Factors Contributing To Incomplete Vaccination among Children Aged 12 to 59 Months in Mbale City, Eastern Uganda: A Caregivers and Health Workers’ Perspective

Factors Contributing To Incomplete Vaccination among Children Aged 12 to 59 Months in Mbale City, Eastern Uganda: A Caregivers and Health Workers’ Perspective | 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 Factors Contributing To Incomplete Vaccination among Children Aged 12 to 59 Months in Mbale City, Eastern Uganda: A Caregivers and Health Workers’ Perspective Mary A. Bwade, Samuel Olowo, Ashley Nakawuki, Eunice Namubiru, and 7 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-8712475/v1 This work is licensed under a CC BY 4.0 License Status: Under Revision Version 1 posted 14 You are reading this latest preprint version Abstract Background: Vaccination is one of the most effective public health interventions, substantially reducing morbidity, disability, and mortality among children under five years of age from vaccine-preventable diseases. Despite global progress, vaccination coverage remains suboptimal, with the highest burden of incomplete vaccination reported in sub-Saharan Africa. In 2020, an estimated 14 million infants worldwide did not receive the first dose of diphtheria pertussis tetanus (DPT1) vaccine. Partially vaccinated children remain highly vulnerable to vaccine-preventable diseases, contributing to outbreaks, morbidity, disability, and mortality. This study explored caregivers’ and health workers’ perspectives on factors contributing to incomplete vaccination among children aged 12–59 months in Mbale City, Eastern Uganda. Materials and methods: A descriptive qualitative study was conducted in Namatala (Industrial Division) and Nakaloke (Northern Division), Mbale City, Eastern Uganda. Ethical approval was obtained from the Busitema University Research and Ethics Committee. Participants were selected using purposive sampling. Data were collected from 18 caregivers and 30 health care workers and analyzed thematically using Colaizzi’s seven-step approach. Results: Six major themes emerged: misconceptions about vaccination; perceived susceptibility to and severity of incomplete vaccination; perceived benefits of vaccination; perceived barriers to vaccination; information gaps; and strategies for ending incomplete vaccination. Misconceptions included myths surrounding vaccination, perceived vaccine-related morbidity, and mortality. Limited understanding and misbeliefs regarding the benefits of vaccination were common. Information gaps were driven by misinformation from social media, delayed, unclear, or inadequate communication, and general ignorance. Identified barriers included fear of side effects, transportation challenges, and negative health worker attitudes, lack of partner support, peer influence, multiple injections, child illness, and caregivers’ busy schedules. Proposed solutions included training village health teams (VHTs), continuing medical education (CMEs) for health workers, intensified community sensitization, male partner involvement, and improved accessibility to vaccination services. Conclusion: Factors contributing to incomplete vaccination are multifaceted, involving individual, community, and health system related challenges. Strengthening collaboration between health teams and religious and cultural leaders, alongside targeted interventions such as mobile vaccination clinics to address access barriers, is essential to improving vaccination completion rates in this setting. Caregivers Health workers Perspective factors Incomplete Vaccination Children Uganda Background Globally, childhood immunization is recognized as one of the most effective public health interventions for reducing morbidity and mortality from vaccine-preventable diseases. Despite significant progress in expanding vaccination programs, millions of children remain partly vaccinated, with an estimated 20 million children worldwide missing out on basic vaccines each year [ 1 ] and over 14 million remain unvaccinated [ 2 ]. The WHO and UNICEF emphasize that vaccine-preventable diseases continue to claim numerous lives, particularly in low-and middle-income countries where access to immunization services is often limited [ 3 ]. Partly vaccinated children are a critical focus of global health initiatives, such as Immunization Agenda 2030, which aims to halve the number of unvaccinated children by the end of the decade [ 4 ]. Factors contributing to incomplete vaccination globally include logistical challenges, vaccine hesitancy, and inequalities in healthcare access, which are compounded by socioeconomic disparities and weak health systems [ 5 ]. In sub-Saharan Africa, the burden of vaccine-preventable diseases remains disproportionately high, accounting for a significant portion of global childhood mortality. Approximately 30 million children under five in the region suffer from these diseases annually, with over 500,000 deaths attributed to inadequate vaccination coverage [ 6 ]. Despite efforts to improve immunization through programs like the Expanded Program on Immunization (EPI), the region struggles with low vaccination rates, with many countries failing to meet the Global Vaccine Action Plan targets [ 7 ]. Barriers such as poor infrastructure, limited health worker capacity, and cultural beliefs contribute to incomplete vaccination [ 8 ]. Within East Africa, childhood vaccination coverage remains suboptimal, with an average of 69.21% of children aged 12–23 months receiving all recommended vaccines [ 9 ]. This figure varies widely across the 19 countries in the region, including Uganda, Kenya, Tanzania, and Ethiopia. Children who are partially vaccinated are particularly prevalent in hard-to-reach communities, where factors such as distance to health facilities, low maternal education, and