Special Vaccine Uptake Among Children With Sickle Cell Disease: Coverage, Determinants and Barriers in a Tertiary Hospital in Benin City, Nigeria

Special Vaccine Uptake Among Children With Sickle Cell Disease: Coverage, Determinants and Barriers in a Tertiary Hospital in Benin City, Nigeria | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Special Vaccine Uptake Among Children With Sickle Cell Disease: Coverage, Determinants and Barriers in a Tertiary Hospital in Benin City, Nigeria Lilian Chinasa Ezeuko This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-9033320/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 17 You are reading this latest preprint version Abstract Background C hildren with sickle cell disease (SCD) are highly susceptible to severe infections due to functional asplenia. Special vaccines such as pneumococcal, Haemophilus influenzae type b(Hib), meningococcal, influenza and hepatitis B vaccines are recommended to reduce infection- related morbidity and morbidity. However, uptake in low- resource settings remain suboptimal Objective To assess caregivers’ knowledge, attitude and practices regarding special vaccination of children with SCD and determine factors associated with vaccination status. Methods A hospital-based cross-sectional study was conducted among 130 caregivers of children with SCD attending University of Benin teaching hospital Benin city. Data were collected using a structured questionnaire assessing socio-demographic characteristics, knowledge, attitude, vaccination history (Cards sited) and barriers to uptake. Knowledge and attitude were graded using predefined scoring systems. Data were analysed using descriptive and inferential statistics, with statistical significance set at p < 0.05. Results Although 60.8% of caregivers knew that children with SCD are prone to serious infections, only 16.2% demonstrated good knowledge. Nearly half (49.2%) of the children were unvaccinated with special vaccines and only 3.1% were fully vaccinated. Financial constraints (65.6%) was the major barrier to uptake. Caregivers’ knowledge (p < 0.001), attitude (p = 0.018) were significantly associated with vaccination status. Conclusion Despite generally positive attitudes, poor knowledge and financial barriers contribute to low uptake of special vaccines among children with SCD. Subsidization and targeted caregiver education are recommended. Caregivers’ knowledge Sickle cell disease Special vaccination Vaccine uptake Figures Figure 1 Figure 2 Introduction Sickle cell disease (SCD) is a genetic haemoglobin disorder that significantly increases susceptibility to infections, particularly those caused by encapsulated bacteria such as Streptococcus pneumoniae and Haemophilus influenzae 1-3 .These infections contribute substantially to the morbidity and mortality seen in paediatric SCD populations worldwide, despite progress in clinical care 1,2 . Compared with healthy children, those with SCD suffer higher rates of invasive pneumococcal disease, sepsis, and severe viral illnesses, such as influenza, due to functional asplenia and impaired immune responses 2-4 . Vaccination is therefore a cornerstone of preventive care for children with SCD, with both routine and “special” vaccines recommended to mitigate infection risks and associated complications 2-5 . The term special vaccine uptake in SCD refers to not only routine immunizations included in national schedules (e.g., diphtheria-tetanus-pertussis [DTP], measles, hepatitis B) but also additional or enhanced immunization recommendations targeting pathogens of high risk in the context of SCD, such as pneumococcal conjugate vaccine (PCV), 23-valent pneumococcal polysaccharide vaccine (PPSV23), and annual influenza vaccines 2-5 . In many high-income countries, expanded immunization guidelines recommend early and extended pneumococcal vaccination schedules, meningococcal vaccines, and annual influenza immunization for children with SCD to reduce the burden of serious infections 1,3,5 . However, despite clear benefits, vaccine uptake among children with SCD remains inconsistent, with evidence pointing to both high coverage for some routine vaccines and suboptimal adherence for specialized vaccine doses 3-6 . Understanding the coverage, determinants, and barriers related to special vaccine uptake in this vulnerable population is essential to improving health outcomes. Studies from diverse settings show that coverage for standard immunization series among children with SCD is often higher than in the general paediatric population, likely due in part to increased contact with healthcare systems and heightened parental awareness of illness risk 6-8 . For example, research in clinical cohorts has documented high uptake of primary EPI (Expanded Programme on Immunization) vaccines, such as DTP and measles, with coverage rates frequently exceeding 80–90% 7 . Conversely, uptake of vaccines explicitly recommended because of SCD risk—such as PCV boosters and annual influenza vaccination—tends to lag significantly behind routine immunizations 7-9 .In some cohorts, influenza vaccination among paediatric SCD patients has been suboptimal, with one study reporting uptake as low as 50–60% in seasons prior to intensified public health promotion, although higher rates are achieved where structured reminder systems and provider engagement exist 8,9 .The variability in special vaccine uptake reflects underlying differences in health systems, patient and caregiver knowledge, and access to care. A major determinant of vaccine uptake among children with SCD is caregiver awareness and understanding of vaccine benefits. Studies indicate that parents or guardians who recognize the increased infection risk associated with SCD and the protective role of vaccines are more likely to ensure that their children complete recommended vaccine series, including specialized immunizations 7,10 . Educational level, health literacy, and exposure to targeted counselling from healthcare providers are positively correlated with improved adherence to immunization schedules 10,11 . In contrast, lack of information or misconceptions about vaccine necessity and safety have been consistently linked to incomplete vaccination 11 . Healthcare delivery factors also strongly influence vaccine uptake. Accessibility of immunization services, including geographic proximity to clinics, appointment availability, and efficient vaccine supply chains, are key determinants of coverage in both routine and special vaccinations 7-12 . Children with SCD who live closer to well-resourced health facilities, or who have regular follow-up with specialist clinics, demonstrate higher adherence to recommended vaccine schedules, suggesting that health system organization plays a critical role 12 . Moreover, integration of immunization reminders and electronic health records in clinical practice has been shown to improve completion rates for PCV boosters and seasonal influenza vaccines 9,12 . However, in settings where such systems are weak or absent, delays and missed opportunities for vaccination are more common. Socioeconomic factors further contribute to disparities in vaccine uptake. Low household income, unstable employment, and lack of health insurance have been linked to lower immunization coverage in children with chronic diseases, including SCD 8,10,13 . Financial barriers may limit access to healthcare, reduce time available for clinic visits, and increase the likelihood of missed doses 13 . Even in countries with public immunization programs, indirect costs (e.g., transportation, missed work) can impede caregivers’ ability to adhere to vaccine schedules 8,13 . Beyond structural and socioeconomic determinants, behavioural and perceptual barriers also influence special vaccine uptake. Vaccine hesitancy—defined as delay in acceptance or refusal of vaccines despite availability—has been reported among caregivers of children with SCD 11,13 . Concerns about vaccine safety, fear of side effects, and mistrust of healthcare systems contribute to hesitancy, particularly for newer or less familiar vaccines 11,13 . Addressing such attitudes requires culturally sensitive communication and trust-building between providers and caregivers. Inadequate provider recommendation is another barrier. Parents report that clear and consistent guidance from healthcare professionals significantly affects their decision to vaccinate; however, when providers fail to emphasize the importance of special vaccines or do not routinely check immunization status during visits, children with SCD are more likely to miss recommended doses 10,12 . Training healthcare workers to prioritize immunization discussions and to use every clinical encounter as an opportunity to update vaccinations is therefore essential. In low- and middle-income countries (LMICs), where the majority of children with SCD reside, vaccine uptake is further complicated by broader health system constraints 14 . These include shortages of trained personnel, inconsistent vaccine availability, weak health information systems, and limited outreach to rural or underserved populations 14-16 . Research from sub-Saharan Africa highlight that factors such as caregiver education, distance to health facilities, and health worker shortages are strongly associated with immunization coverage, suggesting that similar challenges shape special vaccine uptake in children with SCD 15,16 . In these settings, strengthening routine immunization platforms and integrating SCD-specific vaccination into broader child health strategies could improve coverage. Overall, although many children with SCD receive core routine immunizations, uptake of special vaccines recommended because of their elevated infection risk remains uneven. Coverage is influenced by a complex interplay of caregiver knowledge, healthcare access, socioeconomic conditions, provider practices, and systemic health infrastructure. Understanding and addressing these determinants and barriers is crucial to optimizing vaccine uptake and reducing preventable infectious disease burden in children living with SCD. Aim and Objectives General Aim: To assess special vaccine uptake among children with sickle cell disease and identify determinants influencing coverage Specific objectives To determine the proportion of SCD children who have received each recommended special vaccine. To examine socio-demographic and clinical factors (age, sex, socioeconomic status, parental education, disease severity, frequency of hospital visits) associated with vaccine uptake. To identify caregiver knowledge, attitudes and perceptions about special vaccines. To explore health system- related barriers (availability, cost, supply chain) to vaccine uptake. METHODOLOGY The study was a hospital-based descriptive cross-sectional study. It was conducted in the Paediatric sickle cell out- patient clinic of the University of Benin Teaching hospital Benin city. Study Population All sickle cell disease children that attended the clinic between July and December 2025 were consecutively recruited. A total of 130 children with SCD were recruited for this study Ethical approval/ consideration Ethical approval was sought and obtained from the Ethics Committee of University of Benin Teaching hospital Benin city (NHREC -UBTH- HREC/24/12/2022B). Informed consent was obtained from the parents and assent from children 7 years and above. Methods Two research assistants (1 registrar and 1 house officer) were trained to assist in this study with administration of the questionnaires and examinations of the participants. The patients and their parents/caregivers were given clear and adequate information in English and/or Bini Languages and allowed to make an informed decision. Data Collection Tool A structured questionnaire with four sections: Socio-demographic data Knowledge and attitudes toward vaccines Uptake history (verified with vaccination cards/ medical records) Perceived barriers Data Analysis The data will be entered into the Excel spreadsheet. IBM Statistical Package for Social Sciences (SPSS) version 26.0 will be used to analyse the data. Frequency tables and figures was used to represent the variables. Descriptive statistics were used to summarize the data. Categorical variables such as caregivers’ knowledge, attitude, vaccination status, sociodemographic characteristics were presented as frequencies and percentages. Continuous variables such as age, attitude scores, amount paid for vaccines were summarized using mean and standard deviation. Knowledge of SCD and special vaccines was assessed using a 10-point scoring system. Each correct response was assigned one point while incorrect or ‘don’t know’ responses scored zero. Total scores were categorized as poor (1-4), fair (5-7) and good (8-10) knowledge. Attitude toward special vaccination was assessed using a Likert- scale scoring system with a maximum score of 30. Scores were categorized as poor (1-10), fair (11-20) and good (21-30) attitude. Inferential statistics were used to test associations between independent variables (sociodemographic factors, knowledge grade and attitude grade) and the dependent variable (vaccination status). Chi- square was used for comparison of categorical variables. A p-value of <0.05 was considered statistically significant. Results Table IA: Socio-demographic characteristics of caregivers and household information . About 45% of the caregivers were aged 40–49 years. Most (86.2%) of the caregivers were female and mothers to the children with SCD, respectively. More than half (52.3%) of the caregivers had a secondary education as highest level of education. Approximately 52% of the caregivers belonged to the lower socioeconomic class according to the Oyedeji classification. Most (75.4%) of the caregivers had only one child with SCD. The greater proportion (52.3%) reported a family monthly income of greater than 150,000 naira. Table IA: Socio-demographic characteristics of caregivers and household information Variable Frequency (n = 130) Percent (%) Age (Mean = 41.7 years) (SD = 8.595) Younger than 30 years 11 8.5 30–39 years 37 28.5 40–49 years 58 44.6 50–59 years 18 13.8 60 years or older 6 4.6 Gender Male 18 13.8 Female 112 86.2 Relationship to child Father 17 13.1 Mother 112 86.2 Grandparent 1 0.8 Highest level of education Primary 15 11.5 Secondary 68 52.3 Tertiary 47 36.2 Socio-economic class (Oyedeji) Upper class 17 13.1 Middle class 45 34.6 Lower class 68 52.3 Number of children with SCD One 98 75.4 Two Three or more 27 5 20.8 3.8 Family monthly income 150,000 68 52.3 Residence Urban 39 30.0 Semi-urban 45 34.6 Rural 46 35.4 Table IB: Socio-demographic characteristics and clinical profile of children with SCD. Slightly more than half (58.5%) of the children with SCD were male than female (41.5%). Approximately 37% (36.9%) of the children were aged 5–9 years (mean age was 9.02 years ± 4.42). Most (72.3%) of the children were diagnosed of SCD between 1–5 years of age. Approximately 45% of the children with SCD reported having 1–2 crises within the last one year; nearly one-third (33.1%) have had none within the same time frame. More than half (52.3%) of the children reported having had no hospital admission within the last one year. The greater proportion (60%) of the children with SCD were on hydroxyurea therapy. Table IB: Socio-demographic characteristics and clinical profile of children with SCD Variable Frequency (n = 130) Percent (%) Gender Male 76 58.5 Female 54 41.5 Age (Mean = 9.02) (SD = 4.421) 1–4 years 23 17.7 5–9 years 48 36.9 10–14 years 40 30.8 15–18 years 19 14.6 Age at diagnosis 4–11 months 10 7.7 1–5 years 94 72.3 6–10 years 20 15.4 11–14 years 6 4.6 