FACTORS AFFECTING COMPLETION OF IMMUNIZATION SCHEDULE AMONG CHILDREN BELOW ONE YEAR AT BWEYOGERE HEALTH CENTRE III KIRA MUNICIPAL COUNCIL WAKISO DISTRICT

INTRODUCTION

This chapter presents the introduction, background, problem statement, purpose of the study, specific objective, research questions and justification for the study.

 1.1 Background

Immunization is the process whereby a person is made immune or resistant to an infectious disease typically by administration of vaccine (CDC,2010). Vaccine stimulate the body`s immune system to protect the person against subsequent infections or diseases.

Immunization is a proven tool for controlling and eliminating life threatening infectious diseases and is estimated to avert between 2 and 3 million death each year (Burton A and Monasch R, 2009it’s one of the most cost effective health investment with proven strategies and that makes it accessible to even the most hard to reach and vulnerable groups. It can be delivered effectively through outreaches and vaccination does not require a lot of lifestyle changes.

The history of immunization schedule is as old as history of immunization and vaccine, it dates back in the late 1790`s particularly in 1796 when the first world vaccination was performed by Edward Jenner recognized in the nineteenth century by the British parliament, Oxford ,Cambridge and Harvard university to prevent cowpox (Baxbony.Jackon, 2010). Its known that with the changing funding issues that were central to the steady development and distribution of vaccines, immunization went beyond far reaching microbiological and immunological discoveries to regulations governing human subject research, enforcement of sterilization and safety standards that follow world war II mostly in 1954, polio field trials accompanied by ethical design and execution of vaccine had become a core concern for many stake holders. Immunization adoption continue through 1974 when WHO launched the expanded programme of immunization with the goal of dramatically increasing rates among children in developing countries that in 1983 it was adopted by Uganda and relaunched in 1987 (Ministry of Health, 2010)

In any health intervention, the number of children covered  receiving the prescribed number of doses for a given vaccine no matter the age as a standard measure for such intervention was not following the necessary intervals as required (Luman ET, 2010) .This therefore means that for maximum protection against preventable diseases, each child is by standard required to receive vaccination at recommended intervals , (Glauber.etal, 2011).

However in Uganda, despite its commitment to achieving the targets set out in National Development Plan through routine Immunization against the eight vaccine preventable diseases i.e.  Tetanus, Polio, measles’, Diphtheria, Hepatitis B, Whooping cough, Influenza, Tuberculosis, Pneumonia and HPV, 70% of the children under one year miss immunization services, (WHO, 2009.) 46% of children under five years actually do not complete their Immunization schedule (Bbaale, 2013).This leaves a hanging question that besides all intervention designed, the dropout rate is still high thus a case study to provide an assessment into the factors hindering completion of Immunization schedule in BH/C III Wakiso District so as to come up with corrective action.

1.2 Problem Statement

Many studies all over the world have investigated why people do not complete the schedule to vaccinate their children. A review by Nigenda-Lópes, et al (2008), covering 40 years showed a variety of reasons all over the world which include cultural that say “vaccinations are not important”, psychological, such as “vaccines are unsafe”; social or socioeconomic, such as parents’ educational, marital or economic status; structural, such as, relation to vaccine distribution; and transmission-related, i.e. failure to transmit enough information about the diseases and vaccines available. These reasons seem to apply to different communities around the world.

According to the Federal Democratic Republic of Ethiopia, Ministry of Health, (2007), the major obstacles in achieving full immunization schedule were low access to immunization services, inadequate awareness of caregivers, and low density of health workers. And the Recent Tanzania Demographic Health Survey, (TDHS, 2010), showed that proportion of fully immunized children is 75% and this is an increase compared to 71% in 1999 (TDHS, 2004-05).

In Uganda, the situation has been worsened by the fact that as much as in 47% of the children under five years by proportion actually never complete their immunization schedule, World Health Organization. (2010). There ar many factors which remain unexplored. This enticed the researcher  to investigate the factors affecting the completion of immunization schedule of children under one year in Bweyogerere Health Centre III, Wakiso district

1.3 Purpose of the study

To establish the factors affecting completion of immunization schedule for children under 1year in Bweyogerere H/C III Wakiso District in order to come up with strategies to create awareness on importance of immunization services.