traditional practices influence vaccination uptake [ 10 ]. In Uganda, according to findings of an equity analysis demonstrated that the national immunization program has made strides in increasing vaccine coverage, yet significant gaps persist [ 11 ]. Available evidence demonstrate that no region within Uganda achieved an under-vaccination rate below 20% [ 12 ]. More reports from Uganda based on a national Demographic and Health Survey analysis shows that overall vaccination completion among children aged 12–23 months in Uganda was 48.6% nationally, with further affirmation of regional variation across sub-regions in Uganda [ 13 ]. Additional evidence from Uganda in a subnational trend analysis demonstrated that from 2006 to 2016, the under-vaccination rate decreased by 21%, but remained high at 40.8% [ 12 ]. These indicate significant challenges in reaching the Sustainable Development Goal target of at least 80% immunization coverage [ 14 ]. The country provides free childhood vaccination through the EPI, but barriers such as inadequate health infrastructure, sockets of vaccines, and limited awareness among caretakers contribute to low uptake [ 15 ]. More factors include limited access to health facilities, poor road networks, and reliance on subsistence agriculture contribute to missed vaccination opportunities [ 16 ]. Uganda’s diverse geography and population density further complicate service delivery, with rural areas experiencing greater challenges than urban centers [ 17 ]. The government’s efforts to achieve universal primary and secondary education also play a role, maternal education has been linked to improved vaccination rates [ 18 ]. The national and subnational variation of vaccination completion in resource constrained settings call for a diverse understanding of the possible factors that can explain these variations. Available evidence show that Eastern Uganda, a region characterized by rural landscapes and socioeconomic challenges, reports lower completion of vaccination compared to other regions [ 19 ]. A study from Butaleja district in Eastern Uganda demonstrated a declining trend in completion of vaccination including the doses of Pneumococcal vaccine (PCV) and Rotavirus vaccine [ 20 ]. The study reported that, in quarter 1 of 2019, out of the 312 children who started immunization, only 2 completed Rota virus immunization and only 117 completed PCV vaccinations a trend that has been observed since 2016 [ 20 ]. Mbale city, located in Eastern Uganda, serves as a key urban center in the region but still grapples with incomplete vaccination among children aged 12–59 months. A study conducted in Nakaloke a suburb within Mbale city found that over 65 (55.08%) of the children were not vaccinated against Rota virus and were likely to have diarrheal diseases compared to the fully vaccinated [ 21 ]. This incomplete vaccination of children could explain the high infant mortality rate and under five mortality rates which is between 34.6 to 45 in Elgon region where Mbale city falls [ 22 ]. The reasons for incomplete vaccination of children in this region are not clearly established. Therefore, the purpose of this research was to explore caregivers and health workers’ perspective on factors contributing to incomplete vaccination among children aged 12 to 59 months in Mbale City, Eastern Uganda. Materials and methods Study area This study was conducted in Nakaloke, northern division and Namatala, Industrial Division, all located in Mbale City, Eastern Uganda. Mbale City is located about 225 kilometers northeast of Kampala. The city is bordered by Sironko District to the north, Bududa District to the northeast, Manafwa District to the southeast, Tororo District to the south, Butaleja District to the southwest, and Budaka District to the west (Geonames. org). As of the 2024 national population and housing census, the city has a population of 290,414. Mbale Regional Referral Hospital served as the primary regional referral facility in the area. Study design The research utilized a descriptive qualitative study design to explore and understand the perspectives of caregivers and healthcare workers regarding factors contributing to incomplete vaccination. This approach allowed for an in-depth examination of the personal, social, and contextual factors that influence their attitudes, beliefs, and behaviors related to vaccination. By focusing on the meanings participants attach to their experiences, the study aimed to uncover the underlying barriers and motivations that contribute to vaccine hesitancy, providing valuable insights that can inform future interventions and policy development in the context of vaccination. Study population This study consisted of caregivers of children aged 12 to 59 months in Mbale City and key informant Health workers involved in immunization and vaccination of children and related programs. These key informants included In-charge of Young Child Clinic (YCC), Village Health Teams (VHTs), City Health Officer (CHO) and staffs directly involved in immunization programs. Sample size estimation We recruited 18 caregivers and 30 health workers which was determined by saturation of data. Saturation of data refers to a point when no new information or themes emerge, suggesting that further data collection did not yield new ideas [ 23 ]. Sampling procedure This study utilized purposive sampling, which is a form of non-probability sampling in which decisions concerning the individuals to be included in the sample are taken by the researcher, based upon a variety of criteria, which may include specialist knowledge of the research issue, or capacity and willingness to participate in the research. It was used to intentionally select care givers of partially vaccinated children aged 12–59 months in Mbale City and key informant health workers involved