Number of SCD crises in last one year 0 time 43 33.1 1–2 times 58 44.6 3–5 times 24 18.5 > 5 times 5 3.8 Number of hospital admissions in last one year 0 68 52.3 1 41 31.5 2 13 10.0 3 8 6.2 Hydroxyurea use Yes 78 60.0 No 52 40.0 Table II: Caregivers’ knowledge of SCD and special vaccines. The greater proportion (60.8%) of the caregivers of children with SCD agreed that a child with SCD is more likely to contract serious infection. However, only 36.9% of them could mention at least one of such serious infections. The greater proportion (56.2%) of the caregivers claimed to know that there are vaccines specifically recommended for children with SCD. However, less than one-third (32.3%) knew that pneumococcal vaccine prevents against severe pneumonia and meningitis. Only 20% of the caregivers of children with SCD knew that influenza vaccine is recommended yearly. Likewise, only 16.9% of the caregivers knew that Hemophilus influenzae type b vaccine (Hib vaccine) prevents meningitis. Most 9.2% claimed that vaccines cause severe disease. See table II Table II: Caregivers’ knowledge of SCD and special vaccines Variable Frequency (n = 130) Percent (%) Do you know that a child with SCD is more likely to get serious infections? Yes 79 60.8 No 41 31.5 Don't know 10 7.7 Do you know any infection children with SCD are at risk of? Yes (if any infection is mentioned) 48 36.9 No/Don't Know 82 63.1 Are there vaccines specifically recommended for children with SCD? Yes 73 56.2 No/I Don't Know 57 43.8 Do you know that pneumococcal vaccine protects against severe pneumonia and meningitis? Yes 42 32.3 No/I Don't know 88 67.7 Is influenza vaccine recommended yearly? Yes 26 20.0 No/I Don't know 104 80.0 Hib vaccine prevents meningitis? Yes 22 16.9 No/I Don't know 108 83.1 Vaccines cause severe disease Yes 12 9.2 No/I Don't know 118 90.8 Who recommends special vaccines for SCD? Doctors/Nurses 115 88.5 Traditional healers 1 0.8 I Don't Know 14 10.8 Place where child can receive vaccines Hospital 120 92.3 Don't know 10 7.7 Table III: Grading of the caregivers’ knowledge on SCD and special vaccines. The greater proportion (54.6%) of the caregivers had poor knowledge, 29.2% had fair knowledge, and only 16.2% of the caregivers had good knowledge of SCD and special vaccines. Table III: Knowledge Grade of Caregivers on SCD and special vaccines * Knowledge grade Frequency (n = 130) Percent (%) Poor knowledge 71 54.6 Fair knowledge 38 29.2 Good Knowledge 21 16.2 * Score: Poor knowledge = 1–4; Fair knowledge = 5–7; Good knowledge = 8–10 (Total score = 10) Table IV: Vaccination history of the children with SCD . Forty percent (40%) had received pneumococcal conjugate vaccine (PCV), 13.8% received Hib, 31.5% received meningococcal vaccine, 20.8% received hepatitis B vaccine, 43.8% received typhoid vaccine, 18.5% received MMR vaccine, and 19.2% received varicella vaccine. Table IV: Vaccination history of children with SCD Variable Frequency (n = 130) Percent (%) Has child ever received pneumococcal conjugate vaccine (PCV)? Yes 52 40.0 No 78 60.0 Has child ever received Hib vaccine? Yes 18 13.8 No 112 86.2 Has child ever received meningococcal vaccine? Yes 41 31.5 No 89 68.5 Has child ever received hepatitis B vaccine? Yes 27 20.8 No 103 79.2 Has child ever received typhoid vaccine? Yes 57 43.8 No 73 56.2 Has child ever received MMR vaccine? Yes 24 18.5 No 106 81.5 Has child ever received Varicella vaccine? Yes 25 19.2 No 105 80.8 Table V: Reasons given by caregivers for not giving the special vaccination to their children . Approximately 5% (4.8%) said that the vaccines were not available; 44.4% that the vaccines are too expensive; 31% reported lack of awareness of the special vaccines as the reason for not vaccinating their children; 1.6% reported fear of side effects; none reported child being ill at scheduled time; and 1.6% reported severe adverse effect (convulsion) as the reason. Table V: Reasons given by caregivers for not giving the special vaccination to their children . Variable Frequency (n = 126) Percent (%) Vaccine not available Yes 6 4.8 No 120 95.2 Vaccine too expensive Yes 56 44.4 No 70 55.6 The caregiver did not know about the special vaccine Yes 39 31.0 No 87 69.0 Fear of side effects Yes 2 1.6 No 124 98.4 Child unwell at scheduled time Yes 0 0 No 126 100.0 Severe adverse effects Yes 2 1.6 No 124 98.4 If yes, what adverse effect? Convulsion 2 100.0 Table VI: Caregivers’ attitude to special vaccination of children with SCD. The greater proportion (53, 40.8%) of the caregivers of children with SCD strongly agreed that the special vaccines are safe. The greater proportion (62, 47.7%) of the caregivers of children with SCD agreed that the special vaccines are effective. The greater proportion (55, 42.3%) of the caregivers of children with SCD strongly disagreed that they worry about side effects. The greater proportion (54, 41.5%) of the caregivers of children with SCD strongly agreed that the costs of the special vaccines are too high. The greater proportion (50, 38.5%) of the caregivers of children with SCD agreed that they would follow a doctor’s advice. The greater proportion (48, 36.9%) of the caregivers of children with SCD strongly agreed that vaccination is a priority. Table VI: Caregivers’ Attitude to Special Vaccination of Children with SCD Variable Strongly Disagree Disagree Neutral Agree Strongly Agree Vaccines are safe 1 (0.8%) 2 (1.5%) 22 (16.9%) 52 (40.0%) 53 (40.8%) Vaccines are effective 2 (1.5%) 6 (4.6%) 25 (19.2%) 62 (47.7) 35 (26.9%) I worry about side effects 40 (30.8%) 55 (42.3%) 14 (10.8%) 13 (10.0%) 8 (6.2%) The costs of vaccines are too high 20 (15.4%) 24 (18.5%) 12 (9.2%) 20 (15.4%) 54 (41.5%) I would follow a doctor’s advice 3 (2.3%) 8 (6.2%) 30 (23.1%) 50 (38.5%) 39 (30.0%) Vaccination is a priority 3 (2.3%) 27 (20.8%) 31 (23.8%) 21 (16.2%) 48 (36.9%) Table VII: Caregivers’ attitude score . Approximately 35(34.6%) and 65 (65.4%) of the caregivers had fair and good attitude, respectively. Table VII: Caregivers’ attitude score* Attitude Frequency (n = 130) Percent (%) Mean = 21.97 SD = 3.781 Poor 0 0.0 Fair 45 34.6 Good 85 65.4 * Score: Poor attitude = 1–10; Fair attitude = 11–20; Good attitude = 21–30 (Total = 30) Table VIII: Caregivers’ health-seeking practices. Most (76.2%) of caregivers of children with SCD had a frequency of clinic visit of three-monthly. Most (78.5%) of caregivers of children with SCD reported that a health worker had recommended the special vaccine. The greater proportion (43.9%) of caregivers have paid 25,001–50,000 naira for the special vaccine. Most (86.9%) of caregivers of children with SCD reported that they would take the special vaccine if it were available for free. Table VIII: Caregivers’ health-seeking practices Variable Frequency (n = 130) Percent (%) Frequency of clinic visit Monthly 16 12.3 3-monthly 99 76.2 6-monthly 5 3.8 Yearly 2 1.5 Only when sick 8 6.2 Has any health worker recommended the special vaccines? Yes 102 78.5 No 28 21.5 Which health worker recommended the vaccine? Paediatrician recommended 78 76.5% Nurse recommended 13 12.7% Immunization officer recommended 10 9.8% Other persons 1 1.0% Where do you take your child for vaccination? Teaching Hospital/SCD Clinic 124 95.4 PHC Centre 4 3.1 Private Hospital 2 1.5 How much have you paid for vaccines in naira? (n = 66) Median = 50,000 naira IQR = 114,500 naira 25,000 naira or less 12 18.2 25,001–50,000 naira 29 43.9 50,001–100,000 naira 8 12.1 100,001–200,000 naira 12 18.2 200,001–600,000 naira 5 7.6 If special vaccines were available for free at the SCD clinic, would you get them? (n = 130) Yes 113 86.9 No 1 0.8 Not Sure 16 12.3 Table IX: Barriers and motivators of special vaccines of children with SCD. Out of the 64 caregivers who did not vaccinate their child at all, the greater proportion (65.6%) gave financial constraints as the main reason for not vaccinating their child. Out of the 66 caregivers who partially or completely vaccinated their children, the greater proportion (57.6%) vaccinated their child to prevent infection, disease, or crises. Table IX: Barriers and motivators of special vaccines of children with SCD Variable Frequency (n = 64) Percent (%) Main reason for not vaccinating your child Financial constraints 42 65.6 Lack of awareness of special vaccines 2 3.1 Fear of adverse side effects 4 6.3 No reason given 16 25.0 Main reason for vaccinating your child (n = 66) The doctor recommended it 7 10.6 To prevent infection, disease, or crises 38 57.6 To cure my child 4 6.1 To improve growth and health of my child 4 6.1 To prevent future complications 1 1.5 No reason given 12 18.2 Table X: Association between socio-demographic factors and vaccination status of children with SCD. The greater proportion (38, 80.9%) of caregivers with a tertiary level of education had SCD children that were unvaccinated. However, the association between caregivers’ highest level of education and vaccination status of their children was not statistically significant, (ꭓ 2 = 2.003, P = 0.367). The greater proportion (52, 96.3%) of caregivers with a monthly income of 50,000–150,000 naira had SCD children that were unvaccinated. The association between caregivers’ family monthly income and vaccination status of their children was statistically significant, (ꭓ 2 = 8.082, P = 0.018). The greater proportion (61, 86.2%) of caregivers with lower class SES had SCD children that were unvaccinated. The association between caregivers’ SES and vaccination status of their children was not statistically significant, (ꭓ 2 = 1.508, P = 0.470). The greater proportion (69, 97.2%) of caregivers with poor knowledge of SCD and special vaccines had SCD children that were unvaccinated. The association between caregivers’ knowledge and vaccination status of their children was statistically significant, (ꭓ 2 = 19.246, P < 0.001). The greater proportion (43, 95.6%) of caregivers with a fair attitude to vaccination had SCD children that were unvaccinated. The association between caregivers’ attitude and vaccination status of their children was statistically significant, (ꭓ 2 = 5.100, P = 0.024). Table X: Association between socio-demographic factors and vaccination status of children with SCD Variable Vaccination status ꭓ 2 (or Fisher’s exact) statistic P-value Unvaccinated Vaccinated (Partially/Fully) Caregivers’ highest level of education Primary 14 (93.3%) 1 (6,7%) 2.003 0.367 Secondary 60 (88.2%) 8 (11.8%) Tertiary 38 (80.9%) 9 (19.1%) Family monthly income 150,000 54 (79.4%) 14 (20.6%) Parents’ socio-economic class Upper class 14 (82.4%) 3 (17.6%) 1.508 0.470 Middle class 37 (82.2%) 8 (17.8%) Lower class 61 (86.2%) 7 (13.8%) Caregivers’ knowledge Poor knowledge 69 (97.2%) 2 (2.8%) 19.246 < 0.001* Fair knowledge 30 (78.9%) 8 (21.1%) Good knowledge 13 (61.9%) 8 (38.1%) Caregivers’ attitude Fair 43 (95.6%) 2 (4.4%) 5.100 0.024* Good 69 (81.2%) 16 (18.8%) Discussion In this study, 44.6% of the caregivers were aged 40–49 years and the majority were female mothers of children with SCD (86.2%) reflecting the central role mothers play in chid health decision- making in many African contexts Similar caregiver profiles have been described in Lagos and Ilorin, where female caregivers constituted the majority of respondents in studies exploring health literacy and immunization practices among high- risk paediatric populations 17 , 18 .Over half of caregivers had secondary education and 52.3% belonged to lower socioeconomic class according to Oyedeji’s classification. Socioeconomic class has been widely reported as a determinant of health access in sub-Saharan Africa, with lower class correlating with reduced uptake of preventive services, including vaccination 19 , 20 . The finding that many caregivers reported higher monthly incomes (> 150,000 Naria) may reflect urban catchment characteristics of the teaching hospital but this did not translate into high vaccination coverage suggesting that income alone is insufficient to overcome systemic and informational barriers. The clinical profile of children in this study shows that most were male (58.5) with a mean age of approximately 9 years. Most children were diagnosed between 1 and 5 years and more than half (52.3%) reported no admissions in the past year, possibly indicating relatively stable disease status. About 60% of children were on hydroxyurea therapy, a disease- modifying treatment increasingly recognised in Nigeria but still not widely accessible in all regions 21 , 22 . The prevalence of hydroxyurea use in this cohort reflects growing awareness among clinicians and caregivers about comprehensive SCD care. In this study, although 60.8% of caregivers knew that children with SCD are more prone to serious infections, only 36.9% could mention at least one specific infections. This limited depth of knowledge is comparable to findings from studies in Nigeria and other sub- Saharan African countries, where general awareness of infection risk in SCD was moderate but specific knowledge of causative organisms was low 21 , 23 . A study by Brown et al., 21 in south- West Nigeria reported that while most caregivers recognized infection as a complication of SCD, few could identify pneumococcal infection as a major threat. Similar findings were reported in Ghana and Uganda, where knowledge of infection susceptibility did not translate into comprehensive understanding of preventive strategies 24 , 25 . Knowledge of specific vaccines was particularly poor in the present study. Only 32.3% knew the role of pneumococcal vaccine, 20% knew influenza vaccine is recommended yearly and 16.9% knew that Hib prevents meningitis. These findings align with reports from Enugu and Kano Nigeria where caregivers demonstrated poor knowledge of optional or special vaccines outside the National Programme on Immunization (NPI) schedule 24 , 25 . In many African settings, routine childhood vaccines are better known than additional vaccines recommended for high-risk groups such as SCD patients 23 , 25 . Overall, more than half of the caregivers had poor knowledge and only 16.2% had good knowledge. This is consistent with previous Nigerian studies that reported inadequate caregiver knowledge regarding comprehensive SCD care including infection prevention 21 , 24 . Poor knowledge significantly influenced vaccination status in this study (p < 0.001), reinforcing evidence that caregiver education is a key determinant of vaccine uptake 26 . Despite poor knowledge, caregivers demonstrated generally positive attitude scores; most agreed that vaccines are safe and effective and 86.9% were willing to vaccinate if vaccines were available free of charge. This positive disposition is similar to findings from Lagos and Ibadan, where caregivers expressed trust in healthcare providers and confidence in vaccines but cited cost as a major barrier 27 , 28 . The association between positive attitude and vaccination status in this study (p = 0.024) further highlights the importance of behavioural and perceptual factors in vaccine acceptance. However, actual vaccination coverage was low. Only 40% had received PCV, 13.8% Hib and 31.5% meningococcal vaccine. Overall, 49.2% were completely unvaccinated with special vaccines and only 3.1% were fully vaccinated. These findings are consistent with other Nigerian hospital- based studies that reported low uptake of optional vaccines among children with chronic illnesses 24 , 27 . In contrast, higher coverage rates have been documented in high-income countries, where comprehensive SCD programs and insurance coverage improve access 28 . Financial constraints emerged as the principal barrier. Among unvaccinated children, 65.6% of their caregivers cited financial difficulties. Monthly income was