1.4 Specific Objectives

1. To identify the social economic factors affecting completion of immunization schedule for children under 1 year in Bweyogerere H/C III
2. To assess the knowledge of mothers on related factors affecting completion of immunization schedules for their children under 1 year.
3. To ascertain the culture related factors affecting completion of immunization schedule among children under 1 year in Bweyogerere H/C III

1.5 Research questions.

1. What social economic factors affect completion of immunization schedule for their children under one year at Bweyogerere H/C III?
2. What knowledge do mothers have regarding immunization schedule for their children under one year?
3. What culture factors affect completion of immunization schedule for their children under one year at Bweyogerere H/C III?

1.6 Justification of the study

The findings of this study will aid ministry of health in conjunction with policy makers to design the policies that promote immunization schedule of children under one year

These findings shall also be used to provide baseline information for further researches in this area and also to develop health education materials for the subject under study.

The study will benefit the community of Bweyogerere parish through improving immunization among their children under one year as they realize its importance.

The findings of this study will help the researcher to acquire minimal qualification for the diploma in midwifery.

CHAPTER TWO

LITERATURE REVIEW

2.1 Introduction

This chapter reviews the related literature on factors affecting completion of immunization schedule of children under one year. It is organized under three sections which include the knowledge on immunization schedule among mothers, the social economic factor affecting completion immunization schedule for children under one year and the cultural factors effecting completing immunization schedule for the children under one year.

2.2 Social – economic factors affecting completion of immunization schedule in young children among mothers

Demographic studies of childhood immunization differences have often shown that house hold social-economic factors as an important factor in explaining different immunization levels among and within societies Blaikie, P,.et al, (2014)

Results of Multi logistic model explained that the women who were less empowered had less attention towards participation in full child immunization, the probabilities in three countries India, Bangladesh, and Pakistan was 0.664, 0.830 and 0.587.respectively (Bhandari P, 2007)  showed the same results, that the employed mothers were more conscious to immunize their children compared to the unemployed mothers.

Low standard and poorest persons also showed less attention towards participation in partial child immunization (Bandhari, et al, 2009).

Comparatively, the study by (Antai, 2009), revealed different results; the children living in rural areas had more chances to get immunization as compared to the children living in urban areas.

Distance of vaccination booths or health centre also affects the vaccination uptake, especially, in the context of developing countries. One study conducted in Bangladesh showed that the proximity of Health Centre From the residence was directly proportion to the vaccination coverage, (Breiman, et al, 2009). Similarly, a study conducted in China showed that vaccination coverage was poor in remote areas where it was hard to reach the health services and parents encountered more barriers in reaching the Health Centre, (Han K, 2014). A study conducted in Uganda showed that, rural areas are disadvantaged due to poor networks, especially during rainy seasons resulting in poor vaccination coverage, (Bbaale 2006).

Mother’s occupation and that of their partner are important in the attainment of full childhood immunization. Children whose parents held white –collar jobs were more advantaged compared to those in agriculture, blue –collar jobs, and services /sales, (Bbaale E, 2013). In general, the immunization coverage is lowest among poor populations and in peripheral areas mainly due to inability to afford transportation to bring the child to immunization clinics, (Streefland PH, 2013).

The major findings of a study conducted in Uganda showed that the supportive or non-supportive roles are major influences in the involvement or non-involvement of parents in childhood immunization (Babirye JN, 2015). Similarly, reasons for unintentional missed vaccinations showed by a study were forgetting appointment, lack of time after mother return or having other children commitment, (Ticker S, 2009).

Religion and spirituality are integral components of socio-demographics (rural culture) and influence perceived vulnerability to infection and perceived severity to infection (Thomas, 2013).Religious leaders are highly esteemed ,and their authority can convince members of their congregation to accept or reject vaccination, (RuijsWLM, 2013), A WHO report from polio endemic region in Nigeria states that only a total of 16% children were adequately vaccinated  in the region , the main reason being that, the community was predominantly of Muslim background and believed  that polio drops were used as a tool for causing sterility in the children and had been shunned by community leaders. This led to a substantial rise in that area, (Kapp, 2009) .