in vaccination programs were selected to ensure rich, focused data collection. Pre-testing the tool A survey was conducted prior to the data collection to identify the children aged 12 to 59 months who have missed vaccination by checking their immunization cards, and then their caregivers were recruited in the study. The in-depth interview and key informant interview guide refined by an iterative pilot testing process. Six participants, including 3 Caregivers of partially vaccinated children, and 3 health workers involved in vaccination programs from Mbale District were identified in an interview to assess whether the questions are understandable, culturally appropriate and were capable of eliciting meaningful responses. Participants from Mbale District were used in pre-testing because it has similar characteristics concerning vaccination of children as study area. Data collection procedure Data collection for this study involved in-depth interviews of care givers of partially vaccinated children and key informant interviews for health workers involved in vaccination programs. This guide was adopted from articles reviewed and was modified by the investigators based on study objectives to be achieved. It consisted of open-ended questions followed by specific prompts based on their individual experiences and perceptions. Face-to-face interviews were conducted by the researchers in English; participants who don’t understand English questions were translated into their local language. The interviews were one-on-one, conducted by the researchers. Interviews were carried out in private and quiet settings to ensure confidentiality. Before interviews, the purpose, risks, and benefits of participation were explained to the participants. Written informed consent were obtained from all participants. The interviews were audio recorded with a digital audio recorder after permission from the prospective participants. Notes were also taken for the non-verbal cues. Data management Data management for this study involved careful organization, storage, and protection of interview data to ensure confidentiality and accuracy. All interview transcripts were securely stored in encrypted digital files, and access was restricted to authorized research team members only. The data was organized by participant type (caregiver or healthcare worker) and categorized based on the identified themes during analysis. Any identifying information was anonymized to maintain privacy. Data analysis and presentation The data collected from caregivers and healthcare workers regarding incomplete vaccinations was analyzed using thematic analysis. Colaizzi’s seven step approach [ 24 ] was used to analyze data collected from caregivers and health workers to understand the reasons why some children miss their vaccinations. The process began with reading and re-reading the data to fully understand it. Next, significant statements related to incomplete vaccinations were identified, and these were translated into meanings that capture the core ideas. These meanings were then be grouped into clusters to form broader themes. A thematic map was created to visualize the experiences of caregivers and health workers in relation to unvaccinated children. Finally, the results were validated by sharing them with participants to ensure accuracy. Colaizzi’s approach provided a clear framework for understanding the challenges involved in ensuring children receive their vaccines. Data will be presented in the form of tables and thematic map. Trustworthiness of the study The study applied the four criteria by Lincoln and Gubba [ 25 ] which are: Credibility, Transferability, Dependability and conformability. Credibility was ensured by allowing participants to review and confirm the accuracy of the thematic map and the identified meanings. Transferability was achieved by providing rich, detailed descriptions of the research context, participants, and methodology so that others can assess the applicability of the findings to similar settings. Dependability was ensured through a clear and systematic audit trail, where all decisions made during data collection and analysis were documented. Finally, conformability was ensured by maintaining a reflexive approach, where the researcher continuously reflects on their potential biases and seeks feedback from supervisors or experts in the field to enhance objectivity in the interpretation of data. These measures contributed to the overall trustworthiness of the study, ensuring the results are credible and accurate. Community engagement In Mbale City, a community engagement plan was implemented during data collection by collaborating closely with local health centers, vaccination clinics, and community leaders. An introduction letter from Busitema University was presented to the local authorities, health workers, and community leaders to ensure they are aware of the study and its objectives. Local leaders, including family heads, were engaged to help spread awareness and encourage caregivers to participate. Informational sessions were held at local health centers, where the study’s purpose, benefits, and procedures will be explained. During these sessions, caregivers were invited to share their experiences and challenges related to missed vaccinations. Informed consent forms were provided to all participants, ensuring they understand their rights and agree voluntarily to take part in the study. This process fostered trust, ensure active community participation, and ensure the data collected is both accurate and representative of the community’s concerns. Ethical considerations Regarding ethical approval, the researcher obtained ethical clearance of the study from the administration of Busitema University, clearance from BUFHSREC with registration number: REF BUFHS-2025-808 . The