significantly associated with vaccination status (p = 0.018). This finding is consistent with multiple Nigerian and African studies identifying cost as the leading barrier to uptake of non-routine vaccines 10 , 29 , 30 . Unlike routine childhood vaccines provided free under NPI, many special vaccines for SCD must be paid for out-of-pocket, posing challenges in low- resource settings 30 . Encouragingly, 78.5% of caregivers reported that a health worker had recommended vaccination which is well- documented predictor of vaccine uptake 26 , 27 . In this study, 57.6% of caregivers who vaccinated their children did so to prevent infection or crises, suggesting awareness of vaccine benefits among those who complied The significant association between caregiver knowledge and vaccination status (p < 0.001) aligns with evidence from Ghana and Kenya demonstrating that improved caregiver knowledge correlates with better preventive practice 22 , 31 . However, caregiver education level itself was not significantly associated with vaccination status, indicating that formal education alone may not translate to disease- specific knowledge, a knowledge finding also reported in previous Nigerian studies 21 , 23 . Overall, this study highlights a critical gap between positive attitudes and actual vaccination uptake, largely driven by poor knowledge and financial barriers. Similar patterns have been documented across sub- Saharan Africa, where structural barriers such as cost and vaccine availability limit uptake despite willingness 32 , 33 . Conclusion This study demonstrated that caregivers of children with SCD had generally positive attitudes toward special vaccination but insufficient knowledge and very low vaccine uptake. Although more than half of the caregivers were aware that children with SCD are more susceptible to severe infections, only a minority could identify specific infection or correctly state the role of recommended vaccines. Overall, more than half of the caregivers had poor knowledge scores. Despite these knowledge gaps, attitudes toward vaccination were largely favourable. Most caregivers believed that vaccines are safe and effective, trusted healthcare providers recommendations and expressed willingness to vaccinate their children if vaccines were made free of charge. This indicate that vaccine hesitancy was not the principal problem in this population. However, vaccination coverage for special vaccines remained suboptimal. Nearly half of the children were completely unvaccinated and only a very small proportion were fully vaccinated. Financial constraint emerged as the major barrier to uptake with many caregivers reporting high out-of-pocket costs. Monthly income was significantly associated with vaccination status, underscoring the economic burden of accessing special vaccines not included in routine NPI. In addition, caregiver knowledge and attitude were significantly associated with vaccination status, highlighting the importance of health education and counselling in improving preventive practices. Recommendations Structured health education sessions should be incorporated into routine SCD clinic visits Counselling should emphasize the role of pneumococcal, Hib, meningococcal, influenza vaccines in preventing severe infections and complications Government and policymakers should consider subsidizing or fully integrating special vaccines for children with SCD into the NPI to reduce out-of-pocket expenditure. Reminder systems and vaccination tracking registers should be implemented in SCD clinics to monitor coverage. Limitations The study was conducted in a tertiary hospital and may not be generalizable to caregivers who receive care at private hospitals or primary health care centres The cross- sectional study design limits the ability to establish causal relationships between caregivers’ knowledge, attitude, socio-demographic factors and vaccination status. Declarations Conflict of Interest: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper. Funding : This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors. The study was self-funded by the authors. Consent for publication: Written informed consent was obtained from all individual participants (or their legal guardians) for publication of this study and its accompanying data. Availability of data and materials : The datasets used and/or analysed during the current study are available from the corresponding author on reasonable request. References Platt OS, Brambilla DJ, Rosse WF, Milner PF, Castro O, Steinberg MH, et al. Mortality in sickle cell disease—life expectancy and risk factors for early death. N Engl J Med. 1994;330(23):1639–44. Gaston MH, Verter JI, Woods G, Pegelow C, Kelleher J, Presbury G, et al. Prophylaxis with oral penicillin in children with sickle cell anemia. N Engl J Med. 1986;314(25):1593–99. De Montalembert M, Tshilolo L, Kafando E. Sickle cell disease in Africa: a challenge for governments, health systems and communities. Bull World Health Organ. 2019;97(6):386–92. Brousseau DC, Owens PL, Mosso AL, Panepinto JA, Steiner CA. Acute care utilization and rehospitalizations for sickle cell disease. JAMA. 2010;303(13):1288–94. Centre for Disease Control and Prevention (CDC). Immunization recommendations for people with sickle cell disease. Atlanta, GA: CDC; 2023. Jarovsky D, Romanzini P, Faria de Matos S, Almeida FJ, Palazzi Safadi MA, Hegg ICO et al,. Vaccination in paediatric patients with sickle cell disease: uptake report and mini-review. J Trop Pediatr. 2022;68(3): fmac034. Doi:10.1093/tropej/fmac034 Walden J, Stanek JR, Young J, Griffth MM, Nahata L, Creary SE. Influenza vaccine uptake among youth with sickle cell disease seen in clinic before and after the COVID- 19 pandemic. Vaccine. 2024;42(22):789–97. Persaud Y, Mandrell BN, Sharma A, Carroll Y, Irvine M, Olufadi Y, et al. Attitude toward COVID-19 vaccine among pediatric patients with sickle cell disease and their caregivers. Pediatr Blood Cancer. 2023;70(5):e30274. Doi.10.1002/pbc.30274. Bundy DG, Strouse JJ, Casella JF, Miller MR. Pneumococcal vaccination coverage and invasive disease in children with sickle cell disease. Blood. 2017;130(7):858–65. Ngoungou EB, Makoutode M, Amougou AK, Boguikouma JB, Mba JR, Kombila M. Determinants of immunization uptake among children with sickle cell disease in Libreville, Gabon. J Public Health Afr. 2023;14(2): 2191. Doi:10.4081/jphia.2023.2191. Uzochukwu BS, Onwujekwe OE, Akpala CO. Community- based interventions for increasing immunization coverage in low-income countries. Cochrane Databas Syst Rev. 2015; (7): CD008145. Doi: 10.1002/14651858.CD008145. Szilagyi PG, Bordley C, Vann JC, Chelminski A, Kraus RM, Margois PA, et al. Effect of patient reminder/ recall interventions on immunization rates. JAMA. 2000;284(14):1820-27. Larson HJ, Jarrett C, Schulz WS, Chaudhuri M, Zhou Y, Dube E, et al. Measuring vaccine hesitancy: development of a survey tool. Vaccine. 2015;33(34):4165–75. World Health Organization. Sickle cell disease: a global public health priority. Geneva: WHO; 2021. Iroha E, Ibekwe R, Eze J. Barriers to immunization in rural Nigeria. Afr J Health Sci. 2024;37(1):45–54. Bangura JB, Xiao S, Qiu D, Ouyang F, Chen L. Barriers to childhood immunization in sub- Saharan Africa: a systematic review. BMC public Health. 2020;20:1108. Doi:10.1186/s12889-020-09169-4. Adebola SO, Okeke TA, Oladapo OT. Knowledge and attitudes toward childhood immunization among caregivers in Lagos, Nigeria, West Afr J Med. 2018;35(2): 85-90 Adeyemi AO, Olatunde AS. Primary caregiver profiles and child health practices in Ilorin, Nigeria. Niger J Paediatr. 2019;46(1):12-18 Oyedeji GA. Socioeconomic and cultural background of hospitalized children in Ilesha. Niger J Paediatr. 1985; 12:111-17 Ezeaka VC, Ibekwe RC. Socioeconomic determinants of immunization uptake in Enugu, Nigeria, Nigeria. Niger Med J. 2017;58(4): 156-62 Brown BJ, Okereke JO, Lagunju IA, Orimadegun AE, Ohaeri JU. Burden of health-care of carers of children with sickle cell disease in Nigeria. Health Soc Care Community. 2010; 18(3): 289-295 Mwashungi A, Deodatus K, Calvin S, Tone K, Kare M, Makani J, et al. Caregivers’ deliefs about hydroxyurea usage among children with sickle cell disease: a cross- sectional study in Dar-es-Salaam, Tanzania. Pan Afr Med J. 2025; 52:31. Doi:10.11604/pamj.2025.52.31.45975 Chianumba BN, Nwagha UI. Hydroxyurea adherence and outcomes among Nigerian children with SCD. Afr J Haematol Oncol. 2019;11(1): 12-20 Ohemeng A, Edusei L, Bonney I. Knowledge and health- seeking behaviour of caregivers of children with sickle cell disease in Ghana. BMC Public Health. 2019; 19:1235 Ndeezi G, Kizito S, Okwera A, Ndugwa CM. Preventive care practices among caregivers of children with sickle cell disease in Uganda. Afr Health Sci. 2016;16(2):456-62 Ezeonu PO, Modebe O, Ezeaka C. Immunization practices in children with sickle cell disease in Enugu, Nigeria. Niger J Pediatr. 2015;42(4):290-95 Sani UM, Jiya NM, Ahmed H. Uptake of optional vaccines among children in kano, Nigeria. Niger J Basic Clin Sci. 2017; 14:45-50 Opel DJ, Heritage J, Taylor J, Mangione-Smith R, Salas HS, DeVere V, et al. The influence of provider communication on vaccine acceptance. Pediatrics. 2013;132(6):1037-46 Adebola SO, Musa IA, Ekanem PO, Oladipo TF, Okonkwo CU. Uptake of pneumococcal vaccine among children with sickle cell disease in Lagos. West Afr J Med. 2018;35(2):85-90 Centers of Disease Control and prevention. Immunization schedule for persons with high- risk conditions. 2022.MMWR Morb Mortal Wkly Rep. 2022;71(7):234-36 Ilesanmi OS, Afolabi AA. Determinants of optional vaccine uptake in Ibadan, Nigeria. Pan Afr Med J. 2017; 27:112-20 Adedokun ST, Uthman OA. Out-of-pocket costs and immunization inequities in sub-Saharan Africa. Vaccine.2019;37:1585-91 Essoh TA, Adeyanju GC, Adamu AA, Tall H, Aplogan A, Tabu C. Exploring the factors contributing to low vaccination uptake for nationally recommended routine childhood and adolescent vaccine in Kenya. BMC Public Health. 2023; 23:912. Doi: 10.1186/s12889-023-15855-w Additional Declarations No competing interests reported. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-9033320","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":603367407,"identity":"d0864350-8aab-4317-a039-32ac7d105fd1","order_by":0,"name":"Lilian Chinasa Ezeuko","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAABDklEQVRIiWNgGAWjYBACPmbmhgNQNjMDQwVMnA23FjZmRmQtZ4jRwsDYAGMzMzC2EaOFnbHxwM8dDHLy7T3GBh/n3cnTbT97gOFD2WEGc/4FOB12sPcMgzFjzxnjxJnbnhWbnclLYJxx7jCD5YwHuP3C28aQ2CyRY3yYd9vhxG03eAyYedsOMxjcOIBTy8G/bQz1bfJvgFrmQLX8JaDlMNCWBB4JHuNk3gaoFkaQlvMNuLXItkkYzuBJKzacceww0C85Bgd7zqXzGNzAHmL8/IcPf3zbZiMv3354s8SHmsN5ZsfPGD74UWYtZ3Aeu8OgQALOSgARILU8DBIJ+LQgAJIyfry2jIJRMApGwcgBAEYCXwPCjoMqAAAAAElFTkSuQmCC","orcid":"","institution":"","correspondingAuthor":true,"prefix":"","firstName":"Lilian","middleName":"Chinasa","lastName":"Ezeuko","suffix":""}],"badges":[],"createdAt":"2026-03-04 19:08:55","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-9033320/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-9033320/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":104343520,"identity":"1849f38f-3c97-47e2-b51b-fe1d1a8406ad","added_by":"auto","created_at":"2026-03-10 17:11:32","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":76779,"visible":true,"origin":"","legend":"\u003cp\u003eKnowledge grade of caregivers of children with SCD\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-9033320/v1/30f4835868b109d546c832e7.png"},{"id":104343519,"identity":"29bd4eed-a26e-4b3b-850f-2af98f6e7c6b","added_by":"auto","created_at":"2026-03-10 17:11:32","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":65445,"visible":true,"origin":"","legend":"\u003cp\u003eProportion of children with SCD by vaccination status\u003c/p\u003e","description":"","filename":"2.png","url":"https://assets-eu.researchsquare.com/files/rs-9033320/v1/e081adb39ef40f6dbf3b4d47.png"},{"id":104343543,"identity":"03855f88-fe1a-4ad0-b7a0-f1e80f8d830a","added_by":"auto","created_at":"2026-03-10 17:11:38","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":2717548,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-9033320/v1/d376945b-c7cb-43a3-a2fb-fcd70a687226.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"\u003cp\u003eSpecial Vaccine Uptake Among Children With Sickle Cell Disease: Coverage, Determinants and Barriers in a Tertiary Hospital in Benin City, Nigeria\u003c/p\u003e","fulltext":[{"header":"Introduction","content":"\u003cp\u003eSickle cell disease (SCD) is a genetic haemoglobin disorder that significantly increases susceptibility to infections, particularly those caused by encapsulated bacteria such as Streptococcus pneumoniae and Haemophilus influenzae\u003csup\u003e1-3\u003c/sup\u003e.These infections contribute substantially to the morbidity and mortality seen in paediatric SCD populations worldwide, despite progress in clinical care\u003csup\u003e1,2\u003c/sup\u003e. Compared with healthy children, those with SCD suffer higher rates of invasive pneumococcal disease, sepsis, and severe viral illnesses, such as influenza, due to functional asplenia and impaired immune responses\u003csup\u003e2-4\u003c/sup\u003e. Vaccination is therefore a cornerstone of preventive care for children with SCD, with both routine and \u0026ldquo;special\u0026rdquo; vaccines recommended to mitigate infection risks and associated complications\u003csup\u003e2-5\u003c/sup\u003e.\u003c/p\u003e\n\u003cp\u003eThe term special vaccine uptake in SCD refers to not only routine immunizations included in national schedules (e.g., diphtheria-tetanus-pertussis [DTP], measles, hepatitis B) but also additional or enhanced immunization recommendations targeting pathogens of high risk in the context of SCD, such as pneumococcal conjugate vaccine (PCV), 23-valent pneumococcal polysaccharide vaccine (PPSV23), and annual influenza vaccines\u003csup\u003e2-5\u003c/sup\u003e. In many high-income countries, expanded immunization guidelines recommend early and extended pneumococcal vaccination schedules, meningococcal vaccines, and annual influenza immunization for children with SCD to reduce the burden of serious infections\u003csup\u003e1,3,5\u003c/sup\u003e. However, despite clear benefits, vaccine uptake among children with SCD remains inconsistent, with evidence pointing to both high coverage for some routine vaccines and suboptimal adherence for specialized vaccine doses\u003csup\u003e3-6\u003c/sup\u003e. Understanding the coverage, determinants, and barriers related to special vaccine uptake in this vulnerable population is essential to improving health outcomes.