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©IDOSR PUBLICATIONS ISSN: 2579-0781

International Digital Organization for Scientific Research IDOSRJES103.18.38

IDOSR JOURNAL OF EXPERIMENTAL SCIENCES 10(3) 18-38, 2024.
https://doi.org/10.59298/IDOSR/JES/103.18.38
Factors Influencing Utilisation of Immunisation Services
among Children Under Five Years in Lira Municipality Lira
District Northern Uganda
Olila Daniel
Faculty of Clinical Medicine and Dentistry Kampala International University Uganda.

ABSTRACT
This study investigated the factors influencing the utilization of immunization services among children under 5
years in Lira Municipality, Lira district, Northern Uganda. Utilizing a community-based cross-sectional design with
quantitative data collection methods, 380 mother-infant pairs were randomly selected from residents of Lira
Municipality. Univariate, bivariate, and multivariate logistic regression analyses were conducted using STATA
software version 14.0 to identify significant factors affecting immunization service utilization. The study found that
77.63% (295/380) of children under 5 years utilized immunization services, with the highest utilization observed
among male children (82.71%). Factors significantly influencing utilization included mothers' education level (aOR
7.46, 95%CI 2.17 – 25.65, P=0.001), religion (Muslims vs. Christians: aOR 0.15, 95%CI 0.07 – 0.32, P<0.001),
rudeness of health workers (aOR 3.50, 95%CI 1.73 – 7.06, P<0.001), awareness of subsequent immunization
schedules (aOR 0.38, 95%CI 0.20 – 0.70, P=0.002), possession of a child immunization card (aOR 0.34, 95%CI 0.19
– 0.63, P=0.001), and understaffing at health facilities (aOR 2.87, 95%CI 1.43 – 5.78, P=0.003). The study highlights
the importance of addressing these factors to improve immunization coverage, which currently falls below the global
target recommended by WHO and UNICEF.
Keywords: Immunization services, Children, Under-Vaccinated, Unvaccinated, Mothers, No versus Yes.

INTRODUCTION
Immunization is defined as the process of injecting coverage improves [6]. In 2014, about 115 million
or vaccinating an individual to receive active (86%) of infants worldwide received three doses of
protection against a particular illness. Utilization of diphtheria-tetanus-pertussis (DTP3) vaccine, and
immunization services is defined as the provision 129 countries reached at least 90% coverage of
and uptake of immunization services [1]. DTP3 vaccine [7]. This increased to 116 million
Immunizing children is one of the public health (86%) of infants worldwide, while only 126 countries
interventions which has been proven to be effective reached at least 90% coverage of DTP3 vaccine [6].
for reducing child morbidity and mortality, and Still, about 18.7 million infants worldwide were not
attaining high levels of coverage with potent reached with routine immunization services in 2014.
vaccines administered at the appropriate ages [2, 3, In Africa, despite the fact that there has been
4]. Globally, it is estimated that more than 50% of remarkable progress in provision and supporting
mortality in children under five years of age is due immunization services; the biggest number of
to diseases that are preventable and treatable by children remain unvaccinated and under-vaccinated
utilization of simple and affordable interventions [8]. In Africa, Immunization rates for children
like a vaccine [5]. In 2016, the World Health under 5 years are steadily behind any other region
Organization (WHO) estimated that 5.6 million in the world and it was estimated to be between 37%
children under five years old died, translating into - 76% [9]. The immunization coverage in Africa is
15,000 deaths every day [5]. According to WHO, negatively influenced by many factors including
immunization prevents about 2 to 3 million deaths inadequate provision of vaccines, location of
annually that could have resulted from vaccine services, poor infrastructure, negative perceptions
preventable diseases (VPDs) such as diphtheria, towards vaccines among other factors [10]. In Sub
tetanus, pertussis, and measles; and an additional 1.5 Saharan Africa (SSA), the utilization of
million deaths could be avoided if global vaccination immunization varies widely from only 11% of
18
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children of ages 12 to 23 Months in Chad to 78% in Northern Uganda remains low [20]. According to
Zambia [11]. According to [12], vaccine coverage the New vision report of 2013, Lira District was
rates remain well below the WHO goal of 90%, with reported among the 11 Districts lagging behind in
82% of the children receiving the measles vaccine routine immunization. [21] also reported a failed
and 78% completing the three-dose series of target of Districts achieving the 80% Coverage of
pentavalent vaccine in the Sub-Saharan African DTP-3 vaccine in all Districts. This was why there
Countries. SSA has the highest under-five mortality was a need to carry out a study to determine the
rate of the entire world and accounts for 40% of the factors influencing the utilization of immunization
total deaths in this age group. This is mainly due to services among children under 5 years of age in Lira
vaccine- preventable diseases [13]. In 2014, it was Municipality, Lira district.
reported that only Zimbabwe among the Sub- Statement of the problem
Saharan region was estimated to have met the It is the right of every child to be immunized against
Global Vaccine Action Plan threshold of 80% or the childhood immunizable diseases and it’s the duty
higher coverage of diphtheria–tetanus-pertussis of every parent/caretaker to ensure this [22].
vaccine (DTP3), a benchmark used to measure However, according to Ministry of Health, the
performance of routine vaccine delivery system utilization of immunization services for childhood
[14]. Similarly, in East African countries such as immunizable diseases remains low in Uganda [20].
Kenya and Tanzania, immunization coverage Many strategies have been used to improve and
continues to average between 41% - 68% for most of sustain utilization of routine childhood immunization
the child hood immunizable diseases [15]. services; one of which is establishing outreach
However, immunization coverage in Uganda varies immunization services. Outreach immunization
with different geographical locations and is lower in services are used globally to engage vulnerable
rural settings [16]. In Hoima, one of the rural individuals and communities with limited
Ugandan districts coverage for DPT3 among geographical access to health facilities [23, 24].
children aged 12–23 months is administratively Despite the universal childhood immunization
estimated at 72% for DPT3 and measles at 76%. program, coverage rates are still low and they decline
These are all below the district and the national for subsequent doses. According to Uganda
targets of 85% for DPT3 and 90% for measles [17] Demographics and Health Survey, 96% of children
and may partly explain the frequent outbreaks of received the BCG vaccination, 95%, dose of polio 0,
vaccine preventable diseases. Major childhood 95% received the first dose of DPT- Hep B-Hib, and
diseases in Uganda include measles, tuberculosis, 87% the first dose of the PCV and 80% of children
poliomyelitis, pertussis (whooping cough), received a measles vaccination [18]. The URCS
diphtheria, tetanus, hepatitis B, Haemophilus quarterly project reports of July 2012–June 2014
influenzae and neonatal tetanus. However, some showed that there were 738 routine immunizations
48% of children under the age of five were un- defaulters out of the households visited in Lira
immunized or under-immunized - meaning they District in 2014 [25]. The above reports indicate a
started immunization but did not complete the gap which needs to be filled by conducting a research
schedule [16]. Between 2000 and 2010, the on utilization of immunization services. It has been
percentage of children who were fully immunized noted that often the factors relevant for health-
increased from 56% to 85% under Uganda’s seeking behavior is not considered during program
Expanded Program on Immunization (EPI). implementation [23]. Unfortunately, there is hardly
However, it had subsequently declined to below 80% any documented literature which gives information
over the 2007 – 2011 period [18]. Haemophilus about utilization of immunization services and
Influenza type B, (Hib) is the leading cause of associated factors in Lira Municipality. For the above
childhood meningitis in Uganda with a case fatality reason, this study sought to find out the socio-cultural
of up to 30 – 40% [19]. Children who survive Hib factors associated with incomplete routine
meningitis face permanent disability including: immunization of children under 5 years of age in Lira
brain damage, paralysis of the legs, hearing loss and municipality in Lira District to ensure that parents
mental retardation [18]. Whereas the Uganda support the utilization of immunization of their
MoH is committed to achieving 90% immunization children thus promoting more infant survival and
coverage of all Ugandan children below 5 years, the improved health.
trend in most parts of Uganda like Lira district in