administration of Mbale City was given an introductory letter from Busitema University introducing the researchers to conduct the study in the city. The city administration there after gave city administrative clearance. The researcher obtained informed consent from the respondents by informing the respondents about the purpose of the study and how they were expected to participate, the benefits of the study to them and the risks involved if any. Participation was voluntary basis. The researcher observed anonymity by keeping the identities of the respondents undisclosed and confidential by not using their names. The researcher ensured that the responses that were obtained were kept confidential under lock and key and were only used for academic purposes. Results Socio demographic characteristics of the participants The socio demographic features of the participants are presented in Table 1 and Table 2. The care givers characteristics included age, sex, tribes, religions and educational level Table 1. The relevant demographic information of the health workers included the age, sex, working Care givers’ and health workers’ perspective towards factors contributing to zero dose vaccination in Mbale City The qualitative findings of this study are presented according to the themes generated. The themes include perceived susceptibility and severity of incomplete vaccination, perceived benefits of vaccination, misconceptions on vaccination, perceived barriers, and information gaps among others Table 3 and Table 4. Care givers’ perspective regarding the factors contributing to incomplete vaccination among children aged 12 to 59months in Mbale City Theme one: Misconceptions on vaccination Subtheme one: Myths about vaccination Participants also admitted that the vaccines weaken the immunity of the children. Some agreed that the vaccinated children had a weaker immunity as compared to the non-vaccinated. Others shared that the vaccines brought illnesses upon their children. Disabilities like lameness was also associated with vaccination. “……………….Society talks about vaccination as it is something that they put on the babies and it weakens their immunity, unlike those days when babies were not vaccinated and they stay stronger……………...” [CT2]. Others attributed vaccination to clinical trials. The participants noted that the vaccines had not been tested and therefore had to be tried on the African race. Others said that the vaccines were duplicate. “They are brought for trials for our children. The vaccines are being brought by the whites and sold to give our children. That is why you see that these children fall sick … ………..” [II CT12]. “That is all but at times, society knows that most drugs are brought for us in Uganda for trials so that they can detect whether they are working or not. That is what I usually hear from people ……….” [II CT 4]. Participants also shared that the vaccines are meant to kill people. Vaccines were introduced to reduce the population of the Africans. “… the people were saying that it is not confirmed that they want to eliminate Africans, …” [II CT12]. Other care takers believed the vaccines were not effective and that there was something wrong with them. ‘…….me as me I claim that maybe there is something wrong with the vaccine after all… we feel like that thing just came to take our children's lives…………… ...” [II CT 09]. Theme two: Perceived susceptibility and severity of incomplete vaccination Subtheme one: Associated morbidity Some of the care givers mentioned that the children were at a risk of getting the vaccine preventable diseases like the polio, diphtheria and others if they were not vaccinated. Others discussed that children were at a risk of obtaining complications related to the vaccine preventable diseases like lameness and blindness if children were not vaccinated. “…………………When you vaccinate your children very well, you will also make sure that your children do not get blind, they will see very well at night, even at daytime, they don’t become blind………….” [II CT 08]. Other caretakers stated that zero dose vaccination may or may not predispose one to vaccine preventable diseases. “…….I think it is a 50 50. Maybe, maybe not … I feel like my child will not have any complication when they are not vaccinated. On the other hand, in my village, I saw someone in the village whose child has not been vaccinated, and the child is crippled……………” [II CT 09]. Others have based on past successful experiences where despite being not vaccinated, many people did not succumb to the vaccine preventable diseases like polio, diphtheria and tetanus. This ideology has made the care takers believe that their children are less likely to get vaccine preventable diseases even when they have not been vaccinated. This is contributing to more zero dose children. “………………… you find yourself saying, aaah kasita we did not die yet we did not get all the doses, this child won’t die if he does not get all the doses. So, let me just stay home, this child will survive like me…………………….” [II CT 08]. Some care givers have perceived that the vaccines are ineffective and therefore even those who are vaccinated suffer from vaccine preventable diseases. This means according to some care givers, vaccination does not reduce the risk of obtaining vaccine preventable diseases. “…those that are vaccinated, they also get issues, I can say, like some rare issues which we have never seen yet they have been vaccinated. so, me as me I claim that maybe there is something wrong with the vaccine after all…………………… .” [II CT 08]. Subtheme two: Associated mortality Some participants also noted that the children were likely to end up dying if they were not vaccinated. Others did not know what would happen to children if they were not vaccinated. "……………..They can die because now when the child is failing sick