\u003c/p\u003e\n\u003cp\u003eStudies from diverse settings show that coverage for standard immunization series among children with SCD is often higher than in the general paediatric population, likely due in part to increased contact with healthcare systems and heightened parental awareness of illness risk\u003csup\u003e6-8\u003c/sup\u003e. For example, research in clinical cohorts has documented high uptake of primary EPI (Expanded Programme on Immunization) vaccines, such as DTP and measles, with coverage rates frequently exceeding 80\u0026ndash;90%\u003csup\u003e7\u003c/sup\u003e. Conversely, uptake of vaccines explicitly recommended because of SCD risk\u0026mdash;such as PCV boosters and annual influenza vaccination\u0026mdash;tends to lag significantly behind routine immunizations\u003csup\u003e7-9\u003c/sup\u003e.In some cohorts, influenza vaccination among paediatric SCD patients has been suboptimal, with one study reporting uptake as low as 50\u0026ndash;60% in seasons prior to intensified public health promotion, although higher rates are achieved where structured reminder systems and provider engagement exist\u003csup\u003e8,9\u003c/sup\u003e.The variability in special vaccine uptake reflects underlying differences in health systems, patient and caregiver knowledge, and access to care. A major determinant of vaccine uptake among children with SCD is caregiver awareness and understanding of vaccine benefits. Studies indicate that parents or guardians who recognize the increased infection risk associated with SCD and the protective role of vaccines are more likely to ensure that their children complete recommended vaccine series, including specialized immunizations\u003csup\u003e7,10\u003c/sup\u003e. Educational level, health literacy, and exposure to targeted counselling from healthcare providers are positively correlated with improved adherence to immunization schedules\u003csup\u003e10,11\u003c/sup\u003e. In contrast, lack of information or misconceptions about vaccine necessity and safety have been consistently linked to incomplete vaccination\u003csup\u003e11\u003c/sup\u003e.\u003c/p\u003e\n\u003cp\u003eHealthcare delivery factors also strongly influence vaccine uptake. Accessibility of immunization services, including geographic proximity to clinics, appointment availability, and efficient vaccine supply chains, are key determinants of coverage in both routine and special vaccinations\u003csup\u003e7-12\u003c/sup\u003e. Children with SCD who live closer to well-resourced health facilities, or who have regular follow-up with specialist clinics, demonstrate higher adherence to recommended vaccine schedules, suggesting that health system organization plays a critical role\u003csup\u003e12\u003c/sup\u003e. Moreover, integration of immunization reminders and electronic health records in clinical practice has been shown to improve completion rates for PCV boosters and seasonal influenza vaccines\u003csup\u003e9,12\u003c/sup\u003e. However, in settings where such systems are weak or absent, delays and missed opportunities for vaccination are more common. Socioeconomic factors further contribute to disparities in vaccine uptake. Low household income, unstable employment, and lack of health insurance have been linked to lower immunization coverage in children with chronic diseases, including SCD\u003csup\u003e8,10,13\u003c/sup\u003e. Financial barriers may limit access to healthcare, reduce time available for clinic visits, and increase the likelihood of missed doses\u003csup\u003e13\u003c/sup\u003e. Even in countries with public immunization programs, indirect costs (e.g., transportation, missed work) can impede caregivers\u0026rsquo; ability to adhere to vaccine schedules\u003csup\u003e8,13\u003c/sup\u003e.\u003c/p\u003e\n\u003cp\u003eBeyond structural and socioeconomic determinants, behavioural and perceptual barriers also influence special vaccine uptake. Vaccine hesitancy\u0026mdash;defined as delay in acceptance or refusal of vaccines despite availability\u0026mdash;has been reported among caregivers of children with SCD\u003csup\u003e11,13\u003c/sup\u003e. Concerns about vaccine safety, fear of side effects, and mistrust of healthcare systems contribute to hesitancy, particularly for newer or less familiar vaccines\u003csup\u003e11,13\u003c/sup\u003e. Addressing such attitudes requires culturally sensitive communication and trust-building between providers and caregivers. Inadequate provider recommendation is another barrier. Parents report that clear and consistent guidance from healthcare professionals significantly affects their decision to vaccinate; however, when providers fail to emphasize the importance of special vaccines or do not routinely check immunization status during visits, children with SCD are more likely to miss recommended doses\u003csup\u003e10,12\u003c/sup\u003e. Training healthcare workers to prioritize immunization discussions and to use every clinical encounter as an opportunity to update vaccinations is therefore essential.\u003c/p\u003e\n\u003cp\u003eIn low- and middle-income countries (LMICs), where the majority of children with SCD reside, vaccine uptake is further complicated by broader health system constraints\u003csup\u003e14\u003c/sup\u003e. These include shortages of trained personnel, inconsistent vaccine availability, weak health information systems, and limited outreach to rural or underserved populations\u003csup\u003e14-16\u003c/sup\u003e. Research from sub-Saharan Africa highlight that factors such as caregiver education, distance to health facilities, and health worker shortages are strongly associated with immunization coverage, suggesting that similar challenges shape special vaccine uptake in children with SCD\u003csup\u003e15,16\u003c/sup\u003e. In these settings, strengthening routine immunization platforms and integrating SCD-specific vaccination into broader child health strategies could improve coverage.\u003c/p\u003e\n\u003cp\u003eOverall, although many children with SCD receive core routine immunizations, uptake of special vaccines recommended because of their elevated infection risk remains uneven. Coverage is influenced by a complex interplay of caregiver knowledge, healthcare access, socioeconomic conditions, provider practices, and systemic health infrastructure. Understanding and addressing these determinants and barriers is crucial to optimizing vaccine uptake and reducing preventable infectious disease burden in children living with SCD.\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAim and Objectives\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eGeneral Aim:\u0026nbsp;\u003c/strong\u003eTo assess special vaccine uptake among children with sickle cell disease and identify determinants influencing coverage\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eSpecific objectives\u003c/strong\u003e\u003c/p\u003e\n\u003col\u003e\n \u003cli\u003eTo determine the proportion of SCD children who have received each recommended special vaccine.\u003c/li\u003e\n \u003cli\u003eTo examine socio-demographic and clinical factors (age, sex, socioeconomic status, parental education, disease severity, frequency of hospital visits) associated with vaccine uptake.\u003c/li\u003e\n \u003cli\u003eTo identify caregiver knowledge, attitudes and perceptions about special vaccines.\u003c/li\u003e\n \u003cli\u003eTo explore health system- related barriers (availability, cost, supply chain) to vaccine\u0026nbsp;\u003c/li\u003e\n\u003c/ol\u003e\n\u003cp\u003euptake.\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e"},{"header":"METHODOLOGY","content":"\u003cp\u003eThe study was a hospital-based descriptive cross-sectional study. It was conducted in the Paediatric sickle cell out- patient clinic of the University of Benin Teaching hospital Benin city.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eStudy Population\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll sickle cell disease children that attended the clinic between July and December 2025 were consecutively recruited. A total of 130 children with SCD were recruited for this study\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthical approval/ consideration\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eEthical approval was sought and obtained from the Ethics Committee of University of Benin Teaching hospital Benin city (NHREC -UBTH- HREC/24/12/2022B). Informed consent was obtained from the parents and assent from children 7 years and above.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eTwo research assistants (1 registrar and 1 house officer) were trained to assist in this study with administration of the questionnaires and examinations of the participants.\u003c/p\u003e\n\u003cp\u003eThe patients and their parents/caregivers were given clear and adequate information in English and/or Bini Languages and allowed to make an informed decision.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData Collection Tool\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eA structured questionnaire with four sections:\u003c/p\u003e\n\u003cul\u003e\n \u003cli\u003eSocio-demographic data\u003c/li\u003e\n \u003cli\u003eKnowledge and attitudes toward vaccines\u003c/li\u003e\n \u003cli\u003eUptake history (verified with vaccination cards/ medical records)\u003c/li\u003e\n \u003cli\u003ePerceived barriers\u003c/li\u003e\n\u003c/ul\u003e\n\u003cp\u003e\u003cstrong\u003eData Analysis\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe data will be entered into the Excel spreadsheet. \u0026nbsp;IBM Statistical Package for Social Sciences (SPSS) version 26.0 will be used to analyse the data. \u0026nbsp;Frequency tables and figures was used to represent the variables. Descriptive statistics were used to summarize the data. Categorical variables such as caregivers’ knowledge, attitude, vaccination status, sociodemographic characteristics were presented as frequencies and percentages. Continuous variables such as age, attitude scores, amount paid for vaccines were summarized using mean and standard deviation. Knowledge of SCD and special vaccines was assessed using a 10-point scoring system. Each correct response was assigned one point while incorrect or ‘don’t know’ responses scored zero. Total scores were categorized as poor (1-4), fair (5-7) and good (8-10) knowledge. Attitude toward special vaccination was assessed using a Likert- scale scoring system with a maximum score of 30. Scores were categorized as poor (1-10), fair (11-20) and good (21-30) attitude. Inferential statistics were used to test associations between independent variables (sociodemographic factors, knowledge grade and attitude grade) and the dependent variable (vaccination status). Chi- square was used for comparison of categorical variables. A p-value of \u0026lt;0.05 was considered statistically significant.\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003e \u003cb\u003eTable IA: Socio-demographic characteristics of caregivers and household information\u003c/b\u003e.\u003c/p\u003e \u003cp\u003eAbout 45% of the caregivers were aged 40\u0026ndash;49 years. Most (86.2%) of the caregivers were female and mothers to the children with SCD, respectively. More than half (52.3%) of the caregivers had a secondary education as highest level of education. Approximately 52% of the caregivers belonged to the lower socioeconomic class according to the Oyedeji classification. Most (75.4%) of the caregivers had only one child with SCD. The greater proportion (52.3%) reported a family monthly income of greater than 150,000 naira.\u003c/p\u003e \u003cp\u003e \u003cb\u003eTable IA: Socio-demographic characteristics of caregivers and household information\u003c/b\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"No\" id=\"Taba\" border=\"1\"\u003e \u003ccolgroup cols=\"3\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVariable\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFrequency (n\u0026thinsp;=\u0026thinsp;130)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003ePercent (%)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eAge\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e(Mean\u0026thinsp;=\u0026thinsp;41.7 years)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e(SD\u0026thinsp;=\u0026thinsp;8.595)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYounger than 30 years\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e8.5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e30\u0026ndash;39 years\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e37\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e28.5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e40\u0026ndash;49 years\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e58\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e44.6\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e50\u0026ndash;59 years\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e18\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e13.8\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e60 years or older\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4.6\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eGender\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e18\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e13.8\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e112\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e86.2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eRelationship to child\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFather\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e17\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e13.1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMother\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e112\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e86.2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGrandparent\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.8\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eHighest level of education\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePrimary\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e15\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e11.5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSecondary\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e68\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e52.3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTertiary\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e47\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e36.2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eSocio-economic class (Oyedeji)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eUpper class\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e17\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e13.1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMiddle class\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e45\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e34.6\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLower class\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e68\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e52.3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eNumber of children with SCD\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOne\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e98\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e75.4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTwo\u003c/p\u003e \u003cp\u003eThree or more\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e27\u003c/p\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e20.8\u003c/p\u003e \u003cp\u003e3.8\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eFamily monthly income\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;50,000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e6.2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e50,000\u0026ndash;150,000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e54\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e41.5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026gt;\u0026thinsp;150,000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e68\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e52.3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eResidence\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eUrban\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e39\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e30.