2.3 Knowledge about immunization schedules among mothers with young children under one year

Various studies on assessment of mother’s knowledge on immunization schedule show mixed findings, with others reporting high levels of knowledge and others low levels. For example, assessment of partner’s knowledge about immunization schedule by, (Gellin BG, 2010), in the United Arab Emirates showed variations in response to questions designed to assess their knowledge on childhood immunization. The majority of them knew that routine vaccination prevent children from some serious infectious diseases and its complication. In contrast, in study conducted in UAE, more than 85% of the participants knew the role of childhood vaccination in prevention of life threatening diseases, (Gellin et al, 2011).

Illiterate mothers due to little knowledge, had less attention towards immunization. (Ibnouf AH, 2009), observed that uneducated   low standard women were reluctant to immunize their children (Easterly, 2009), Similarly, (Njau, J,2014), found that the mother’s education had positive impact on child, immunization.  (Jamil k, 2010), had observed the same results that uneducated fathers showed the same attitude and give less attention towards full immunization of their children. Similarly illiterate fathers were also not interested in full immunization of their children.

In another study, by CDC) pointed out that most vaccines in the childhood immunization schedule require two or more doses for development of an adequate and persisting antibody response (C D C, 2011).

A study in Western Uganda by, (James KP. 2009), nearly 45% of the parents knew that vaccination of children against seasonal influenza is important. Parents might be motivated to vaccinate their children if education about the central role of children transmitting the infection in households and communities, besides the health and economic burden of contracting influenza. It was also pointed out that parents need reliable and accurate information on true contraindications to vaccination. Among the parents who participate in, 61.7% considered or did not know that common colds, ear infection and diarrhea are not contraindications for vaccination. Delay of immunization based on misconceptions about contra-indications puts an infant or child at risk.

Generally, there is inadequate knowledge on benefits of immunization by parents and caretakers. The depth of knowledge available to parents and VHTs on the eight immunizable diseases, schedules of immunization, modes and sites of immunization, confirmed that this knowledge is limited, (Gellin et al, 2011).

2.4 Cultural beliefs and attitude affecting completion of immunization schedule in young children among mothers

There are a number of cultural beliefs which negatively affect the uptake of immunization service. In some societies with cultural discrimination against female children, boys have a greater chance to be vaccinated, (Gindler, 2011) .

Gender discrimination is an important factor which guides the uptake of vaccination. A study conducted in India showed that girls were less likely to be fully immunized compared to boys (Borooah, 2009), another study conducted in Nepal showed that female children were more likely to dropout compared to male children (Basel, 2012). In the study conducted in migrant population in  china, boys showed higher up to date immunization rate than  girls. It indicated some preference towards immunization services in migrate children in china (W.H.O, 2001)  However few studies, on the contrary showed that there was no difference in immunization coverage by gender of the children

Local culture shapes people`s perception of risk or perceived vulnerability people assign value to an issue on the basis of their experience and they trust expert about vaccine is key to increasing vaccine rates, which are significantly lower among children from minority groups and  children living in rural areas (Ministry of health, 2006) .social demographic directly influenced perceived vulnerability and severity as reported in health belief model and these socio-demographics comprises of the local rural culture, including religious affiliation

Traditional health care providers usually in developing countries and mothers use their services for pediatric care to various degrees. Traditional medicine may include herbal, spiritual or religious practices. A study done in Haiti found that the use of traditional healers by mothers was negatively associated with the vaccination rate of their children (Chen, 2013)

CHAPTER THREE

METHODOLOGY

3.1 Introduction

This chapter presented the methodology which includes the study design and rationale, study setting and rationale, study population, sample size determination, sampling procedure inclusive criteria, definition of variables, research instruments, data collection procedure, data management data analysis, ethical consideration, limitation of the study and dissemination of results.