19
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METHODOLOGY
Research Design Sample Size determination
The study design was cross sectional and descriptive The overall sample size was estimated using Kish and
[26], employing quantitative data collection Lesley formula [27]. This formula was used because
methods. It was a cross sectional type of design it is appropriate for determining proportions of a
because it involved collection of data from a single variable in a given population.
point in time. Cross-sectional study design is used N= Z2PQ
when studying different groups of people in the D2
groups of people who differ in the variable of interest Where:
but share other characteristics like, educational N = The required sample size
background, economic among others. Quantitative Z = The confidence level at 95% (standard value of
data collection method was used because it enabled 1.96)
the researcher to collect numerical data and perform D = Precision given as +/-0.05 (Margin of error)
quantitative analysis using statistical procedures P= Proportion of children that received all basic
Area of Study vaccinations is 55.8% (Uganda Bureau of Statistics,
The study was conducted in Lira Municipality, a 2016).
major town in Lira District in Northern Uganda. Q = (1-P).
The Municipality has four divisions; Adyel, Ojwina, N = 1.96 x 1.96 x 0.558 x 0.442
Railway and Central divisions. Lira municipality is 0.052
bordered by Pader District to the north, Otuke N= 3.841 X 0.247
District to the northeast, Alebtong District to the 0.0025
east, Dokolo District to the southeast, Apac District N= 0.948727
to the southwest and Kole District to the west. The 0.0025
main municipal, administrative and commercial N= 379 Respondents
center in the district, Lira, is located 110 kilometres Therefore,
(68 mi), by road, southeast of Gulu, the largest city 380 respondents participated in the study
in Northern Uganda. The coordinates of the district Sampling Techniques
are: 02 20N, 33 06E (Latitude: 02.3333; All the 4 divisions in Lira Municipality constituted
Longitude:33.1000). In 2012, the population of Lira the sample frame. To give a fair representation of
District was estimated at about 403,100. The utilization among children under 5 years of age in
majority of the population are ethnic Langi and the Lira Municipality, consecutive sampling was used.
predominant language spoken is Luo. As such, all the 4 divisions were selected for the
Study Population study.
The study population comprised of mothers or Selection of Parishes and Villages
caretakers of children under five years of age living in Simple random sampling technique was used to
the four divisions in Lira Municipality who will be select the parishes where the study was conducted.
present at the time of the study. The names of the parishes in each division were
Inclusion criteria written on pieces of paper, folded, put in a container
i. All care takers/mothers of children under 5 and the lid closed. The container was shaken
years of age who were present during the vigorously to make sure the folded pieces of papers
time of the study. were mixed up. The lid of the container was opened
ii. All care takers/mothers of children under 5 and then folded pieces of papers were picked
years of age who were residents of the four randomly until half of the parishes in each division
divisions in Lira Municipality. were selected. The names of the parishes in the
iii. All care takers/mothers who were 18 years pieces of paper which were picked were used. The
of age and above. same technique was used to choose the villages
Exclusion criteria where the study was conducted.
i. Mothers of children under 5 years of age Selection of Households
who were not present at the time of the Households were mapped and numbered according
study. to the mapping strategy. Systematic sampling
ii. Mothers of children under 5 years of age technique was used. Systematic sampling is a type of
who never consented to the study. probability sampling method in which sample
iii. Mothers of children outside the age bracket. members from a larger population are selected
iv. Mothers of children under 5 years of age according to a random starting point but with a
who were not living within the four fixed, periodic interval. This interval, called the
divisions in Lira Municipality. sampling interval, was calculated by dividing the
20
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population size by the desired sample size. Houses questionnaire was prepared after consulting with the
were selected at a calculated periodic interval (from immediate supervisor at the university and was self-
a random start). This method was used to ensure administered to mothers who knew how to read and
that each house gets an equal probability of being write. Participants who were illiterates were helped
selected. The first household was selected through to fill the question by the researcher but whatever was
simple random sampling followed by the selection of filled in the questionnaire was their actual response.
every other third house in that order. The questionnaire was composed of 4 sections with
Selection of Respondents in Households each section covering each of the specific objectives of
In each village, based on the proportionate the study. The questionnaire was composed of closed
distribution of respondents in the communities, ended questions will require dichotomous responses
individuals were contacted at the household level. which require ticking yes or no. Other questions had
Purposive sampling technique was adopted in multiple choices which required the respondents to
selecting eligible respondents; this was on the choose the most appropriate answers.
premise of having a child under 5 years of age in the Quality control Measures
household. For each of the households approached, The researcher developed a semi-structured
it was first determined whether the household had a questionnaire which was pretested on 10% of the
child under 5 years of age verbally confirmed that sample size in Bar Sub County before application to
they had slept at the house the night before, and the study area since it had a similar setting. Double
were willing to consent to the study procedures. If checking was done on all questionnaires for
there were more than two children in that age completeness and approval for storage was made by
bracket within a given household, those to the principal investigator.
participate in the study were chosen through simple Validity of the research instruments
random sampling. Validity refers to the extent to which a measurement
Data sources instrument actually measures what it is meant to
Data was collected from both primary and secondary measure [29]. It is the ability of a data collection
sources. Primary data was collected from the instrument to measure what it was formulated to
respondents using researcher administered measure. Content validity of the data collection tool
questionnaires in Lira Municipality and Secondary for this study was done doing a pilot study in a nearby
data was accessed from the internet, other district, both the content and face validity were
documents plus related Journals, electronic books, checked during the pilot study which were tested by
library books, research dissertations. the experts in the field of immunization.
Study Procedure Reliability
Before entry into the villages to conduct the data According to [29], reliability or precision refers to
collection, the researcher went to the chair persons the degree of similarity of the results obtained when
LC 1 with introductory letters from the University the measurement is repeated on the same subject or
and sought for permission to do data collection in same group. To address reliability for this study the
the chosen villages. The researcher explained the questionnaire was administered to a small group of
purpose of the study to the study participants after mothers of children aged 0- 59 months at different
which they were given opportunities to ask time intervals.
questions and their questions were answered Data Management
accordingly. Written consent was sought from the The questionnaire responses were edited for
study participants. Those who consented to accuracy without changing the meaning given in the
participate in the study were recruited to participate response. Responses were manually coded and
in the study and they were given to complete the arranged properly for presentation analysis. It also
self-administered study questionnaires whereas involved data cleaning during data entry to ensure
those who refused to consent were exempted from quality inputs. Data was then exported to STATA
the study. version 140, exploratory data analysis was carried
Data collection Instrument out to check the levels of missing values, presence of
Data was collected by the use of pre tested semi- influential outliers, and independence of errors,
structured questionnaires that is researcher multicollinearity and normality [30].
administered. As stated in [28], "questionnaires can Data Analysis Plan
be designed to determine facts about the subject or Data was analyzed by the use of STATA version
persons known by the subject; facts about events or 14.0. Continuous variables were described in terms
situations known by the subject; or beliefs, attitudes, of mean, standard deviation, min, max, skewness,
opinions, levels of knowledge or intentions of the kurtosis and median (inter-quartile range, IQR)
subject. The data collection instrument or the meanwhile categorical variables were described in
21
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percentages. Continuous variables were compared the principles of scientific integrity and honesty.
using Mann-Whitney test and categorical variables Data collection was preceded by a letter of
were compared using Chi-square test or Fischer’s introduction from the Dean’s office as prerequisite
exact test as appropriate. Binary and multivariate for carrying out the study. The researcher got
logistic regressions were run to assess the factors permission from the authorities of Lira Municipality
influencing utilization of immunization services. and the authorities of the different villages to enable
Significant Variables at bivariate analysis and data collection at the at the various study sites. After
Variables having P<0.25 level in the bivariate permission was granted, the authorities introduced
analysis were included in the final binary logistic the researcher to the in-charge of chair persons L.C
regression analysis, to identify independent factors. 1 who then introduced the researcher to the
The forward stepwise regression method was respondents. The written informed consent of the
applied to get a list of best predictors and any respondents was obtained after the purpose and
statistical test was considered significant at P level objectives of the study had been identified and well
less than 0.05 in the final model. Findings were explained to the respondents. The respondents were
summarized in form of tables, pie charts and graphs informed that their participation was purely on
as well as plain text models to determine factors voluntary terms and that their withdrawal of
influencing the utilization of immunization services. consent/participation would not affect their
Ethical considerations relationship with the researcher nor the health
Approval of ethical clearance was secured from institutions. The study was purely for academic
Kampala International University-Western purposes and all the information given was treated
Campus Institutional Research and Ethics with confidentiality and numbers instead of names
committee (KIUWC-IREC) who then award me were used to identify the respondents [31].
with data collection clearance letter for collecting
information and ensured that the study adhered to
RESULTS
The Socio-Demographic Characteristics of the participants 53.68% (204/380) being married in
Study Participants addition to having female children under five years of
The researcher sampled a total of 380 participants age 65.00% (247/380). More than half of the mothers
table 1 below shows the socio-demographic 53.42% (203/280) had a monthly income of less than
characteristics of the study participants. Majority of 300,000 Ugandan Shillings, had children below five
the study participants 46.84% (178/380) were in the years of age who were of first birth order 54.74%
age group of 18 – 25 years, were not educated 35.26% (208/280) and finally, less than half of the study
(134/380) and more than of the participants 57.11% participants 45.53% (173/380) found it hard to leave
(217/380) were unemployed. The highest proportion their work so as to take their children for
of study participants were 68.95% (262/380) were immunization.
from urban areas of residence, belonged to Christian
religion 41.05% (156/380) with more than half of the