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSemi-urban\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e45\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e34.6\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRural\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e46\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e35.4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cb\u003eTable IB: Socio-demographic characteristics and clinical profile of children with SCD.\u003c/b\u003e \u003c/p\u003e \u003cp\u003eSlightly more than half (58.5%) of the children with SCD were male than female (41.5%). Approximately 37% (36.9%) of the children were aged 5\u0026ndash;9 years (mean age was 9.02 years\u0026thinsp;\u0026plusmn;\u0026thinsp;4.42). Most (72.3%) of the children were diagnosed of SCD between 1\u0026ndash;5 years of age. Approximately 45% of the children with SCD reported having 1\u0026ndash;2 crises within the last one year; nearly one-third (33.1%) have had none within the same time frame. More than half (52.3%) of the children reported having had no hospital admission within the last one year. The greater proportion (60%) of the children with SCD were on hydroxyurea therapy.\u003c/p\u003e \u003cp\u003e \u003cb\u003eTable IB: Socio-demographic characteristics and clinical profile of children with SCD\u003c/b\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"No\" id=\"Tabb\" border=\"1\"\u003e \u003ccolgroup cols=\"3\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVariable\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFrequency (n\u0026thinsp;=\u0026thinsp;130)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003ePercent (%)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGender\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e76\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e58.5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e54\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e41.5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eAge\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e(Mean\u0026thinsp;=\u0026thinsp;9.02)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e(SD\u0026thinsp;=\u0026thinsp;4.421)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e1\u0026ndash;4 years\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e23\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e17.7\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e5\u0026ndash;9 years\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e48\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e36.9\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e10\u0026ndash;14 years\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e40\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e30.8\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e15\u0026ndash;18 years\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e19\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e14.6\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eAge at diagnosis\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e4\u0026ndash;11 months\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e7.7\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e1\u0026ndash;5 years\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e94\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e72.3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e6\u0026ndash;10 years\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e20\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e15.4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e11\u0026ndash;14 years\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4.6\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eNumber of SCD crises in last one year\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e0 time\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e43\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e33.1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e1\u0026ndash;2 times\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e58\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e44.6\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e3\u0026ndash;5 times\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e24\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e18.5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026gt;\u0026thinsp;5 times\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3.8\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eNumber of hospital admissions in last one year\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e68\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e52.3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e41\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e31.5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e10.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e6.2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eHydroxyurea use\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e78\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e60.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e52\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e40.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cb\u003eTable II: Caregivers\u0026rsquo; knowledge of SCD and special vaccines.\u003c/b\u003e \u003c/p\u003e \u003cp\u003e The greater proportion (60.8%) of the caregivers of children with SCD agreed that a child with SCD is more likely to contract serious infection. However, only 36.9% of them could mention at least one of such serious infections. The greater proportion (56.2%) of the caregivers claimed to know that there are vaccines specifically recommended for children with SCD. However, less than one-third (32.3%) knew that pneumococcal vaccine prevents against severe pneumonia and meningitis. Only 20% of the caregivers of children with SCD knew that influenza vaccine is recommended yearly. Likewise, only 16.9% of the caregivers knew that Hemophilus influenzae type b vaccine (Hib vaccine) prevents meningitis. Most 9.2% claimed that vaccines cause severe disease. See table II\u003c/p\u003e \u003cp\u003e \u003cb\u003eTable II: Caregivers\u0026rsquo; knowledge of SCD and special vaccines\u003c/b\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"No\" id=\"Tabc\" border=\"1\"\u003e \u003ccolgroup cols=\"3\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVariable\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFrequency (n\u0026thinsp;=\u0026thinsp;130)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003ePercent (%)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDo you know that a child with SCD is more likely to get serious infections?\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e79\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e60.8\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e41\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e31.5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDon't know\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e7.7\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eDo you know any infection children with SCD are at risk of?\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes (if any infection is mentioned)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e48\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e36.9\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo/Don't Know\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e82\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e63.1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eAre there vaccines specifically recommended for children with SCD?\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e73\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e56.2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo/I Don't Know\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e57\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e43.8\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eDo you know that pneumococcal vaccine protects against severe pneumonia and meningitis?\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e42\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e32.3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo/I Don't know\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e88\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e67.7\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eIs influenza vaccine recommended yearly?\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e26\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e20.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo/I Don't know\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e104\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e80.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eHib vaccine prevents meningitis?\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e22\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e16.9\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo/I Don't know\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e108\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e83.1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eVaccines cause severe disease\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e9.2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo/I Don't know\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e118\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e90.8\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eWho recommends special vaccines for SCD?\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDoctors/Nurses\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e115\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e88.5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTraditional healers\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.8\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eI Don't Know\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e14\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e10.8\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003ePlace where child can receive vaccines\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHospital\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e120\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e92.3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDon't know\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e7.7\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cb\u003eTable III: Grading of the caregivers\u0026rsquo; knowledge on SCD and special vaccines.\u003c/b\u003e \u003c/p\u003e \u003cp\u003eThe greater proportion (54.6%) of the caregivers had poor knowledge, 29.2% had fair knowledge, and only 16.2% of the caregivers had good knowledge of SCD and special vaccines.\u003c/p\u003e \u003cp\u003e \u003cb\u003eTable III: Knowledge Grade of Caregivers on SCD and special vaccines\u003c/b\u003e*\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"No\" id=\"Tabd\" border=\"1\"\u003e \u003ccolgroup cols=\"3\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eKnowledge grade\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFrequency (n\u0026thinsp;=\u0026thinsp;130)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003ePercent (%)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePoor knowledge\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e71\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e54.6\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFair knowledge\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e38\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e29.2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGood Knowledge\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e21\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e16.2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"3\"\u003e* Score: Poor knowledge\u0026thinsp;=\u0026thinsp;1\u0026ndash;4; Fair knowledge\u0026thinsp;=\u0026thinsp;5\u0026ndash;7; Good knowledge\u0026thinsp;=\u0026thinsp;8\u0026ndash;10 (Total score\u0026thinsp;=\u0026thinsp;10)\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003e \u003cb\u003eTable IV: Vaccination history of the children with SCD\u003c/b\u003e.\u003c/p\u003e \u003cp\u003eForty percent (40%) had received pneumococcal conjugate vaccine (PCV), 13.8% received Hib, 31.5% received meningococcal vaccine, 20.8% received hepatitis B vaccine, 43.8% received typhoid vaccine, 18.5% received MMR vaccine, and 19.2% received varicella vaccine.\u003c/p\u003e \u003cp\u003e \u003cb\u003eTable IV: Vaccination history of children with SCD\u003c/b\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"No\" id=\"Tabe\" border=\"1\"\u003e \u003ccolgroup cols=\"3\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVariable\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFrequency (n\u0026thinsp;=\u0026thinsp;130)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003ePercent (%)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHas child ever received pneumococcal conjugate vaccine (PCV)?\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e52\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e40.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e78\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e60.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eHas child ever received Hib vaccine?\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e18\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e13.8\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e112\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e86.2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eHas child ever received meningococcal vaccine?\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e41\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e31.5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e89\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e68.5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eHas child ever received hepatitis B vaccine?\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e27\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e20.8\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e103\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e79.2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eHas child ever received typhoid vaccine?\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e57\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e43.8\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e73\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e56.2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eHas child ever received MMR vaccine?\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e24\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e18.5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e106\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e81.5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eHas child ever received Varicella vaccine?\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e25\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e19.2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e105\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e80.8\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003e \u003cb\u003eTable V: Reasons given by caregivers for not giving the special vaccination to their children\u003c/b\u003e. Approximately 5% (4.8%) said that the vaccines were not available; 44.4% that the vaccines are too expensive; 31% reported lack of awareness of the special vaccines as the reason for not vaccinating their children; 1.6% reported fear of side effects; none reported child being ill at scheduled time; and 1.6% reported severe adverse effect (convulsion) as the reason.