Why Were the Targets Not Achieved? A Study of the Factors Affecting Immunisation Coverage in The Cape Coast Municipality

Abstract

The Immunisation of children is one of the most powerful interventions to improve child survival and reduce morbidity. For immunisation to be effective in reducing mortality as well as preventing the transmission of disease, a high proportion of the target group must be immunised. The regular evaluation of the immunisation programme is necessary to assess progress, identify problems and develop strategies, which may be used to improve the coverage. The study was conducted in the Cape Coast Municipality in My 2000 to evaluate the immunisation programme following a drop in the immunisation coverage calculated from routine data in 1999. The aim of the study was to determine the actual immunisation coverage, and other factors affecting this coverage. The study combined both quantitative and qualitative methods, using a modification of the WHO 30-cluster sample survey to establish the coverage. The study population was children aged 12-23 months, and the sample size was increased from 210 to 480, thereby increasing the precision of the results obtained. In-depth interviews with mothers and health workers were also conducted to investigate in more detail the factors affecting immunisation coverage, and assess the techniques used by the health staff to monitor the immunisation services. The immunisation coverage for the various vaccines exceeded 75%, however, only 68% of the children were fully immunised by their first birthday. The coverage for DPT3/OPV3 was higher (78%) than it was in the routine reports (64%). The potential immunisation coverage among the immunised children was decreased due to the inappropriately timed vaccinations that had been given. Although the knowledge of immunisation among the mothers was low, competing priorities were the main deterrents preventing mothers from attending immunisation sessions. The vaccinations had all been received at government service delivery points mainly the health centre or the outreach stations. Missed immunisation opportunities,

poor attitude o f staff and poor communities’ involvement in immunisation activities were also problems o f the immunisation programme. Improvement in the immunisation programme in the immediate future requires the retraining and supervision o f health staff, increasing the accessibility o f services provided, ensuring the availability o f vaccines and using all opportunities to vaccinate children. In the medium term, the programme must be reorganised with a well-spelt out mechanism for monitoring the immunisation services, involving the communities and educating mothers in detail on immunisation. In the long term, the main requirement is to improve the educational level ofthe people in the municipality particularly the women.