22
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Table 1: Frequency table showing socio-demographic characteristics of the study participants
CATEGORY OPTIONS FREQUENCY(n) PERCENTAGE (%)
Age of Mothers 18 – 25 years 178 46.84
26 – 35 years 100 26.32
≥ 36 years 102 26.84
TOTAL 380 100
Education Level Not educated 134 35.26
Primary 125 32.89
Secondary 63 16.58
Post-secondary 58 15.26
TOTAL 380 100
Employment status Employed 163 42.89
Unemployed 217 57.11
TOTAL 380 100
Residence Rural 118 31.05
Urban 262 68.95
TOTAL 380 100
Religion Christian 156 41.05
Muslim 80 21.05
Born again 82 21.58
Others 62 16.32
TOTAL 380 100
Marital Status Single 90 23.68
Married 204 53.68
Divorced 55 14.47
Widowed 31 08.16
TOTAL 380 100
Gender of the child Male 133 35.00
Female 247 65.00
TOTAL 380 100
Monthly Income Less than 300,000 203 53.42
300,0000 or more 177 46.58
TOTAL 380 100
Birth Order of the child First 208 54.74
Second 86 22.63
Third or more 86 22.63
TOTAL 380 100
Busy Schedule at Work Yes 173 45.53
No 207 54.47
TOTAL 380 100

Health Worker Related Characteristics available. A high proportion of study participants