\u003c/p\u003e \u003cp\u003e \u003cb\u003eTable V: Reasons given by caregivers for not giving the special vaccination to their children\u003c/b\u003e.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"No\" id=\"Tabf\" border=\"1\"\u003e \u003ccolgroup cols=\"3\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVariable\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFrequency (n\u0026thinsp;=\u0026thinsp;126)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003ePercent (%)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVaccine not available\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4.8\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e120\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e95.2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eVaccine too expensive\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e56\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e44.4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e70\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e55.6\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eThe caregiver did not know about the special vaccine\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e39\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e31.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e87\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e69.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eFear of side effects\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.6\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e124\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e98.4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eChild unwell at scheduled time\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e126\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e100.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eSevere adverse effects\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.6\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e124\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e98.4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eIf yes, what adverse effect?\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eConvulsion\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e100.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cb\u003eTable VI: Caregivers\u0026rsquo; attitude to special vaccination of children with SCD.\u003c/b\u003e \u003c/p\u003e \u003cp\u003eThe greater proportion (53, 40.8%) of the caregivers of children with SCD strongly agreed that the special vaccines are safe. The greater proportion (62, 47.7%) of the caregivers of children with SCD agreed that the special vaccines are effective. The greater proportion (55, 42.3%) of the caregivers of children with SCD strongly disagreed that they worry about side effects. The greater proportion (54, 41.5%) of the caregivers of children with SCD strongly agreed that the costs of the special vaccines are too high. The greater proportion (50, 38.5%) of the caregivers of children with SCD agreed that they would follow a doctor\u0026rsquo;s advice. The greater proportion (48, 36.9%) of the caregivers of children with SCD strongly agreed that vaccination is a priority.\u003c/p\u003e \u003cp\u003e \u003cb\u003eTable VI: Caregivers\u0026rsquo; Attitude to Special Vaccination of Children with SCD\u003c/b\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"No\" id=\"Tabg\" border=\"1\"\u003e \u003ccolgroup cols=\"6\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVariable\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eStrongly Disagree\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eDisagree\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eNeutral\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eAgree\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eStrongly Agree\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eVaccines are safe\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1 (0.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e2 (1.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e22 (16.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e52 (40.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e53 (40.8%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eVaccines are effective\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e2 (1.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e6 (4.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e25 (19.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e62 (47.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e35 (26.9%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eI worry about side effects\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e40 (30.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e55 (42.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e14 (10.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e13 (10.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e8 (6.2%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eThe costs of vaccines are too high\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e20 (15.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e24 (18.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e12 (9.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e20 (15.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e54 (41.5%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eI would follow a doctor\u0026rsquo;s advice\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e3 (2.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e8 (6.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e30 (23.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e50 (38.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e39 (30.0%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eVaccination is a priority\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e3 (2.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e27 (20.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e31 (23.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e21 (16.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e48 (36.9%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cb\u003eTable VII: Caregivers\u0026rsquo; attitude score\u003c/b\u003e.\u003c/p\u003e \u003cp\u003e Approximately 35(34.6%) and 65 (65.4%) of the caregivers had fair and good attitude, respectively.\u003c/p\u003e \u003cp\u003e \u003cb\u003eTable VII: Caregivers\u0026rsquo; attitude score*\u003c/b\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"No\" id=\"Tabh\" border=\"1\"\u003e \u003ccolgroup cols=\"3\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eAttitude\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFrequency (n\u0026thinsp;=\u0026thinsp;130)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003ePercent (%)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMean\u0026thinsp;=\u0026thinsp;21.97\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eSD\u0026thinsp;=\u0026thinsp;3.781\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePoor\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFair\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e45\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e34.6\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGood\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e85\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e65.4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"3\"\u003e* Score: Poor attitude\u0026thinsp;=\u0026thinsp;1\u0026ndash;10; Fair attitude\u0026thinsp;=\u0026thinsp;11\u0026ndash;20; Good attitude\u0026thinsp;=\u0026thinsp;21\u0026ndash;30 (Total\u0026thinsp;=\u0026thinsp;30)\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cb\u003eTable VIII: Caregivers\u0026rsquo; health-seeking practices.\u003c/b\u003e \u003c/p\u003e \u003cp\u003eMost (76.2%) of caregivers of children with SCD had a frequency of clinic visit of three-monthly. Most (78.5%) of caregivers of children with SCD reported that a health worker had recommended the special vaccine. The greater proportion (43.9%) of caregivers have paid 25,001\u0026ndash;50,000 naira for the special vaccine. Most (86.9%) of caregivers of children with SCD reported that they would take the special vaccine if it were available for free.\u003c/p\u003e \u003cp\u003e \u003cb\u003eTable VIII: Caregivers\u0026rsquo; health-seeking practices\u003c/b\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"No\" id=\"Tabi\" border=\"1\"\u003e \u003ccolgroup cols=\"3\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVariable\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFrequency (n\u0026thinsp;=\u0026thinsp;130)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003ePercent (%)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFrequency of clinic visit\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMonthly\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e16\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e12.3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e3-monthly\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e99\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e76.2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e6-monthly\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e3.8\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYearly\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1.5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOnly when sick\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e6.2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eHas any health worker recommended the special vaccines?\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e102\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e78.5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e28\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e21.5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eWhich health worker recommended the vaccine?\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePaediatrician recommended\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e78\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e76.5%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNurse recommended\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e12.7%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eImmunization officer recommended\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e9.8%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOther persons\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1.0%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eWhere do you take your child for vaccination?\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTeaching Hospital/SCD Clinic\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e124\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e95.4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePHC Centre\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e3.1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePrivate Hospital\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1.5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eHow much have you paid for vaccines in naira?\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003e(n\u0026thinsp;=\u0026thinsp;66)\u003c/b\u003e\u003c/p\u003e \u003cp\u003eMedian\u0026thinsp;=\u0026thinsp;50,000 naira\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eIQR\u0026thinsp;=\u0026thinsp;114,500 naira\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e25,000 naira or less\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e18.2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e25,001\u0026ndash;50,000 naira\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e29\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e43.9\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e50,001\u0026ndash;100,000 naira\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e12.1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e100,001\u0026ndash;200,000 naira\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e18.2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e200,001\u0026ndash;600,000 naira\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e7.6\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eIf special vaccines were available for free at the SCD clinic, would you get them?\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003e(n\u0026thinsp;=\u0026thinsp;130)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e113\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e86.9\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.8\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNot Sure\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e16\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e12.3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cb\u003eTable IX: Barriers and motivators of special vaccines of children with SCD.\u003c/b\u003e \u003c/p\u003e \u003cp\u003e Out of the 64 caregivers who did not vaccinate their child at all, the greater proportion (65.6%) gave financial constraints as the main reason for not vaccinating their child. Out of the 66 caregivers who partially or completely vaccinated their children, the greater proportion (57.6%) vaccinated their child to prevent infection, disease, or crises.\u003c/p\u003e \u003cp\u003e \u003cb\u003eTable IX: Barriers and motivators of special vaccines of children with SCD\u003c/b\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"No\" id=\"Tabj\" border=\"1\"\u003e \u003ccolgroup cols=\"3\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVariable\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFrequency (n\u0026thinsp;=\u0026thinsp;64)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003ePercent (%)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMain reason for not vaccinating your child\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFinancial constraints\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e42\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e65.6\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLack of awareness of special vaccines\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e3.1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFear of adverse side effects\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e6.3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo reason given\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e16\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e25.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eMain reason for vaccinating your child\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003e(n\u0026thinsp;=\u0026thinsp;66)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eThe doctor recommended it\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e10.6\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTo prevent infection, disease, or crises\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e38\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e57.6\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTo cure my child\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e6.1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTo improve growth and health of my child\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e6.1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTo prevent future complications\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1.5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo reason given\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e18.2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cb\u003eTable X: Association between socio-demographic factors and vaccination status of children with SCD.