Research proposal
PRESENTATION AND INTEPRETATION OF RESULTS
3.0 . Overview
This section covers the study’s findings, the interpretations, and a summary of the findings respectively. The study focused on how the p-factors affects EPI service adherence and compliance especially in routine immunization schedules. House to house study questionnaires were used, and the diverse responses to the Likert scale-based “Agree and Disagree” study questions were evaluated using a thematic method of the research objectives. The various outcomes of the study data were reviewed and presented in the following tables and charts.
3.1 . The Response rates, adherence and compliance of mothers and caregivers to EPI services
Through an appropriate engagement with the community leaders right from the municipal to the household levels before and during the study period, the results achieved surpassed the planned target and the study managed to reached 341/323 (105.5%) households. This study intended to understand the thematic factors of mothers and caregivers who adhered and complied with routine immunisation scheduled at their various EPI service points in the period Jan -December 2021. Overall, 84% of mothers and caregivers were able to finished routine EPI services while about 16% didn’t complete their routine EPI schedules as required.
The completion as a result of adherence and compliance to routine EPI service against defaulting is shown in the results chart below.
Figure 4. 1Adherence and compliance to EPI rate amongst mothers and caregivers in Pager Cell, Kitgum Municipality, May 2024.
3.2 . Socio-Demographic characteristics of respondents
3.2.1 Distribution of respondents by gender
The proportion by sex 07(2%) males and 334 (98%) females were reached during the study. Response rate in social research have been a discussion of concern since the turn of the 21st Century. Until the end of 2020, there is a conclusion that a response rate of 68% and above would provide a generalisable results that can be used to give meaningful interpretation to study outcome, hence this response rate was extremely appropriate to provide a hypothetical conclusion on this study(Brooks Holtom, Yehuda Baruch, Herman Aguinis, Gary A Ballinger, 2022). This also indicates how readily community are becoming aware and interested in participating in community health surveys. But equally it demonstrates how the male counterpart is less concern in child health yet they are having a due responsibility on child health and general development.
The response rate disaggregation by gender is as shown in the table below.
| Frequency | Percent | ||
| Valid | Male | 7 | 2.1 |
| Female | 334 | 97.9 | |
| Total | 341 | 100 |
Table 4.1 The respondent’s aggregation by gender
3.2.2 The Age group of Respondents in the study
Overall, majority 151 (44.3%) were respondents in 26-35 age group while those in 19-25 and 36-45 were equally between 60-80 (18.5% and 25.2%) by proportion. Less than 30 and 20 were those in the age group below 18 years of age and those above 45 years of age. This result could be an indication that there are high teenage pregnancies in the area given the municipal statistics recently showed that in 2019 there were over 2,000 teenage pregnancies. However, on the opposite end those above 45 years of age taking care of children could be an indication of many widowed or orphaned children in the community whose responsibility are in the care of elders as relatives or NOK.
The figure below shows the respondents age bracket during the study.
Figure 4.2. The Respondents Age Group in the study, May 2024.
3.2.3 The Education level and employment status of the Respondents in the study
More than 70% of the respondents were having little or no formal education. That is 135 (39.6%) had certificate of education which is either primary (PLE) or senior four (O’Level) while 117 (34.3%) had no formal education at all. Meaning they have neither attained PLE or O’Level of education in the Ugandan system of education. This result also showed that outside the urban cities for example Gulu and Kampala, there is probably high level of illiteracy among mothers. While those with diploma, Bachelors and Masters were only 89 (53, 26, and 10) (15.5, 7.6, and 2.9%) respectively and constituting less than 30% of the mothers and caregivers reached during the study.
The study was able to understand the employment status of the mothers and households’ heads as shown in the chart below. Majority of the mothers and caregivers 111(32.6%) are self-employed while employed and not employed are 95 (27.3%) and 100 (29.7%) respectively. Only 35 (10.3%) are considered others that is they are living without any clear source of daily income for the family. This result also showed how mothers as household heads form majority of the informal sector to raise a living for their children. It further indicates how vulnerable they may be in term of power in the society and other resource holding in the house.
The education level and employment status of the respondents is shown in table below.
| Frequency | Percent | Frequency | Percent | ||
| No Education | 117 | 34.3 | Self Employed | 111 | 32.6 |
| Certificate | 135 | 39.6 | Employed | 95 | 27.9 |
| Diploma | 53 | 15.5 | Not Employed | 100 | 29.3 |
| Bachelors | 26 | 7.6 | Others | 35 | 10.3 |
| Masters | 10 | 2.9 | |||
| Total | 341 | 100.0 | 341 | 100 |
Table 4.2. The level of education and employment status of the respondents, May 2024
3.2.4 Marital status of the respondents in the study
275(80.6%) of the household reached were married and recognised in the community while the rest of the 20% constituted single, divorced, widowed, and others. In Acholi community though there are high level of poverty and little education, people get engaged and marry before settling to start having children. In fact, many of the girls once pregnant is sent to the home of the child’s father irrespective of whether he (the father) is around or not. Therefore, the community still practice a very strong traditional and cultural habit of marriage and responsible living in the family.