Table 2 shows the health worker related 62.37% (237/380) complained that the health workers
characteristics of mothers who participated in this were rude to them whenever they took their children
study. Majority of the mothers 55.79% (212/380) for immunization meanwhile 52.89% (201/380) of the
stated that they had ever heard immunization mothers stated that the health workers used abusive
campaigns on radio with 54.74% (208/380) saying languages. When asked if the health workers gave
that there was high level of mobilization for then information about the upcoming immunization
immunization by health workers in the community. schedule, less than half of the study participants
Almost half of the study participants 52.63% 48.95% (186/380) said yes and lastly, only 23.68%
(200/380) said that they had not been told about the (90/380) of study participants said that the health
benefits of immunization by health workers during workers refuse to immunize their children for one
antenatal care. When they take their children for reason or the other.
immunization, majority of the mothers 52.37%
(199/380) said that they always find health workers

23
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Table 2: Health Worker related Characteristics of study participants
CATEGORY OPTIONS FREQUENCY(n) PERCENTAGE (%)
Immunization Yes 168 44.21
Campaign on Radio No 212 55.79
TOTAL 380 100
High Mobilization on Yes 208 54.74
Immunization No 172 45.26
TOTAL 380 100
Immunization Yes 180 47.37
Education during ANC No 200 52.63
TOTAL 380 100
Availability of health Yes 199 52.37
workers No 181 47.63
TOTAL 380 100
Rudeness of Health Yes 237 62.37
workers No 143 37.63
TOTAL 380 100
Abuse from Health Yes 201 52.89
workers No 179 47.11
TOTAL 380 100
Information about Yes 186 48.95
subsequent No 194 51.05
immunization TOTAL 380 100
schedules
Clean Immunization Yes 166 43.68
site No 214 56.32
TOTAL 380 100
Refusal by health Yes 90 23.68
workers to immunize No 290 76.32
children

Health System Characteristics of the study health facility, but more than half of the participants
participants 53.68% (204/380) don’t have access to immunization
Shown in table 3 below are the frequencies and services within the community with 62.89%
percentages of health system characteristics of the (239/380) staying the health facilities are
study participants. The table shows that majority of understaffed much as 55.79% (212/380) accepted that
the study participants 58.95% (224/380) were in there was adequate immunization coverage. Lastly,
possession of child immunization card, were staying when asked about immunization outreaches, 52.63%
less than 5 km from the nearest health facility 40.26% (200/380) said that immunization outreaches were
(153/380) and had no vaccination posts near to their being organized in their communities.
69.74% (265/380). Vast majority of the study
participants 75.00% (285/380) delivered from the

24
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Table 3: Frequency table for health services characteristics of study participants

CATEGORY OPTIONS FREQUENCY(n) PERCENTAGE (%)
Possession of Child Yes 224 58.95
Immunization Card No 156 41.05
TOTAL 380 100
Distance to Nearest <5 km 153 40.26
health facility 5 – 10 km 134 35.26
> 10 km 93 24.47
TOTAL 380 100
Vaccination post near Yes 115 30.26
home No 265 69.74
TOTAL 380 100
Delivered from a health Yes 285 75.00
facility No 95 25.00
TOTAL 380 100
Access to Yes 176 46.32
Immunization services No 204 53.68
in community TOTAL 380 100
Understaffing at the Yes 239 62.89
health facility No 141 37.11
TOTAL 380 100
Adequate coverage of Yes 212 55.79
immunization services No 168 44.21
TOTAL 380 100
Immunization Yes 180 47.37
outreaches No 200 52.63
TOTAL 380 100

The Level of Utilization of Immunization Services the polio vaccine, 72.11% (274/380) received the OPV
Among Children Under 5 Years in Lira 0, 74.47% (283/380) received the OPV 1, 73.68%
Municipality, Lira District, Northern Uganda. (280/380) received OPV 2 whereas 60.79% (231/380)
Table 4 shows that 72.89% (277/380) of the study received the OPV 3 vaccine. Lastly, 61.58% (234/380)
participants received the BCG vaccine, 74.47% of study participants received the measles vaccine.
(283/380) received the DPT 1 vaccine. On the other Overall, 52.89% (201/380) of the children under 5
hand, DPT 2 was received by 71.05% (270/380) of the years of age had received all the doses of vaccines as
children under 5 years of age meanwhile 60.79% per the national schedule.
(231/380) received the DPT vaccine. Pertaining to

25
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Table 4: Level of utilization of the Individual Immunization services

VACCINE STATUS FREQUENCY(n) PERCENTAGE (%)
BCG Received 277 72.89
Not Received 103 27.11
TOTAL 380 100
DPT 1 Received 283 74.47
Not Received 97 25.53
TOTAL 380 100
DPT 2 Received 270 71.05
Not Received 110 28.95
TOTAL 380 100
DPT 3 Received 231 60.79
Not Received 149 39.21
TOTAL 380 100
OPV 0 Received 274 72.11
Not Received 106 27.89
TOTAL 380 100
OPV 1 Received 283 74.47
Not Received 97 25.53
TOTAL 380 100
OPV 2 Received 280 73.68
Not Received 100 26.32
TOTAL 380 100
OPV 3 Received 231 60.79
Not Received 149 39.21
TOTAL 380 100
Measles Received 234 61.58
Not Received 146 38.42
TOTAL 380 100
Overall Vaccination Complete 201 52.89
Status Incomplete 94 24.74
Not Immunized 85 22.37
TOTAL 380 100

Overall Level of utilization of immunization (295/380) of the children under 5 years of age
Table 7 below shows the overall level of utilization of meanwhile 22.37% (22.37/380) of the children under
immunization services among children under 5 years five years of age did not utilize the immunization
of age in Lira Municipality. Results showed that services.
immunization services were utilized by 77.63%

Table 5: The overall level of utilization of immunization services

Immunization services Frequency Percentage 95% CI
Not Utilized 85 22.37 18.16 – 26.58
Utilized 295 77.63 73.42 – 81.84

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Figure 1

22%

Not Utilized

78% Utilized

Figure 1: Pie chart showing the overall level of utilization of immunization services

Gender-Specific Utilization of Immunization 89.22. Immunization services were least utilized by

Services female children 74.90% (185/247) with a 95% CI of
Table 6 shows the gender-specific utilization of 69.45-80.34. The difference in the utilization of
immunization services among children under 5 years immunization services between males and females
of age in Lira Municipality. Immunization services was not statistically significant with a P value of 0.081
were utilized highest by male children 82.71% and a chi square value of 3.035.
(110/133) with a 95% confidence interval of 76.20-
Table 6: Gender-Specific Level of Utilization of Immunization Services
Gender of the Total Utilization of Immunization Services Chi P Value
children Square
(Χ2)
Not Utilized Utilized
Count, Count,
% (95% CI) % (95% CI)
Male 133 23 110
17.29% (10.78-23.80) 82.71% (76.20-89.22)
Female 247 62 185 3.035 0.081
25.10% (19.66-30.55) 74.90% (69.45-80.34)

