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)