3.2 Study design and rationale

The study used a cross sectional survey with different categories of women who participated. The study employed both qualitative and quantitative approaches to analyze the findings   

3.3 Study setting and rationale

The study was conducted at Bweyogerere Health Centre III Kira municipal council Wakiso district central Uganda. The health Centre is one of the health facilities in the district and it offers many health services including immunization, obstetrics and emergency care, HIV/AIDS management services to mention but a few. The study setting was selected because the problem understudy was prevalent on the ground and the health Centre was representative enough of other facilities in the district. It’s approximately six kilometers from Kampala city, the main means of transport is taxi and Bodaboda. Its capacity is 2000 patients per month. Bweyogerere health center three is located in Wakiso district which is bordered by Mukono in the East, Kampala in the west.

3.4 Study population

The study targeted women with children of under one year who attended young child clinic at Bweyogerere health Centre III.

3.4.1 Sample Size determination

The study population constituted of 35 mothers who brought their children below one year for immunization at Bweyogerere Health Centre III Wakiso District.

3.4.2 Sampling procedure

The respondents were selected using purposive sampling techniques. Berg (2006) purposive sampling is where the researcher chooses the respondent based on what He/ she thinks would be appropriate for the study. Purposive sampling technique was used because it was cheap..

3.4.3 Inclusion Criteria

Only those mothers with children under the age of one year who visited Bweyogerere Health Centre III during the period of study were included in the study. Mothers were interviewed when they voluntarily accepted to be interviewed.

3.5 Definition of Variables 

Variables are logical grouping of attributes and the study used both independent and dependent variables

Independent variables

These included the specific objective that is to say the knowledge of the mothers about immunization schedule, socio-economic factors and cultural factors that influence immunization

Dependent variables

Completion of immunization schedule

3.6 Research Instrument

Interview guide was designed and contained both close and open ended questions but mostly close ended question so as to simplify the answering procedure. The questions were based on the research questions in the study. This tool was selected because the study involves mixed groups of respondents, where by some respondents are illiterate while others are literate and thus unable to read, write and understand.

Quality control involved pre-visiting the study area

3.7 Data Collection Procedure

The researcher administered the questionnaire to the respondents. This helped to improve efficiency and maintain privacy during data collection. Data was collected for a period of 6 days and the researcher interviewed 5 respondents every day.

3.7.1 Data Management

Data management included data editing before leaving the area of study to ensure that there are no mistakes or areas left blank. Any mistakes found were corrected before leaving there area of study

3.7.2 Data Analysis

Data analysis was done using quantities approach. Data was entered in the statistical package for social scientist (SPSS version 12).The entered data was checked for correctness during entry. The result based on a single valuable was presented mostly in tabular forms with some graphs that were developed using Microsoft Excel figures. Findings were presented in figures, tables and statistical statement.

3.8 Ethical Consideration

A letter of introduction was obtained from PHN College which the researcher presented to the management of Bweyogerere Health Centre III, when allowed she proceeded to administer the research instruments.  Consent was obtained from the respondents before they are engaged in the study.  The study commenced after the objectives of the study were clearly explained to the respondents and when they had understood and voluntarily accepted to participate in the study

There was also be privacy of the respondents; confidentiality of information obtained from the respondents and acknowledgement of their views.

3.9 Limitations of the Study

The anticipated limitations were from the respondents who would not be co-operative and some who found hardship in answering the questionnaire. In addition some mothers feared to share their views and in this case respondents were reassured of the confidentiality and the researcher explained to them the purpose and future benefits of the study which she believed would convince them to respond positively.

There other limitation was lack of enough resources in terms of finance and human resource to help in transport, logistics and distribution of the questionnaires to mothers in this case the researcher’s budget catered for that challenge

Lack of enough time to interview all the respondents, but this was properly provided for in the work plan.

Due to the fact that the interview was hurried there was a probability of getting inadequate and inaccurate data so questionnaires were checked before leaving the respondent.

3.10 Dissemination of Results

The result of the study were compiled and four copies produced one for Bweyogerere Health Centre III another for PHN College and another for Uganda Nurses and midwives Examinations Board.