27
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Chart Title
80
70
60
50
Axis Title

40
Received
30
Not Received
20
10
0
BCG DPT1 DPT2 DPT3 OPV0 OPV1 OPV2 OPV3 Measles
Axis Title

Figure 1: Bar Graph showing Level of utilization of the Individual Immunization services

The Socio-Demographic Factors Influencing Children with mothers who had secondary level of
Utilization of Immunization Services among education were 6.50 times more likely to utilize
Children Under 5 Years in Lira Municipality, Lira immunization services than children who had
District, Northern Uganda uneducated mothers (cOR 6.50, 95%CI 2.21 – 19.10,
In order to establish the socio-demographic factors P=0.001). Children with Muslim mothers were 84%
influencing utilization of immunization services less likely to utilize immunization services than
among children under 5 years of age in the study area, children who had Christian mothers (cOR 0.16,
a bivariate logistic regression was run and the results 95%CI 2.21 – 19.10, P<0.001). Then finally, children
of the analysis are shown in table 7 below. Education who had a birth order of 3 or more were 49% less
level of the mothers, Religion of the mothers and likely to utilize immunization services than children
Birth order of the children were the only socio- who had a birth order of 1 (cOR 0.51, 95%CI 0.29 –
demographic factors which statistically influenced 0.90, P<0.019).
utilization of immunization services among the
children under 5 years of age in the study area.

28
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Table 7: Results of Bivariate Logistic Regression Showing Socio-Demographic Factors Influencing
Utilization of Immunization Services among Children Under 5 Years in Lira Municipality
VARIABLE CATEGORY UTILIZATION OF AOR 95% CI P VALUE
IMMUNIZATION
NO=85 YES=295
n (%) n (%)
Age of Mothers 18 – 25 years 41 (23.03) 137 (76.97) Reference
26 – 35 years 26 (26.00) 74 (74.00) 0.85 0.48 – 1.50 0.579
≥ 36 years 18 (17.65) 84 (82.35) 1.40 0.75 – 2.59 0.289
Education Level Not educated 41 (30.60) 93 (69.40) Reference
Primary 26 (20.80) 99 (79.20) 1.68 0.95 – 2.96 0.073
Secondary 04 (06.35) 59 (93.65) 6.50 2.21 – 19.10 0.001*
Post-secondary 14 (24.14) 44 (75.86) 1.39 0.68 – 2.80 0.364
Employment Employed 43 (26.38) 120 (73.62) Reference
status Unemployed 42 (19.35) 175 (80.65) 1.50 0.92 – 2.42 0.105
Residence Rural 23 (19.49) 95 (80.51) Reference
Urban 62 (23.66) 200 (76.34) 0.78 0.46 – 1.34 0.367
Religion Christian 19 (12.18) 137 (87.82) Reference
Muslim 37 (46.25) 43 (53.75) 0.16 0.08 – 0.31 <0.001*
Born again 17 (20.73) 65 (79.27) 0.53 0.26 – 1.09 0.083
Others 12 (19.35) 50 (80.65) 0.58 0.26 – 1.28 0.175
Marital Status Single 22 (24.44) 68 (75.56) Reference
Married 40 (19.61) 164 (80.39) 1.33 0.73 – 2.40 0.350
Divorced 17 (30.91) 38 (69.09) 0.72 0.34 – 1.53 0.395
Widowed 06 (19.35) 25 (80.65) 1.35 0.49 – 3.71 0.563
Gender of the Male 23 (17.29) 110 (82.71) Reference
child Female 62 (25.10) 185 (74.90) 0.62 0.37 – 1.06 0.083
Monthly Income Less than 300,000 46 (22.66) 157 (77.34) Reference

300,0000 or more 39 (22.03) 138 (77.97) 1.04 0.64 – 1.68 0.884

Birth Order of the First 41 (19.71) 167 (80.29) Reference
child Second 16 (18.60) 70 (81.40) 1.07 0.57 – 2.04 0.827
Third or more 28 (32.56) 58 (67.44) 0.51 0.29 – 0.90 0.019*
Busy Schedule at Yes 33 (19.08) 140 (80.92) Reference
Work No 52 (25.12) 155 (74.88) 0.70 0.43 – 1.15 0.160
cOR= Crude odds ratio. CI= Confidence interval. P Value is Significant at 0.05 level.

The Health Worker Related Factors Influencing influencing utilization of immunization services
Utilization of Immunization Services among among children under 5 years of age within the study
Children Under 5 Years in Lira Municipality, Lira area. Study participants with who said health workers
District, Northern Uganda were not rude were 3.58 times more likely to make
Table 8 shows results of a bivariate logistic their children to utilize immunization services (cOR
regression which was run to establish health worker 3.5, 95%CI 1.96 – 6.54, P<0.001). On the other hand,
related factors influencing utilization of mothers who were not given information about
immunization services among children under 5 years subsequent immunization schedule by the health
in Lira Municipality, Lira District, Northern Uganda. workers were 63% less likely to make their children
Results of the analysis showed that Rudeness of to utilize immunization services (cOR 0.37, 95%CI
health workers and being informed by the health 0.22 – 0.622, P<0.001).
workers about subsequent immunization schedules
were the only two health worker related factors

29
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Table 8: Results of Bivariate Logistic Regression to show Health Worker Related Factors Influencing
Utilization of Immunization Services among Children under 5 Years of Age
VARIABLE CATEGORY UTILIZATION OF cOR 95% CI P VALUE
IMMUNIZATION
NO=85 YES=295
n (%) n (%)
Immunization Yes 37 (22.02) 131 (77.98) Reference
Campaign on No 48 (22.64) 164 (77.36) 0.97 0.59 – 1.57 0.886
Radio
High Yes 46 (22.12) 162 (77.88) Reference
Mobilization on No 39 (22.67) 133 (77.33) 0.97 0.60 – 1.57 0.896
Immunization
Immunization Yes 39 (21.67) 141 (78.33) Reference
Education No 46 (23.00) 154 (77.00) 0.93 0.57 – 1.50 0.756
during ANC
Availability of Yes 52 (26.13) 147 (73.87) Reference
health workers No 33 (18.23) 148 (81.77) 1.59 0.97 – 2.60 1.59
Rudeness of Yes 70 (29.54) 167 (70.46) Reference
Health workers No 15 (10.49) 128 (89.51) 3.58 1.96 – 6.54 <0.001*