\u003c/b\u003e \u003c/p\u003e \u003cp\u003eThe greater proportion (38, 80.9%) of caregivers with a tertiary level of education had SCD children that were unvaccinated. However, the association between caregivers\u0026rsquo; highest level of education and vaccination status of their children was not statistically significant, (ꭓ\u003csup\u003e2\u003c/sup\u003e = 2.003, P\u0026thinsp;=\u0026thinsp;0.367). The greater proportion (52, 96.3%) of caregivers with a monthly income of 50,000\u0026ndash;150,000 naira had SCD children that were unvaccinated. The association between caregivers\u0026rsquo; family monthly income and vaccination status of their children was statistically significant, (ꭓ\u003csup\u003e2\u003c/sup\u003e = 8.082, P\u0026thinsp;=\u0026thinsp;0.018). The greater proportion (61, 86.2%) of caregivers with lower class SES had SCD children that were unvaccinated. The association between caregivers\u0026rsquo; SES and vaccination status of their children was not statistically significant, (ꭓ\u003csup\u003e2\u003c/sup\u003e = 1.508, P\u0026thinsp;=\u0026thinsp;0.470). The greater proportion (69, 97.2%) of caregivers with poor knowledge of SCD and special vaccines had SCD children that were unvaccinated. The association between caregivers\u0026rsquo; knowledge and vaccination status of their children was statistically significant, (ꭓ\u003csup\u003e2\u003c/sup\u003e = 19.246, P\u0026thinsp;\u0026lt;\u0026thinsp;0.001). The greater proportion (43, 95.6%) of caregivers with a fair attitude to vaccination had SCD children that were unvaccinated. The association between caregivers\u0026rsquo; attitude and vaccination status of their children was statistically significant, (ꭓ\u003csup\u003e2\u003c/sup\u003e = 5.100, P\u0026thinsp;=\u0026thinsp;0.024).\u003c/p\u003e \u003cp\u003e \u003cb\u003eTable X: Association between socio-demographic factors and vaccination status of children with SCD\u003c/b\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"No\" id=\"Tabk\" border=\"1\"\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eVariable\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003eVaccination status\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eꭓ\u003csup\u003e2\u003c/sup\u003e (or Fisher\u0026rsquo;s exact) statistic\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eP-value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eUnvaccinated\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eVaccinated\u003c/p\u003e \u003cp\u003e(Partially/Fully)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eCaregivers\u0026rsquo; highest level of education\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePrimary\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e14 (93.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1 (6,7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e2.003\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.367\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSecondary\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e60 (88.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e8 (11.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTertiary\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e38 (80.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e9 (19.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eFamily monthly income\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;50,000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e6 (75.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2 (25.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e8.082\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e0.018*\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e50,000\u0026ndash;150,000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e52 (96.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2 (3.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026gt;\u0026thinsp;150,000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e54 (79.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e14 (20.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eParents\u0026rsquo; socio-economic class\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eUpper class\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e14 (82.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3 (17.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e1.508\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.470\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMiddle class\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e37 (82.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e8 (17.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLower class\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e61 (86.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e7 (13.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eCaregivers\u0026rsquo; knowledge\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePoor knowledge\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e69 (97.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2 (2.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e19.246\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001*\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFair knowledge\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e30 (78.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e8 (21.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGood knowledge\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e13 (61.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e8 (38.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eCaregivers\u0026rsquo; attitude\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFair\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e43 (95.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2 (4.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e5.100\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e0.024*\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGood\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e69 (81.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e16 (18.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eIn this study, 44.6% of the caregivers were aged 40\u0026ndash;49 years and the majority were female mothers of children with SCD (86.2%) reflecting the central role mothers play in chid health decision- making in many African contexts Similar caregiver profiles have been described in Lagos and Ilorin, where female caregivers constituted the majority of respondents in studies exploring health literacy and immunization practices among high- risk paediatric populations \u003csup\u003e\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e,\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e\u003c/sup\u003e .Over half of caregivers had secondary education and 52.3% belonged to lower socioeconomic class according to Oyedeji\u0026rsquo;s classification. Socioeconomic class has been widely reported as a determinant of health access in sub-Saharan Africa, with lower class correlating with reduced uptake of preventive services, including vaccination \u003csup\u003e\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e,\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e\u003c/sup\u003e. The finding that many caregivers reported higher monthly incomes (\u0026gt;\u0026thinsp;150,000 Naria) may reflect urban catchment characteristics of the teaching hospital but this did not translate into high vaccination coverage suggesting that income alone is insufficient to overcome systemic and informational barriers. The clinical profile of children in this study shows that most were male (58.5) with a mean age of approximately 9 years. Most children were diagnosed between 1 and 5 years and more than half (52.3%) reported no admissions in the past year, possibly indicating relatively stable disease status. About 60% of children were on hydroxyurea therapy, a disease- modifying treatment increasingly recognised in Nigeria but still not widely accessible in all regions \u003csup\u003e\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e,\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e\u003c/sup\u003e. The prevalence of hydroxyurea use in this cohort reflects growing awareness among clinicians and caregivers about comprehensive SCD care.\u003c/p\u003e \u003cp\u003eIn this study, although 60.8% of caregivers knew that children with SCD are more prone to serious infections, only 36.9% could mention at least one specific infections. This limited depth of knowledge is comparable to findings from studies in Nigeria and other sub- Saharan African countries, where general awareness of infection risk in SCD was moderate but specific knowledge of causative organisms was low\u003csup\u003e\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e,\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e\u003c/sup\u003e. A study by Brown et al.,\u003csup\u003e21\u003c/sup\u003e in south- West Nigeria reported that while most caregivers recognized infection as a complication of SCD, few could identify pneumococcal infection as a major threat. Similar findings were reported in Ghana and Uganda, where knowledge of infection susceptibility did not translate into comprehensive understanding of preventive strategies\u003csup\u003e\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e,\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e\u003c/sup\u003e. Knowledge of specific vaccines was particularly poor in the present study. Only 32.3% knew the role of pneumococcal vaccine, 20% knew influenza vaccine is recommended yearly and 16.9% knew that Hib prevents meningitis. These findings align with reports from Enugu and Kano Nigeria where caregivers demonstrated poor knowledge of optional or special vaccines outside the National Programme on Immunization (NPI) schedule\u003csup\u003e\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e,\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e\u003c/sup\u003e. In many African settings, routine childhood vaccines are better known than additional vaccines recommended for high-risk groups such as SCD patients\u003csup\u003e\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e,\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eOverall, more than half of the caregivers had poor knowledge and only 16.2% had good knowledge. This is consistent with previous Nigerian studies that reported inadequate caregiver knowledge regarding comprehensive SCD care including infection prevention\u003csup\u003e\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e,\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e\u003c/sup\u003e. Poor knowledge significantly influenced vaccination status in this study (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001), reinforcing evidence that caregiver education is a key determinant of vaccine uptake\u003csup\u003e\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e\u003c/sup\u003e. Despite poor knowledge, caregivers demonstrated generally positive attitude scores; most agreed that vaccines are safe and effective and 86.9% were willing to vaccinate if vaccines were available free of charge. This positive disposition is similar to findings from Lagos and Ibadan, where caregivers expressed trust in healthcare providers and confidence in vaccines but cited cost as a major barrier\u003csup\u003e\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e,\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e\u003c/sup\u003e. The association between positive attitude and vaccination status in this study (p\u0026thinsp;=\u0026thinsp;0.024) further highlights the importance of behavioural and perceptual factors in vaccine acceptance. However, actual vaccination coverage was low. Only 40% had received PCV, 13.8% Hib and 31.5% meningococcal vaccine. Overall, 49.2% were completely unvaccinated with special vaccines and only 3.1% were fully vaccinated. These findings are consistent with other Nigerian hospital- based studies that reported low uptake of optional vaccines among children with chronic illnesses\u003csup\u003e\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e,\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e\u003c/sup\u003e. In contrast, higher coverage rates have been documented in high-income countries, where comprehensive SCD programs and insurance coverage improve access\u003csup\u003e\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eFinancial constraints emerged as the principal barrier. Among unvaccinated children, 65.6% of their caregivers cited financial difficulties. Monthly income was significantly associated with vaccination status (p\u0026thinsp;=\u0026thinsp;0.018). This finding is consistent with multiple Nigerian and African studies identifying cost as the leading barrier to uptake of non-routine vaccines\u003csup\u003e\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e,\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e,\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e\u003c/sup\u003e. Unlike routine childhood vaccines provided free under NPI, many special vaccines for SCD must be paid for out-of-pocket, posing challenges in low- resource settings\u003csup\u003e\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e\u003c/sup\u003e. Encouragingly, 78.5% of caregivers reported that a health worker had recommended vaccination which is well- documented predictor of vaccine uptake\u003csup\u003e\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e,\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e\u003c/sup\u003e. In this study, 57.6% of caregivers who vaccinated their children did so to prevent infection or crises, suggesting awareness of vaccine benefits among those who complied\u003c/p\u003e \u003cp\u003eThe significant association between caregiver knowledge and vaccination status (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001) aligns with evidence from Ghana and Kenya demonstrating that improved caregiver knowledge correlates with better preventive practice\u003csup\u003e\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e,\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e\u003c/sup\u003e. However, caregiver education level itself was not significantly associated with vaccination status, indicating that formal education alone may not translate to disease- specific knowledge, a knowledge finding also reported in previous Nigerian studies\u003csup\u003e\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e,\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e\u003c/sup\u003e. Overall, this study highlights a critical gap between positive attitudes and actual vaccination uptake, largely driven by poor knowledge and financial barriers. Similar patterns have been documented across sub- Saharan Africa, where structural barriers such as cost and vaccine availability limit uptake despite willingness\u003csup\u003e\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e,\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThis study demonstrated that caregivers of children with SCD had generally positive attitudes toward special vaccination but insufficient knowledge and very low vaccine uptake. Although more than half of the caregivers were aware that children with SCD are more susceptible to severe infections, only a minority could identify specific infection or correctly state the role of recommended vaccines. Overall, more than half of the caregivers had poor knowledge scores. Despite these knowledge gaps, attitudes toward vaccination were largely favourable. Most caregivers believed that vaccines are safe and effective, trusted healthcare providers recommendations and expressed willingness to vaccinate their children if vaccines were made free of charge. This indicate that vaccine hesitancy was not the principal problem in this population.