The researcher also got a copy for future reference

CHAPTER FOUR

RESULTS

4.0. Introduction

This chapter presents the results in reference to objectives in chapter one. Gender of respondents, Age of respondents, education level of respondents, Number of years of respondents, Knowledge about immunization schedule, socio-economic factors affecting completion of immunization, cultural beliefs and attitude towards competition of immunization schedule.

4.1 Finding on respondents response

4.1.1 Findings on whether respondents acknowledge to take part in the study

Table 1 Showing Acknowledgement of Taking Part in the Study

Source: primary data

According to the results in the study all the respondents selected agreed to talk part in the study.

4.1.2 Findings on the age category of the respondents

Table 2 Showing age Category of respondents

Source: primary data

According to majority of respondents (86%) assert that they were in the age brackets of 26-35 years of age , while most of the respondents were in the age brackets of 15-25years of age , the results further indicates that only (13%) of the respondents were in the age group of 36-45years.

4.1.3 Pie-chart showing age category of respondents

Figure 1Chart showing age category of respondents

Sample Size=30

Source: primary data

According to the results figure1 above majority of the respondents (56%) were in the age brackets of 15-25 years this results therefore demonstrates that most of the respondents were young and therefore their participation was welcomed.

4.1.4 Findings on the marital status of the respondents

Table 3 Marital status of the respondents

Source: primary data

According to the findings in the study most of the respondents (70%) were married this indicates that most of the respondents in the study had mature minds and therefore they had to give accurate answers during the study.

Figure 2 Showing marital status

No =30

Source: Primary Data

The result in the study indicates that most of the respondents in the study were married, some of them were single and only a fraction of them were divorced.

4.1.5 Findings on Religious background of the respondents

Table 4 Showing Religion of respondents

Source: primary data

The results in the study show that most of the respondents were Muslims and their percentage was (33.3%), Catholics were (30%), and protestants (26%), born again (6%) and only (3%) were from other religious backgrounds.

Figure 3 Showing occupation of respondents

Source: primary data

According to the results in the study most of the respondents were Muslims therefore the Muslim faith dominated the response rate in the study

4.1.6 Findings on the Level of education

Table 5 Showing the level of education of respondents

Source: primary data

According to the results in the study majority (40%) of the respondents had finished secondary school education, while (33%) of the respondents were primary school dropouts,  (23%) had studied up vocational level of education , the results above therefore indicates that most of the respondents had studies in formal education and therefore they easily understood the topic of study.

Chart showing level of education

Figure 4 Level of education of respondents

N0 =30

Source: primary data

According to the findings from the pie chart above it is evident that most of the respondents were secondary school dropout, and the second largest percentages of respondents were primary school dropouts.

.1.7 Findings on the occupation of respondents

Table 6 Showing occupation of respondents

Source: primary data

According to findings in the study most of the respondents didn’t have a specific profession and their percentage was 33%, this shows that most of the respondents had were not employed in the formal sector, 30% of the respondents were health workers, 16% were famers and teachers.

Figure 5 Showing occupation of respondent.

Source: primary data

According to the Bar chart above majority of the respondents’ don’t have any occupation of respondents (33.3%), (30%) of the respondents were health workers, (16%) of the respondents were farmers and teachers.

4.1.8 Findings on Monthly income of the respondents

Table 7 Showing Monthly income of the respondents

Source: primary data

According to the Findings in the study majority of the respondents did not earn any income, while (36.7%) of the respondents, while (30%) of the respondents earned 50,000, (26%) of the respondents earned less than 40,000.

Figure 6 Showing monthly income of the respondents

No =30

Source: primary data

The bar chart above indicates that most of the respondents were not having monthly income, while (30%) of the respondents earned less than 50,000 of monthly income.

4.1.10 Findings on Duration of visiting the health facility

Table 8 Showing the duration of visiting the health facility

Source: primary data

According to the results in the study most, 46% of the respondents visit health facilities 14 times in less than one year, 1-2 years, (30%), 3 years, (20%), while 4years (3%).