Abuse from Yes 44 (21.89) 157 (78.11) Reference

Health workers No 41 (22.91) 138 (77.09) 0.94 0.58 – 1.53 0.813
Information on Yes 26 (13.98) 160 (86.02) Reference
subsequent No 59 (30.41) 135 (69.59) 0.37 0.22 – 0.622 <0.001*
schedules
Clean Yes 36 (21.69) 130 (78.31) Reference
Immunization No 49 (22.90) 165 (77.10) 0.93 0.57 – 1.52 0.779
site
Refusal by health Yes 20 (22.22) 70 (77.78) Reference
workers to No 65 (22.41) 225 (77.59) 0.99 0.56 – 1.74 0.970
immunize
cOR= Crude odds ratio. CI= Confidence interval. P Value is Significant at 0.05 level

The Health System Factors Influencing the card were 70% less likely to utilize immunization
Utilization of Immunization Services among services as compared to mothers who were in
Children Under 5 Years in Lira Municipality, Lira possession of child immunization card (cOR 0.30,
District, Northern Uganda 95%CI 0.18 – 0.50, P<0.001). Mothers who said there
Possession of immunization card and Understaffing was no understaffing at the health facilities were 3.17
at the health facilities were found to be the health times more likely to utilize immunization services
system factors influencing utilization of than mothers said there was understaffing at the
immunization services among children under 5 years health facilities (cOR 3.17, 95%CI 1.76 – 5.73,
in Lira Municipality as presented in table 9 below. P<0.001).
Mothers who never possessed a child immunization

30
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Table 9; Results of a Bivariate Logistic Regression to show The Health System Factors Influencing the
Utilization of Immunization Services among Children Under 5 Years in Lira Municipality
VARIABLE CATEGORY UTILIZATION OF cOR 95% CI P VALUE
IMMUNIZATION
NO=85 YES=295
n (%) n (%)
Has Child Yes 31 (13.84) 193 (86.16) Reference
Immunization No 54 (34.62) 102 (65.38) 0.30 0.18 – 0.50 <0.001*
Card
Distance to <5 km 30 (19.61) 123 (80.39) Reference
Nearest health 5 – 10 km 37 (27.61) 97 (72.39) 0.64 0.37 – 1.11 0.111
facility > 10 km 18 (19.35) 75 (80.65) 1.02 0.53 – 1.95 0.961
Vaccination post Yes 30 (26.09) 85 (73.91) Reference
near home No 55 (20.75) 210 (79.25) 1.35 0.81 – 2.25 0.253
Delivered from a Yes 67 (23.51) 218 (76.49) Reference
health facility No 18 (18.95) 77 (81.05) 1.31 0.73 – 2.35 0.356
Access to Yes 44 (25.00) 132 (75.00) Reference
Immunization in No 41 (20.10) 163 (79.90) 1.33 0.82 – 2.15 0.254
community
Understaffing at Yes 69 (28.87) 170 (71.13) Reference
the health facility No 16 (11.35) 125 (88.65) 3.17 1.76 – 5.73 <0.001*
Adequate Yes 48 (22.64) 164 (77.36) Reference
coverage of No 37 (22.02) 131 (77.98) 1.04 0.64 – 1.69 0.886
immunization
Immunization Yes 41 (22.78) 139 (77.22) Reference
outreaches No 44 (22.00) 156 (78.00) 1.05 0.65 – 1.70 0.856
cOR= Crude odds ratio. CI= Confidence interval. P Value is Significant at 0.05 level

Multivariate Logistic Regression to Determine following factors were found to significantly influence
Factors Independently Influencing the Utilization the utilization of immunization services; Mothers’
of Immunization Services among Children Under education level; Secondary versus no education (aOR
5 Years in Lira Municipality, Lira District, 7.46, 95%CI 2.17 – 25.65, P=0.001), Religion;
Northern Uganda. Muslims versus Christians (aOR 0.15, 95%CI 0.07 –
A multivariate logistic regression was run to establish 0.32, P<0.001), Rudeness of health workers; No
the independent predictors of utilization of versus Yes (aOR 3.50, 95%CI 1.73 – 7.06, P<0.001),
immunization services among the study participants Being informed about subsequent immunization
and the results are shown in table 10 below. Factors schedules; No versus Yes (aOR 0.38, 95%CI 0.20 –
with p-value less than 0.20 at bivariate logistic 0.70, P=0.002), having a child Immunization card; No
regression analysis were considered for multivariate versus yes (aOR 0.34, 95%CI 0.19 – 0.63, P=0.001),
analysis. Through a stepwise logistic regression with and understaffing at the health facility; No Versus Yes
removal of least significant variable in each step, the (aOR 2.87, 95%CI 1.43 – 5.78, P=0.003).