This is shown in the Table below.
| Marital Status (n=341) | |||||
| Frequency | Percent | Valid Percent | Cumulative Percent | ||
| Valid | Single | 20 | 5.9 | 5.9 | 5.9 |
| Married | 275 | 80.6 | 80.6 | 86.5 | |
| Divorce | 17 | 5.0 | 5.0 | 91.5 | |
| Widow | 14 | 4.1 | 4.1 | 95.6 | |
| Others | 15 | 4.4 | 4.4 | 100.0 | |
| Total | 341 | 100.0 | 100.0 | ||
Table 4. 3. The marital status of respondents interviewed, Pager Cell Division, May 2024.
3.2.5 The number of children and child’s number in each of the household of the Respondents in the study
Majority of household 140 (41.1%) has at least 3 children, 80 (23.5%) has two children, while 46, 41, and 34 (13.5, 12.0, and 10.0%) has one, four, or more than five children in the house. This is similar to the child’s number during the study time. Majority of the household has at least their 3rd child 132 (38.7) defaulted or completed, while 94 (27.6%) had defaulted or completed routine schedule. Only 47, 37, and 31 (13.8, 10.9, and 9.1%) had either defaulted in their first child, fourth, or fifth child.
The table below shows the children’s number and each child number in the study of the respondents at Pager Cell, Kitgum Municipality.
| # of Children’s | Frequency | Percent | Childs # | Frequency | Percent |
| 1 | 46 | 13.5 | 1 | 47 | 13.8 |
| 2 | 80 | 23.5 | 2 | 94 | 27.6 |
| 3 | 140 | 41.1 | 3 | 132 | 38.7 |
| 4 | 41 | 12.0 | 4 | 37 | 10.9 |
| 5+ | 34 | 10.0 | 5+ | 31 | 9.1 |
| Total | 341 | 100.0 | 341 | 100.0 |
Table 4.4. Number of children and children in the household, Pager Cell, Kitgum, May 2024.
3.2.6 The distance to health facility, Pager Cell in Kitgum Municipality, Uganda
The study showed that more than fifty percent travel for more than one hour to the nearest health facility, while 84 (24%) and 74 (22%) can spend 30 minutes to one hour by foot to the nearest health facility for child health services. This is an indication that where innovative services approach such as out-post or outreaches are not available for any reasons, there is a likelihood of the mothers and caregivers not taking their child for immunisation.
The chart below shows the average walking time to the nearest health facility for each of the household reach in Pager Cell, Kitgum Municipality.
Figure 4.3. Average walking time by foot to the nearest health facility for each respondent’s household in Pager Cell, Kitgum Municipality, May 2024.
3.3 . Providers and parental factors affecting vaccine uptake
The first objective of the study examines the relationship between defaulting or completion of routine immunisation schedule among mothers and caregivers in Pager Cell Division against several factors associated with all parents and providers of EPI services. Such factors included; knowledge, culture, religion, race, sex, locations, age, and education of parents or providers in provision or utilisation of EPI services.
The findings from the study showed that education 233(68.3%), knowledge 317(93.0%), and locations 301 (88.3%), religion 185(54.3%) highly influence completion of routine immunisation schedules whereas age 91(26.7%), race 94 (27.6%), sex 105 (30.8%), and culture 116 (34.0%) may or may not influence immunisation defaulting or completion according to the study participants. Education to either parents or providers means having adequate knowledge or skills for understanding the importance of vaccines or making the right decision which affects service quality and uptake, therefore, if a mother is highly educated and have adequate knowledge on the benefits of EPI services for her child growth and development, she will not default from service uptake; similarly a provider who has adequate education and trainings on EPI service provision will enhance and provides quality EPI services which promotes general child health services uptake by the population hence reducing the drop-out rate among children’s under-fives.
Similarly, both parents and providers may be affected by their locations in relations to facility service point, hence negatively affecting adherence and compliance to routine immunisation service provision or uptake. However, because among African parents’ tradition and cultures are highly protective and conservative for every society, there is a negative influence on the service uptake of EPI among parents and providers who has high beliefs and values for their cultures and traditions. Similarly, the age, sex, and race may negatively affect EPI service adherence and compliance especially where a culture of use of traditional medicine for childhood illness is common among communities.
