Parental concerns and uptake of childhood vaccines in rural Tanzania - a mixed methods study

Lavanya Vasudevan, Joy Noel Baumgartner, Sara Moses, Esther Ngadaya, Sayoki Godfrey Mfinanga, Jan Ostermann, Lavanya Vasudevan, Joy Noel Baumgartner, Sara Moses, Esther Ngadaya, Sayoki Godfrey Mfinanga, Jan Ostermann

Abstract

Background: Vaccine hesitancy has been recognized as an important barrier to timely vaccinations around the world, including in sub-Saharan Africa. In Tanzania, 1 in 4 children is not fully vaccinated. The objective of this mixed methods study was to describe and contextualize parental concerns towards vaccines in Tanzania.

Methods: Between 2016 and 2017, we conducted a cross-sectional survey (n = 134) and four focus group discussions (FGDs, n = 38) with mothers of children under 2 years of age residing in Mtwara region in Southern Tanzania. The survey and FGDs assessed vaccination knowledge and concerns and barriers to timely vaccinations. Vaccination information was obtained from government-issued vaccination cards.

Results: In the cross-sectional survey, 72% of mothers reported missed or delayed receipt of vaccines for their child. Although vaccine coverage was high, timeliness of vaccinations was lower and varied by vaccine. Rural mothers reported more vaccine-related concerns compared to urban mothers; literacy and access to information were identified as key drivers of the difference. Mothers participating in FGDs indicated high perceived risk of vaccine-preventable illnesses, but expressed concerns related to poor geographic accessibility, unreliability of services, and missed opportunities for vaccinations resulting from provider efforts to minimize vaccine wastage.

Conclusions: Findings from our cross-sectional survey indicate the presence of vaccination delays and maternal concerns related to childhood vaccines in Tanzania. In FGDs, mothers raised issues related to convenience more often than issues related to vaccine confidence or complacency. Further research is necessary to understand how these issues may contribute to the emergence and persistence of vaccine hesitancy and to identify effective mitigation strategies.

Keywords: Childhood vaccinations; Parental concerns; Sub-Saharan Africa; Tanzania; Vaccination timeliness; Vaccine hesitancy.

Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Childhood vaccination coverage and timeliness for urban and rural children for vaccinations due before 12 months of age (n = 125). Notes: Percentages are based on vaccination dates reported on government-issued vaccination cards for 37 urban and 88 rural children 12–23 months of age. See Supplemental Table 1 for abbreviations of vaccinations. PCV* and Rota* percentages are based on data for 34 urban and 85 rural children. Nine children were excluded due to missing vaccination cards
Fig. 2
Fig. 2
Distribution of maternal knowledge, attitudes, and concerns about childhood vaccines (N = 134). Notes: Numbers indicate counts of women with negative (red) or ambivalent (grey) responses to vaccination-related knowledge and attitude questions. Confidence and importance items were assessed on a 3-point scale including ‘very much’, ‘somewhat’, and ‘not at all’. Knowledge and attitude items were assessed on a 3-point scale including ‘agree’, ‘not sure’, and ‘disagree’. # indicates positively-framed items; all other items were reverse-coded
Fig. 3
Fig. 3
Distribution of vaccine hesitancy in rural vs. urban areas (N = 134). Notes: Vaccine hesitancy index defined using mothers’ responses to 15 questions assessing maternal knowledge, attitudes, and concerns about childhood vaccines; each question is scored on a scale of 0–2; see Fig. 2. A higher index indicates greater vaccine hesitancy

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