31
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Table 10: Multivariate Logistic Regression to Determine Factors Independently Influencing the Utilization
of Immunization Services among Children Under 5 Years in Lira Municipality
VARIABLE CATEGORY UTILIZATION OF aOR 95% CI P VALUE
IMMUNIZATION
NO=85 YES=295
n (%) n (%)
Education Level Not educated 41 (30.60) 93 (69.40) Reference
Primary 26 (20.80) 99 (79.20) 1.91 0.94 – 3.91 0.075
Secondary 04 (06.35) 59 (93.65) 7.46 2.17 – 25.65 0.001*
Post-secondary 14 (24.14) 44 (75.86) 1.29 0.54 – 3.08 0.569
Employment status Employed 43 (26.38) 120 (73.62) Reference
Unemployed 42 (19.35) 175 (80.65) 1.52 0.83 – 2.81 0.569
Religion Christian 19 (12.18) 137 (87.82) Reference
Muslim 37 (46.25) 43 (53.75) 0.15 0.07 – 0.32 <0.001*
Born again 17 (20.73) 65 (79.27) 0.54 0.24 – 1.23 0.143
Others 12 (19.35) 50 (80.65) 0.64 0.26 – 1.61 0.344
Gender of the child Male 23 (17.29) 110 (82.71) Reference
Female 62 (25.10) 185 (74.90) 0.98 0.51 – 1.90 0.957
Birth Order of the First 41 (19.71) 167 (80.29) Reference
child Second 16 (18.60) 70 (81.40) 1.34 0.61 – 2.95 0.469
Third or more 28 (32.56) 58 (67.44) 0.81 0.40 – 1.65 0.567
Busy Schedule at Yes 33 (19.08) 140 (80.92) Reference
Work No 52 (25.12) 155 (74.88) 0.81 0.44 – 1.50 0.507
Availability of Yes 52 (26.13) 147 (73.87) Reference
health workers No 33 (18.23) 148 (81.77) 1.50 0.82 – 2.76 0.187
Rudeness of Health Yes 70 (29.54) 167 (70.46) Reference
workers No 15 (10.49) 128 (89.51) 3.50 1.73 – 7.06 <0.001*
Information on Yes 26 (13.98) 160 (86.02) Reference
subsequent No 59 (30.41) 135 (69.59) 0.38 0.20 – 0.70 0.002*
schedules
Has Child Yes 31 (13.84) 193 (86.16) Reference
Immunization No 54 (34.62) 102 (65.38) 0.34 0.19 – 0.63 0.001*
Card
Distance to <5 km 30 (19.61) 123 (80.39) Reference
Nearest health 5 – 10 km 37 (27.61) 97 (72.39) 0.66 0.34 – 1.31 0.239
facility > 10 km 18 (19.35) 75 (80.65) 1.001 0.44 – 2.32 0.982
Understaffing at Yes 69 (28.87) 170 (71.13) Reference
the health facility No 16 (11.35) 125 (88.65) 2.87 1.43 – 5.78 0.003*
aOR= Adjusted odds ratio. CI= Confidence interval. P Value is Significant at 0.05 level
DISCUSSION
The Level of Utilization of Immunization Services County, Lira District located in Northern part of
Among Children Under 5 Years in Lira Uganda [32]. The probable reason for the agreement
Municipality, Lira District, Northern Uganda in the study findings could be because both studies
This study revealed that immunization services were were conducted in the same region which happens to
utilized by 77.63% (295/380) of the children under 5 be Northern Uganda. The study findings revealed
years of age meanwhile 22.37% (22.37/380) of the that utilization of immunization services for children
children under five years of age did not utilize the under 5 years of age for measles is low at 61.58%
immunization services. The level of utilization of which is below the recommended target by WHO of
immunization found in this study is promising though 85%. These findings are in line with what was found
more can still be done to improve it further because in a study conducted by Canavan et al whose findings
the decision of a single mother not to take her child showed that majority of children had not received all
for immunization put the children in the entire vaccine doses recommended by WHO implying that
community at risk. The finding of the present study not all those children who were started on BCG
is similar to the results of a study done in Amach Sub- completed schedules [33]. In this study, the
32
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proportion of children utilizing the BCG vaccine present study is not in agreement with the results of
(72.89%) was higher than those utilizing the first dose a study conducted in Gambia which reported that
of the polio vaccine (72.11%). This finding indicates 45% fully utilized immunization services [41]. Stock
there are still missed opportunities and highlight the out of vaccines could lead to a low level of utilization
challenge of introducing early polio vaccine which of immunization services, it is therefore crucial for
should be given within 24 h after birth. In our study, health facilities to have focal persons for
there was a decline in coverage of immunization from immunization whose duty is to ensure the smooth
BCG at birth (72.89%) to measles (61.58%). Overall, running of immunization services. Similarly, [42]
the dropout rate between BCG vaccine and measles also report a rate of utilization of immunization
vaccine was around 11.31%. Our findings are in services which is lower than what was reported in the
agreement with those in Nigeria, Guinea, and Uganda present study. [43] in their study reported that 49.8%
[34]. A plausible reason to explain reduction in the of the study participants utilized immunization
proportion of full vaccination coverage when children services, this figure is lower than the 77.63% found in
get older compared to vaccines received after birth the present study. The disagreement in the study
may be due to logistical problems but also the fact findings might have risen from the fact that the
that some mothers may not understand the routine previous was conducted among children less than 2
immunization schedule [35] or may not choose to years whereas the present study was conducted
come back after adverse events following the first among children less than 5 years of age. Additionally,
contact with the immunization system. Immunization [22] in their study conducted in Hoima district.
uptake revealed high utilization of initial antigens The Socio-Demographic Factors Influencing
which are BCG and birth polio given at birth and first Utilization of Immunization Services among
pentavalent, polio, rotavarix and pneumococcal Children Under 5 Years in Lira Municipality, Lira
vaccines given at 6 weeks while the utilization of District, Northern Uganda
subsequent antigens given at 10 weeks, 14 weeks, 9 The second sepecific objective of the present study
months shows a significant decline. This compares was to determine the socio-demographic factrors
well with a study done in a peri-urban area in Kenya influencing the utilization of immunization services
which revealed that utilization of first antigens was among children under 5 years of age in Lira
high followed by a declining trend in subsequent Municipality. Results showed that Mothers’
visits [36]. The utilization of immunization services education level; Secondary versus no education (aOR
which stands at 77.63% in the present study is low 7.46, 95%CI 2.17 – 25.65, P=0.001) and Religion;
compared to the 85% global covered coverage Muslims versus Christians (aOR 0.15, 95%CI 0.07 –
reported by in 2014 by the centers of disease control 0.32, P<0.001) were the socio-demographic factors
[37]. The difference in the study findings could be independently affecting utilization of immunization
because the previous study was a wider study whereas services among the study participants. Mother’s level
the present study was a smaller study done in one a of education; This study showed that mother’s level
single municipality in northern part of the country. of education had a positive influence on utilization of
Immunization has been regarded as the key strategy immunization among children under 5 years of age.
to curb communicable diseases which are number one Education helps to improve health seeking behavior
killer of children aged under five [38]. Furthermore, of an individual. This finding is consistent with other
the figure found in the present study is low compared literatures like [44, 45], that found that maternal
to the results of a study done in Kenya which revealed education was a significant predictor of utilization of
that immunization was highly utilized at 91% [39]. immunization services because highly educated
The discrepancy in the study findings could be mothers will be more aware of the importance of
because of the variation in the sampling techniques immunization. The role of maternal education as an
which were utilized in that the previous study important predictor of utilization of immunization
employed systematic random sampling meanwhile services has also been shown by [46, 47]. In contrast,
the present study made use of simple random in study conducted in Libya by [48], there was no
sampling. The figure of 77.63% found in the present significant relationship between immunization status