Figure 7 Showing duration of visiting health facility

No= 30

Source: primary data

According to the bar-chart above the results indicates that most of the most of the respondents have worked for less than one year.

4.1.12 The relationship between marital status and monthly income of the respondents

Table 9 Chi-square indicating relationship between marital status and monthly Income

According to chi-square, there is a positive relationship between monthly income and marital status; this is represented by a positive correlation.

Table 10 showing knowledge of respondents on immunization

Source: primary data

According to the results in the study (80%) of the respondents asserted that they had knowledge on immunization, these results therefore indicates that most of the respondents had basic knowledge on the benefits of immunization to their children and therefore they willing took their children.

4.1.13 Findings of respondents view on the number of times children are immunized

Table 11 respondents view on the number of times children are immunized

Source: primary data

According to the findings in the study majority of the respondents assert that they had taken their children 1-5 times for immunization, this is mainly due to massive sensitization campaign by the government.

4.1.14 Findings on the Source of Information about immunization

Table 12 Showing Source of Information about immunization

Source: primary data

According to the results in the study (36%) of the respondents asserted that the get information regarding immunization from Health workers, while (26%) of the respondents get information from newspapers, (23%) radio, and (10%) relatives.

4.1.15 Findings on who takes the child for immunization

Table 13 Who takes the child for immunization

Source: primary data

According to the results in the study (63%) of the respondents asserted that it is the wife who takes child for immunization, while (10%) husband and only (23%) both husband and wife.

4.1.6 Findings on husband support during immunization husband escort

Table 14 Showing husband support during immunization husband escort

Source: primary data

According to the results in the study (53%) of the respondents asserted that husbands do not provide support during immunization, only (46%) agreed.

4.1.17 Findings on cultural support towards immunization

Table 15 Showing cultural support towards immunization

Source: primary data

According to the results in the study (90%) of the respondents asserted that their culture supports immunization, only (10%) disagreed.

CHAPTER FIVE

DISCUSSION OF FINDINGS, SUMMARY OF FINDINGS, CONCLUSION, RECOMMENDATION AND AREAS OF FURTHER STUDY

5.0 INTRODUCTION

The study aimed at establishing factors affecting completion of immunization schedule in Bweyogerere health centre III, wakiso district.

5.1 DISCUSSION OF FINDINGS

5.1 .1 Knowledge about immunization schedule

According to the findings in the study majority of the respondents asserts that they had basic knowledge regarding immunization schedule this is also in line with Blaikie, P.et al (2014), who states that Demographic studies of childhood immunization differences have often shown that house hood social-economic factors as an important factor in explaining different immunization levels among and within societies.

According to the results in the study majority of the respondents had finished secondary school education, this shows that most of the women in the study had basic information regarding the benefits of immunization; this is also in line with (Bhandari P, 2007) who states that Results of Multi logistic model explained that the women who were less empowered had less attention towards participation in full child immunization, the probabilities in three countries India, Bangladesh, and Pakistan was 0.664, 0.830 and 0.587.respectively.

The results in the study indicates that most of the respondents didn’t have a specific profession these results contradicts with the findings by (Bbaale E, 2013)  who stresses that Mother’s occupation and that of their partner are important in the attainment of full childhood immunization. While (Streefland PH, 2013)  further states that Children whose parents held white –collar jobs were more advantaged compared to those in agriculture, blue –collar jobs, and services /sales in general, the immunization coverage is lowest among poor populations and in peripheral areas mainly due to inability to afford transportation to bring the child to immunization clinics.

Similarly (Babirye JN, 2015). Further states that the major findings of a study conducted in Uganda showed that the supportive or non-supportive roles are major influences in the involvement or non-involvement of parents in childhood immunization similarly; reasons for unintentional missed vaccinations shown by a study were forgetting appointment, lack of time after mother return or having other children commitment.