\u003c/p\u003e \u003cp\u003eHowever, vaccination coverage for special vaccines remained suboptimal. Nearly half of the children were completely unvaccinated and only a very small proportion were fully vaccinated. Financial constraint emerged as the major barrier to uptake with many caregivers reporting high out-of-pocket costs. Monthly income was significantly associated with vaccination status, underscoring the economic burden of accessing special vaccines not included in routine NPI. In addition, caregiver knowledge and attitude were significantly associated with vaccination status, highlighting the importance of health education and counselling in improving preventive practices.\u003c/p\u003e \u003cp\u003e \u003cb\u003eRecommendations\u003c/b\u003e \u003c/p\u003e \u003cp\u003e \u003col\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003eStructured health education sessions should be incorporated into routine SCD clinic visits\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003eCounselling should emphasize the role of pneumococcal, Hib, meningococcal, influenza vaccines in preventing severe infections and complications\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003eGovernment and policymakers should consider subsidizing or fully integrating special vaccines for children with SCD into the NPI to reduce out-of-pocket expenditure.\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003eReminder systems and vaccination tracking registers should be implemented in SCD clinics to monitor coverage.\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003c/ol\u003e \u003c/p\u003e \u003cp\u003e \u003cb\u003eLimitations\u003c/b\u003e \u003c/p\u003e \u003cp\u003e \u003col\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003eThe study was conducted in a tertiary hospital and may not be generalizable to caregivers who receive care at private hospitals or primary health care centres\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003cspan\u003e \u003cli\u003e \u003cp\u003eThe cross- sectional study design limits the ability to establish causal relationships between caregivers\u0026rsquo; knowledge, attitude, socio-demographic factors and vaccination status.\u003c/p\u003e \u003c/li\u003e \u003c/span\u003e \u003c/ol\u003e \u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eConflict of Interest:\u0026nbsp;\u003c/strong\u003eThe authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e: This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors. The study was self-funded by the authors.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication:\u0026nbsp;\u003c/strong\u003eWritten informed consent was obtained from all individual participants (or their legal guardians) for publication of this study and its accompanying data.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials\u003c/strong\u003e: The datasets used and/or analysed during the current study are available from the corresponding author on reasonable request.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n \u003cli\u003ePlatt OS, Brambilla DJ, Rosse WF, Milner PF, Castro O, Steinberg MH, et al. Mortality in sickle cell disease\u0026mdash;life expectancy and risk factors for early death. N Engl J Med. 1994;330(23):1639\u0026ndash;44.\u003c/li\u003e\n \u003cli\u003eGaston MH, Verter JI, Woods G, Pegelow C, Kelleher J, Presbury G, et al. Prophylaxis with oral penicillin in children with sickle cell anemia. N Engl J Med. 1986;314(25):1593\u0026ndash;99.\u003c/li\u003e\n \u003cli\u003eDe Montalembert M, Tshilolo L, Kafando E. Sickle cell disease in Africa: a challenge for governments, health systems and communities. Bull World Health Organ. 2019;97(6):386\u0026ndash;92.\u003c/li\u003e\n \u003cli\u003eBrousseau DC, Owens PL, Mosso AL, Panepinto JA, Steiner CA. Acute care utilization and rehospitalizations for sickle cell disease. JAMA. 2010;303(13):1288\u0026ndash;94.\u003c/li\u003e\n \u003cli\u003eCentre for Disease Control and Prevention (CDC). Immunization recommendations for people with sickle cell disease. Atlanta, GA: CDC; 2023.\u003c/li\u003e\n \u003cli\u003eJarovsky D, Romanzini P, Faria de Matos S, Almeida FJ, Palazzi Safadi MA, Hegg ICO et al,. Vaccination in paediatric patients with sickle cell disease: uptake report and mini-review. J Trop Pediatr. 2022;68(3): fmac034. Doi:10.1093/tropej/fmac034\u003c/li\u003e\n \u003cli\u003eWalden J, Stanek JR, Young J, Griffth MM, Nahata L, Creary SE. Influenza vaccine uptake among youth with sickle cell disease seen in clinic before and after the COVID- 19 pandemic. Vaccine. 2024;42(22):789\u0026ndash;97.\u003c/li\u003e\n \u003cli\u003ePersaud Y, Mandrell BN, Sharma A, Carroll Y, Irvine M, Olufadi Y, et al. Attitude toward COVID-19 vaccine among pediatric patients with sickle cell disease and their caregivers. Pediatr Blood Cancer. 2023;70(5):e30274. Doi.10.1002/pbc.30274.\u003c/li\u003e\n \u003cli\u003eBundy DG, Strouse JJ, Casella JF, Miller MR. Pneumococcal vaccination coverage and invasive disease in children with sickle cell disease. Blood. 2017;130(7):858\u0026ndash;65.\u003c/li\u003e\n \u003cli\u003eNgoungou EB, Makoutode M, Amougou AK, Boguikouma JB, Mba JR, Kombila M. Determinants of immunization uptake among children with sickle cell disease in Libreville, Gabon. J Public Health Afr. 2023;14(2): 2191. Doi:10.4081/jphia.2023.2191.\u003c/li\u003e\n \u003cli\u003eUzochukwu BS, Onwujekwe OE, Akpala CO. Community- based interventions for increasing immunization coverage in low-income countries. Cochrane Databas Syst Rev. 2015; (7): CD008145. Doi: 10.1002/14651858.CD008145.\u003c/li\u003e\n \u003cli\u003eSzilagyi PG, Bordley C, Vann JC, Chelminski A, Kraus RM, Margois PA, et al. Effect of patient reminder/ recall interventions on immunization rates. JAMA. 2000;284(14):1820-27.\u003c/li\u003e\n \u003cli\u003eLarson HJ, Jarrett C, Schulz WS, Chaudhuri M, Zhou Y, Dube E, et al. Measuring vaccine hesitancy: development of a survey tool. Vaccine. 2015;33(34):4165\u0026ndash;75.\u003c/li\u003e\n \u003cli\u003eWorld Health Organization. Sickle cell disease: a global public health priority. Geneva: WHO; 2021.\u003c/li\u003e\n \u003cli\u003eIroha E, Ibekwe R, Eze J. Barriers to immunization in rural Nigeria. Afr J Health Sci. 2024;37(1):45\u0026ndash;54.\u003c/li\u003e\n \u003cli\u003eBangura JB, Xiao S, Qiu D, Ouyang F, Chen L. Barriers to childhood immunization in sub- Saharan Africa: a systematic review. BMC public Health. 2020;20:1108. Doi:10.1186/s12889-020-09169-4.\u003c/li\u003e\n \u003cli\u003eAdebola SO, Okeke TA, Oladapo OT. Knowledge and attitudes toward childhood immunization among caregivers in Lagos, Nigeria, West Afr J Med. 2018;35(2): 85-90\u003c/li\u003e\n \u003cli\u003eAdeyemi AO, Olatunde AS. Primary caregiver profiles and child health practices in Ilorin, Nigeria. Niger J Paediatr. 2019;46(1):12-18\u003c/li\u003e\n \u003cli\u003eOyedeji GA. Socioeconomic and cultural background of hospitalized children in Ilesha. Niger J Paediatr. 1985; 12:111-17\u003c/li\u003e\n \u003cli\u003eEzeaka VC, Ibekwe RC. Socioeconomic determinants of immunization uptake in Enugu, Nigeria, Nigeria. Niger Med J. 2017;58(4): 156-62\u003c/li\u003e\n \u003cli\u003eBrown BJ, Okereke JO, Lagunju IA, Orimadegun AE, Ohaeri JU. Burden of health-care of carers of children with sickle cell disease in Nigeria. Health Soc Care Community. 2010; 18(3): 289-295\u003c/li\u003e\n \u003cli\u003eMwashungi A, Deodatus K, Calvin S, Tone K, Kare M, Makani J, et al. \u0026nbsp;Caregivers\u0026rsquo; deliefs about hydroxyurea usage among children with sickle cell disease: a cross- sectional study in Dar-es-Salaam, Tanzania. Pan Afr Med J. 2025; 52:31. Doi:10.11604/pamj.2025.52.31.45975\u003c/li\u003e\n \u003cli\u003eChianumba BN, Nwagha UI. Hydroxyurea adherence and outcomes among Nigerian children with SCD. Afr J Haematol Oncol. 2019;11(1): 12-20\u0026nbsp;\u003c/li\u003e\n \u003cli\u003eOhemeng A, Edusei L, Bonney I. Knowledge and health- seeking behaviour of caregivers of children with sickle cell disease in Ghana. BMC Public Health. 2019; 19:1235\u003c/li\u003e\n \u003cli\u003eNdeezi G, Kizito S, Okwera A, Ndugwa CM. Preventive care practices among caregivers of children with sickle cell disease in Uganda. Afr Health Sci. 2016;16(2):456-62\u003c/li\u003e\n \u003cli\u003eEzeonu PO, Modebe O, Ezeaka C. Immunization practices in children with sickle cell disease in Enugu, Nigeria. Niger J Pediatr. 2015;42(4):290-95\u003c/li\u003e\n \u003cli\u003eSani UM, Jiya NM, Ahmed H. Uptake of optional vaccines among children in kano, Nigeria. Niger J Basic Clin Sci. 2017; 14:45-50\u003c/li\u003e\n \u003cli\u003eOpel DJ, Heritage J, Taylor J, Mangione-Smith R, Salas HS, DeVere V, et al. The influence of provider communication on vaccine acceptance. Pediatrics. 2013;132(6):1037-46\u003c/li\u003e\n \u003cli\u003eAdebola SO, Musa IA, Ekanem PO, Oladipo TF, Okonkwo CU. Uptake of pneumococcal vaccine among children with sickle cell disease in Lagos. West Afr J Med. 2018;35(2):85-90\u003c/li\u003e\n \u003cli\u003eCenters of Disease Control and prevention. Immunization schedule for persons with high- risk conditions. 2022.MMWR Morb Mortal Wkly Rep. 2022;71(7):234-36\u003c/li\u003e\n \u003cli\u003eIlesanmi OS, Afolabi AA. Determinants of optional vaccine uptake in Ibadan, Nigeria. Pan Afr Med J. 2017; 27:112-20\u003c/li\u003e\n \u003cli\u003eAdedokun ST, Uthman OA. Out-of-pocket costs and immunization inequities in sub-Saharan Africa. Vaccine.2019;37:1585-91\u003c/li\u003e\n \u003cli\u003eEssoh TA, Adeyanju GC, Adamu AA, Tall H, Aplogan A, Tabu C. Exploring the factors contributing to low vaccination uptake for nationally recommended routine childhood and adolescent vaccine in Kenya. BMC Public Health. 2023; 23:912. Doi: 10.1186/s12889-023-15855-w\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"egyptian-pediatric-association-gazette","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"epag","sideBox":"Learn more about [Egyptian Pediatric Association Gazette](https://epag.springeropen.com)","snPcode":"43054","submissionUrl":"https://submission.springernature.com/new-submission/43054/3?","title":"Egyptian Pediatric Association Gazette","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Springer Hybrid","inReviewEnabled":true,"inReviewRevisionsEnabled":false},"keywords":"Caregivers’ knowledge, Sickle cell disease, Special vaccination, Vaccine uptake","lastPublishedDoi":"10.21203/rs.3.rs-9033320/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-9033320/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003e \u003cb\u003eC\u003c/b\u003ehildren with sickle cell disease (SCD) are highly susceptible to severe infections due to functional asplenia. Special vaccines such as pneumococcal, Haemophilus influenzae type b(Hib), meningococcal, influenza and hepatitis B vaccines are recommended to reduce infection- related morbidity and morbidity. However, uptake in low- resource settings remain suboptimal\u003c/p\u003e\u003ch2\u003eObjective\u003c/h2\u003e \u003cp\u003eTo assess caregivers\u0026rsquo; knowledge, attitude and practices regarding special vaccination of children with SCD and determine factors associated with vaccination status.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003e A hospital-based cross-sectional study was conducted among 130 caregivers of children with SCD attending University of Benin teaching hospital Benin city. Data were collected using a structured questionnaire assessing socio-demographic characteristics, knowledge, attitude, vaccination history (Cards sited) and barriers to uptake. Knowledge and attitude were graded using predefined scoring systems. Data were analysed using descriptive and inferential statistics, with statistical significance set at p\u0026thinsp;\u0026lt;\u0026thinsp;0.05.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eAlthough 60.8% of caregivers knew that children with SCD are prone to serious infections, only 16.2% demonstrated good knowledge. Nearly half (49.2%) of the children were unvaccinated with special vaccines and only 3.1% were fully vaccinated. Financial constraints (65.6%) was the major barrier to uptake. Caregivers\u0026rsquo; knowledge (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001), attitude (p\u0026thinsp;=\u0026thinsp;0.018) were significantly associated with vaccination status.\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e \u003cp\u003eDespite generally positive attitudes, poor knowledge and financial barriers contribute to low uptake of special vaccines among children with SCD. Subsidization and targeted caregiver education are recommended.\u003c/p\u003e","manuscriptTitle":"Special Vaccine Uptake Among Children With Sickle Cell Disease: Coverage, Determinants and Barriers in a Tertiary Hospital in Benin City, Nigeria","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-03-10 17:11:21","doi":"10.21203/rs.3.rs-9033320/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2026-03-26T04:57:28+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-03-25T22:01:49+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-03-24T20:32:15+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-03-23T06:23:37+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-03-21T20:08:24+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-03-11T20:14:52+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"69127284720544732102517454199176784544","date":"2026-03-10T09:01:28+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"70807675600662369018557919630185631633","date":"2026-03-10T06:27:04+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-03-09T04:14:23+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"33624277854790057985941048229023218228","date":"2026-03-08T00:49:05+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"113358798093908479916617494526825249948","date":"2026-03-07T10:16:34+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"32143861506430604848937079590830087033","date":"2026-03-07T09:49:45+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"234367643182590513594869008143968725602","date":"2026-03-05T18:16:11+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2026-03-05T06:21:25+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2026-03-05T03:50:02+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2026-03-05T03:49:30+00:00","index":"","fulltext":""},{"type":"submitted","content":"Egyptian Pediatric Association Gazette","date":"2026-03-04T18:57:20+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"egyptian-pediatric-association-gazette","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"epag","sideBox":"Learn more about [Egyptian Pediatric Association Gazette](https://epag.springeropen.com)","snPcode":"43054","submissionUrl":"https://submission.springernature.com/new-submission/43054/3?","title":"Egyptian Pediatric Association Gazette","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Springer Hybrid","inReviewEnabled":true,"inReviewRevisionsEnabled":false}}],"origin":"","ownerIdentity":"25c1bbe4-d0a9-4f83-9ca0-185129e5971b","owner":[],"postedDate":"March 10th, 2026","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2026-04-20T16:54:18+00:00","versionOfRecord":[],"versionCreatedAt":"2026-03-10 17:11:21","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-9033320","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-9033320","identity":"rs-9033320","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}