评估免疫服务状况，并确定导致霍马地区免疫接种率低和接种计划完成率低的免疫卫生系统差距。
这是一项横断面混合方法研究，同时使用定性和定量方法。利用疫苗接种者的深入访谈、焦点小组讨论和民族志录像的关键知情人访谈，对免疫服务进行了情况分析。从霍马区总部和疫苗接种中心的记录中获取了二级数据。定量部分采用了集群随机抽样，使用世界卫生组织的 30 个集群抽样技术来估计样本量。
共有 311 对看护人和儿童参与了研究。12 个月以上儿童的免疫接种完成率为 BCG 疫苗 95%，OPV0 疫苗 96%，DPT1 疫苗 93%，DPT2 疫苗 84.5%，DPT3 疫苗 81%，麻疹疫苗 65.5%。由于路况不佳，前往免疫接种中心的机会有限，这影响了外展计划、支持监督、指导以及及时提供免疫规划支持用品（特别是冰箱气体和疫苗）的有效性。一些设施设备不足，无法有效支持该计划。疫苗接种后不良反应（AEFI）的识别、报告和管理理解较差。
霍马地区的免疫服务需要在以下方面紧急改进：疫苗供应、扩大服务提供点、增加卫生工作者、运输和定制机制，以确保卫生工作者和看护人之间的充分沟通。