study is higher than the results of a study conducted and mothers’ educational level. Religion of the
by [40] which revealed that 45% of the study Mothers; this is consistent with the result of the
participants fully utilized the immunization services. research conducted in Nigeria by [49].
The discrepancy in the study finding can be explained Misconception by Muslims affects the immunization
by the difference in the study designs used in the two uptake in Lira municipality as such there is need for
studies in that the previous study utilized case- religious leaders of the Muslim religion to swing in
control design whereas the present study employed action and encourage their followers to take their
the cross-sectional study design. The result of the children for immunization. To the contrary, the
33
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findings of the present study is not in line with the schedules: In one study, community members pointed
findings of a study done about utilization of to a lack of information about particular vaccines,
immunization services among children aged under vaccination scheduling and times of services as one of
five in Kirinyaga County, Kenya [39]. Furthermore, the most common constraints to having a child
a study done on utilization of outreach immunization vaccinated [56]. This finding is in agreement with
services among children in Hoima District found that the finding of the present study. Even where extreme
religion was not a significant predictor. This finding behavior is not normal, health workers commonly
is not in agreement with findings of the present study. communicate little and poorly with mothers, so that
Religion and spirituality are integral components of some mothers leave not knowing when to return and
socio-demographics (rural culture) and influence what to do about side effects (e.g., in Liberia, Niger,
perceived vulnerability to infection and perceived Burkina Faso, Somalia, Guinea, Malawi and Benin)
severity to infection [50]. Religious leaders are [57]. In Mozambique, three quarters of health
highly esteemed, and their authority can convince workers said they always wrote the return dates on
members of their congregations to accept or reject the child's card, but only one quarter of the cards
vaccination [51]. A WHO report from polio endemic examined actually had the date written [58]. Better
region in Nigeria states that only a total of 16% communication was reported in programs In Uganda,
children were adequately vaccinated in that region; Bangladesh and Armenia.
the main reason being that the community was The Health System Factors Influencing the
predominantly of Muslim background and believed Utilization of Immunization Services among
that polio drops were used as a tool for causing Children Under 5 Years in Lira Municipality, Lira
sterility in the children and had been shunned by District, Northern Uganda
community leaders. This led to a substantial rise in When a multivariate logistic regression was run, the
Polio cases in that area. Similar beliefs exist in the health system factors that were found to
Pakistan where several religious and tribal leaders independently utilization of immunization services
express their concern about polio campaign being among children under five years of age were; Having
Western conspiracy to control Muslim population a child Immunization card; No versus yes (aOR 0.34,
[52]. 95%CI 0.19 – 0.63, P=0.001), and understaffing at the
The Health Worker Related Factors Influencing health facility; No Versus Yes (aOR 2.87, 95%CI 1.43
Utilization of Immunization Services among – 5.78, P=0.003). Having child immunization card;
Children Under 5 Years in Lira Municipality, Lira when a mother goes home with an immunization card,
District, Northern Uganda she is more likely to remember the next immunization
Results of the present study showed that Rudeness of schedule and therefore the child will fully utilize the
health workers; No versus Yes (aOR 3.50, 95%CI 1.73 immunization services. The finding of the present
– 7.06, P<0.001), Being informed about subsequent study is in line with the finding of a study carried out
immunization schedules; No versus Yes (aOR 0.38, by [59] which investigated factors associated with
95%CI 0.20 – 0.70, P=0.002) were the health worker immunization status among children aged 12 to 23
related factors that were found to positively influence months in Nouna Health District, Burkina Faso.
the utilization of immunization services among the Findings indicated that complete immunization is
study participants. Rudeness of health workers: significantly associated with availability of
Attitudes and behavior of health staff treating vaccination card [59]. Understaffing at the health
mothers in an unfriendly, disrespectful, or even facility; When staff within the facility are few then
abusive manner are frequently cited as discouraging most probably the immunization services are not
children's vaccination. Health staff reportedly delivered efficiently in addition to existence of certain
screamed at mothers who forgot the child's card, bottle necks such as mothers having to wait for longer
missed a scheduled vaccination appointment, or had a hours to be served by the available few health
dirty, poorly dressed, or malnourished child. Mothers workers, more side effects of the vaccines may also be
felt humiliated and discouraged from returning (e.g. experienced by the immunized children as a result of
in Ethiopia, Zimbabwe, Niger, Kenya, Bangladesh, being immunized by health workers who are
West Africa, Uganda, Benin, Nigeria and Syria) [53, exhausted. As such, some mothers may dodge taking
54]. This factor was not prominent in all settings. In their children for immunization thereby leading to
Uganda only 13% of over 1000 women interviewed incomplete utilization of immunization services [60,
complained about being treated rudely [55]. Being 38].
informed by health workers about subsequent
CONCLUSION
Findings from the study shows that the percentage of below the global immunization goal and strategy
children who utilized immunization services was (GIVS) recommended target of ≥90% national
34
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immunization coverage set by WHO and UNICEF. effort to sensitize parents about the importance of
The study further indicates that Mothers’ education completing the immunization schedule especially the
level, Religion, Rudeness of health workers, being Muslim parents. Education programs that can target
informed about subsequent immunization schedules, poor and uneducated people should be put in place so
having a child Immunization card and understaffing that they are able to make informed decisions
at the health facility were the independently regarding immunization of their children. Free health
influenced utilization of immunization services facilities should be made available to every mother so
among children under 5 years of age in Lira that poor mothers can easily access them. The
Municipality, Northern Uganda. government should work on the problem of
Recommendations understaffing by recruiting and deploying more
Ugandan Government should improve on health workers so as to improve on the immunization
Supplemental immunization activities such as services. Administration of various health facilities
National Immunization Days (NIDs) and Catch-up should encourage the health workers under their
campaigns that are already in place. Ugandan jurisdiction not to be rude to mothers who have taken
ministry of health should conduct immunization their children for immunization. Ministry of health
campaign frequently. Such a campaign should be should embark on printing plenty of immunizations
specific communication focused on all the required cards so that all mothers are given immunization
vaccines. In addition, government should work with cards when they take their children for immunization.
religious leaders so as to improve the uptake of
vaccine. Ugandan Ministry of health should make an
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CITE AS: Olila Daniel (2024). Factors Influencing Utilisation of Immunisation Services among Children
Under Five Years in Lira Municipality Lira District Northern Uganda. IDOSR JOURNAL OF
EXPERIMENTAL SCIENCES 10(3) 18-38. https://doi.org/10.59298/IDOSR/JES/103.18.38

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any medium, provided the original work is properly cited