The results in the study show that most of the respondents were Muslims and their percentage was 33.3%, Catholics were 30%, these findings were also in line with   (Thomas, 2013), who stresses that Religion and spirituality are integral components of socio-demographics(rural culture) and influence perceived vulnerability to infection and perceived severity to infection(Religious leader are highly esteemed ,and their authority can convince members of their congregation to accept or reject vaccination. While ( (RuijsWLM, 2013) further states that ,A WHO report from polio endemic region in Nigeria states that only a total of 16% children were adequately vaccinated  in the region , the main reason being that the community was predominantly of Muslim background and believed  that polio drops were used as a tool for causing sterility in the children and had been shunned by community leaders. This led to a substantial rise in that area.

5.1.2 Socio-Economic factors affecting completion of immunization

According to the results in the study majority of the respondents had finished secondary school education, this shows that most of the mothers had the knowledge on the benefits of immunization this is also in line with (Gellin BG, 2010) who states that Various studies on assessment of mother’s knowledge on immunization schedule show mixed findings, with others reporting high levels of knowledge and others low levels. For example, assessment of partner’s knowledge about immunization schedule by in the United Arab Emirates showed variations in response to questions designed to assess their knowledge on childhood immunization.

On the same note . (Ibnouf AH, 2009),  states that Illiterate mothers due to little knowledge had less attention towards immunizationon, observed that uneducated   low standard women were reluctant to immunize their children, Similarly found that the mother’s education had positive impact on child immunization.  .However  (Ibnouf AH, 2009) further stresses that uneducated fathers showed the same attitude and give less attention towards full immunization of their children. Similarly illiterate fathers were also not interested in full immunization of their children.

Lastly the study indicates that (Gellin et al, 2011) asserts that generally, there is inadequate knowledge on benefits of immunization by parents and caretakers. The depth of knowledge available to parents and VHTs on the eight immunizable diseases, schedules of immunization, modes and sites of immunization, confirmed that this knowledge is limited.

5.1.3 Cultural beliefs and attitude affecting completion of immunization schedule in young children among mothers

According to the findings in the study the results indicated that different culture supports immunization this is also in line with  (Gindler, 2011). Who stresses that there are a number of cultural beliefs which negatively affect the uptake of immunization service. In some societies with cultural discrimination against female children, boys have a greater chance to be vaccinated.

The findings in the study further show that Gender discrimination is an important factor which guides the uptake of vaccination. The results further concur with the findings in by (Basel, 2012) who stresses that female children were more likely to dropout compared to male children. In the study conducted in migrant population in china, boys showed higher up to date immunization rate than girls.

While the (Ministry of health, 2006) streesess that Local culture shapes people`s perception of risk or perceived vulnerability people assign value to an issue on the basis of their experience and they trust expert about vaccine is key to increasing vaccine rates, which are significantly lower among children from minority groups and  children living in rural areas  .social demographic directly influenced perceived vulnerability and severity as reported in health belief model and these socio-demographics comprises of the local rural culture, including religious affiliation

According to the results in the study most of the respondents asserted that they get information regarding immunization from Health workers, this is also in line with (Easterly, 2009), who states that uneducated   low standard women were reluctant to immunize their children.

According to the results in the study majority of the respondents asserted that it is the wife who takes child for immunization,  (Gindler, 2011) who states that In some societies with cultural discrimination against female children, boys have a greater chance to be vaccinated.

Recommendation

The study recommends that that there should be a massive campaign in local areas and radio station to sensitize the people about the benefits of immunization, this will increase on the number of people taking their children to immunization.

Conclusion

The study concludes that the people in rural areas should be sensitized through its local leaders so that they area to participate in immunization.

Areas of further

The study recommends the following areas of further study;

• The influence of immunization to the health of children
• Challenges in administering immunization programmes in the rural areas
• Influence of poverty on the health of children

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APPENDIX I

CONSENT FORM

I  Nakku Rosette, a student of PHN College pursuing a diploma in Midwifery Extension. I am conducting a research to determine the factors affecting completion of immunization schedule among children under one year in Bweyogerere Health Centre III Wakiso District. I am kindly requesting you for your cooperation in providing all the necessary information to achieve the desired objectives.