The results are as shown below in the figure.
Figure 4.4. Providers and parental factors influencing routine immunization adherence and compliance, Pager Cell Division, Kitgum Municipality, May 2024.
3.4 . Procedures and practices affecting vaccine uptake
In the second objective of this study, the researcher intended to understand factors such as operating hours, HR skillset, Vaccine stocks, EPI tools availability, Client-Centred care, and cost of facility operations have a relationship with parents defaulting of adhering and complying to routine schedule for immunisation. The findings showed that operating hours 304(89.1%), vaccine stock availability 292 (85.6%), HR skillsets 242 (71.0%), EPI tools being used and available 244 (71.6%), and client-centred care 219 (64.2%) highly influence adherence and compliance to routine immunisation amongst mothers and caregiver of children aged 0-18 months in Pager Cell Division.
This finding is an indication that parents and caregivers of children understand the implication of operating hours to such child health services and belief that for a facility to provide a quality child friendly service, there should be adequate number of health workforce in the EPI departments, the facility should have adequate stock of vaccines available and with enough tools for service provision- syringes, child health cards, cool boxes, and ice packs.
However, because EPI and other related child health services such as deworming, nutrition screening are provided for free, respondents perceived cost 166 (48.7%) directly related to access of such services as minimal and more than half disagree with cost being factor leading to default of routine EPI services. Because client-centred care is yet a new healthcare delivery approach and many rural or under-developed societies doesn’t understand the meaning very well, the participants were only sure in their responses and this signifies that there is need for more advocacies to enable health services users understand the concept of client-centred care for a better understanding of whether a child health service is poor or not.
The results are as shown in the table below.
Figure 4.5. Procedures and practice factors affecting EPI adherence and compliance amongst mothers and caregivers in Pager Cell Division, May 2024.
3.5 . Policy and program impact on adherence and compliance to routine EPI
Policy and program are broader and more foundational aspects of program that can promotes sustainable service delivery because they act as pillars of existing program and strengthen the overall program lifecycle. Under the third objectives, both policy and other program administrative goals that could indirectly influence child health service development, delivery, uptakes and utilisation among mothers and caregivers in Pager Cell Division were examined and the result in this study showed that general awareness and EPI services advocacy program 312 (91.5%), Mentorship 260(76.2%, Outreaches and outpost strategies 210(61.6%), were highly rated as the reasons for adherence and compliance to routine EPI service uptakes among the mothers and caregivers of children aged 0-18 months.
Similarly, better and functional cold chain system 206(60.4%), budget adequacy 192(56.3%), and intersectoral collaboration and integration of services 183(53.7%) were reported as moderate influencers of mothers and caregiver’s adherence and compliance to service uptake in Pager Cell Division.
General awareness including health education are keys to promote understanding of available services, mentorship strengthen the workforce skills to improve quality of care, outreaches or outpost of EPI reduces cost associated with time and distances to access services; whereas functional cold chain systems enables reliability of the vaccines availability, intersectoral integration and collaboration may reduce cost associated with vertical programs such as EPI, and finally all the above described policy and program factors depends on adequate budgetary availability to adequately functions.
The table below showed the statistical correlations of the operational variables during the study.
Figure 4.6. Policy and programs impact on EPI adherence and compliance among mothers and caregivers in Pager Cell Division, May 2024.
3.6 . Political factors affecting vaccine uptake among mothers and caregivers
In developing or Low-income countries, service development, delivery, uptakes, and sometimes utilisation depends on political context and environment. Therefore, the researcher in this last objective of the study investigated how hypothesized political factors such as alienation of a household to certain political system, road network access, insecurity and conflicts internally and externally, and leadership and governance on sustainability were explored.
The findings showed that sustainability 261 (76.5%) as a function of leadership and good governance on health and individual political lineage 170(49.9%) were major factors attributing to lack of adherence and compliance to service uptake and utilisation. Because Pager Cell Division is in the central location of the municipality, such factors as insecurity and conflicts, bad road networks are not considered key hinderance to EPI service adherence and compliance. But most probably because
The table below shows the results of the analysis on this last objective of political factors impact on routine EPI adherence and compliance among mothers and caregivers in Pager Cell Division, Kitgum Municipality.
Figure 4.7. Impact of political factors on adherence and compliance to routine immunisations.
3.7 . Chapter summary
This chapter had presented, analysed, described, and interpreted the outcome of the study objectives with an outline of key findings stated and described. The various findings were analysed based on the study objectives, the questions under each objective, and the resultant summary were presented in different format as shown in the list of figures and tables in the chapter.