Participation is voluntary, and you have the right to withdrawal at any time, your agreement to participate is highly appreciated.

The information that you will provide will be kept confidential, for any clarification I am available.

…………………………

NAKKU ROSETTE

(RESEARCHER)

APPENDIX II

QUESTIONNAIRE FOR MOTHERS

Dear respondent, my name is Nakku rosette undertaking a study regarding the factors affecting completion of immunization schedule in Bweyogerere health Centre III, Wakiso District  please be informed that the information you provide will remain confidential .

Section A: BIODATA

1. Do you agree to take part in this study?

Yes                                          No

2. How old are you? (years)

• 15-25 (b)   26-35                (c) 36-45                  (d) 46 and above

3. What is your marital status?

(a) Single                    (b) Married                  (c) Divorced                (d) separate

4. What is your religion?

(a) Protestants               (b) catholic                (c) Muslim               (d) born again      (e) others specify………………………….

5. What is your level of Education?

(a) None                (b) primary                (c) secondary                      (d) vocational

(e) University

6. what is your occupation

(a) None              (b) farmer                   (c) Teacher              (d) Health worker

(e) Peasant                   (f) other specify

7. What is your monthly income

(a) None                       (b) less than 40,000           (c) more than 50,000

8. For how long have you been vising this health facility?

(a) Less than a year

(b) 1-2 years                 (c) 3 years and more

Section B Knowledge about immunization schedule

9. As a mother do you know anything concerning immunization schedule?

(a) Yes                        (b) No

10. If yes to question 8 above, how many times is a child supposed to be immunized to complete the immunization schedule? (a)None         (b) 1-5 times

(c) 6 times or more                 (d) others please specify ………………………………

11. What is your source information about immunization schedule?

(a) Radio                  (b) Newspapers                         (c) Health workers

(d) Relatives                (e) Others

12. Did you know that vaccination against the child killer diseases is important?

(a) Yes                    (b) No

13. 13. If yes, then what are those important benefits associated with completion of immunization and completion of immunization schedule?

…………………………………………………………………………………………

…………………………………………………………………………………………

…………………………………………………………………………………………

Section C: socio-economic factors affecting completion of immunization

14. Have you had any challenges associated with socio –economic factors hindering immunization schedule?

(a) Yes                           (b) No

15. If yes in question 13 what are the socio-economic factors that are associated with completion of immunization schedule?

…………………………………………………………………………………………

…………………………………………………………………………………………

…………………………………………………………………………………………

16. What are the possible solutions to the above problems?

…………………………………………………………………………………………

…………………………………………………………………………………………

…………………………………………………………………………………………

17. Who takes the child for immunization?

(a) Husband                (b) wife                (c) Both husband and wife         (d) Others specify

18. Does your husband escort or provide you with transport during immunization schedule?

(a) Yes                          (b) No

Section D: Cultural beliefs and attitude towards completion of immunization schedule

19. Does your culture support immunization?

(a) Yes                             (b) No

20. 20. If yes in question 18 above, use the information below to identify ways in which culture affects completion of immunization schedule?
21. Women are responsible for the completion of immunization schedule.
22. Our culture does not support completion of immunization schedule.
23. Traditional healers can provide alternative solution to completion of immunization.
24. What other cultural beliefs can you give that limit completion of immunization schedule of your children?

…………………………………………………………………………………………

…………………………………………………………………………………………

…………………………………………………………………………………………

…………………………………………………………………………………………

22. What can be done to address the effects of culture and belief in affecting completion of immunization?

…………………………………………………………………………………………………….…………………………………………………………………………………………………………………………………………………………………………

Thank you

APPENDIX III:

WORK PLAN

APPENDIX IV

BUDGET

APPENDIX V

RESPONDENT`S DECLARATION

I have read the above form and I have understood the purpose of the study and accept that have been contacted and given the information needed, I also have the opportunity to ask for clarification. I therefore voluntarily accept to participate in the study and also to withdraw from this study without affecting our relationship with the other researcher.

Signature: …………………………………………………………

Date: ……………………………………………………………

(RESPONDENT)