every time, the child can easily die. That is another problem we face sometimes………………." [II CT 08]. Theme three: Perceived benefits Subtheme one: Ignorance on benefits of vaccination When asked about the benefits of vaccination, there were mixed ideas. Some care givers identified some benefits of vaccination such as boosting immunity, protection from vaccine preventable diseases and protection from disabilities such as being lame and being blind. Others discussed that vaccination helped the parents to save money as children did not fall sick so frequently. “……………….Improves the immunity of our children, aah sometimes we as parents we are saving money because your child will not be sick all the time. There, there is somewhere where you are going to save money………………….” [II CT 10]. However, some care givers did not know of any benefits of vaccinating their children. Ignorance on the benefits of vaccination prohibited some of them from taking their children for vaccination. “………………..Me, I don't know anything that can happen to the child who has not gotten vaccinated ………………..” [II CT 06]. Subtheme two: Misbelief on perceived benefits Some care givers believed that there were no benefits of immunization. Some participants stated that whether vaccinated or not, the children all lived healthy lives. Others stated that the vaccinated children often got illnesses as compared to the unvaccinated children. “…………………..I don't think because the other one that did not complete I saw that the child was fine. So, I think if the child is vaccinated or not vaccinated the child is fine ………………” II [CT 05]. “……………………I have seen a lot of kids in my place; they have not been vaccinated but those kids are all very okay . Choka those that are vaccinated, they also get issues……………” [II CT 09]. Theme four: Information gaps Subtheme one: Misinformation from social media Care givers were also noted that they received information from media that made them skeptical about vaccination. One of the care givers noted that they had watched a video stating that vaccines are meant to control population of Africans. This has made care givers skeptical about taking their children for vaccination. “…………………The other day I was watching a video, and they were saying, for example, that malaria vaccine that has come out. I was seeing a video, and they said, that's how those guys just want to control the number of the population in Africa here. So I am very skeptical about it ……………..” [II CT11]. Subtheme 2: Late communication from health teams Some participants have admitted that care takers received late communication from the health workers. Health workers would communicate about the vaccination program late, finding that the care givers were not prepared to bring children for vaccination. “…………………..Normally, we get our information from churches, from VHTs and sometimes those VHTs they don’t provide us with the information early. That can make us not to take our children for immunization ………………….” [II CT 10]. Subtheme 3: Unclear communication In an attempt to seek knowledge about the vaccination, the care givers posed questions to the health workers. Participants noted that the health workers provided unclear information with regards to vaccination, its side effects and management of side effects. This left the care givers with doubts regarding the vaccination of their children. “And sometimes, we get scared, which medicine they administer for our children. Sometimes if we ask these nurses, they cannot explain for us clearly. that thing can make us not to take our children for vaccination.” II CT10. Subtheme four: Ignorance among society Care givers noted that some of them did not know the importance of vaccination. The care givers noted that the nurses did not tell them the importance of vaccination. Some others said that they did not know the specific vaccines being given to the children, how the vaccines work and their possible expected side effects. The side effects of the vaccines being administered to the children made the care givers so uncomfortable and this raised doubts on the necessity of vaccination. “………………..And also, the nurse who was vaccinating babies did not highlight to us the benefits or did not tell us about the benefits of immunizing or vaccinating babies………... ” [CT 2] “… we don’t know whether it is the vaccine that they inject the baby that makes the baby cry, or it is the changes that the drug brings to the child's body that bring those problems. But we don’t know why again the person gets such a problem after being vaccinated……………. ” [II CT 04] Participants also stated that the caregivers did not know how to manage the side effects from vaccination of children. Identified side effects include fever, excessive crying and at times swelling of the injection site. Meanwhile some participants admitted that they were given paracetamol at the facility, others stated that they were not aware of the ways to manage the side effects. The care givers ended up using remedies like onions which they were not even certain of the effectiveness and also its possible interactions with the vaccine. “……………………They just tell us that Panadol can work very first. That is why after injection, we always go to the nearby pharmacy o nearby clinic to access those, Panadol. Sometimes, they give us direct from the health centers………………..” [II CT 10]. “…………………….And we end up putting onions on the site to reduce the swelling… onions ...which we even don’t know whether it is safe for use. Maybe, those things even spoil the medicine …………..” [II CT 4]. Theme five: Perceived barriers Subtheme one: Fear for side effects Many caregivers had received early vaccination doses. However, concerns about the side effects have been noted. Side effects such as fever, crying all through the night, the pain has been found uncomfortable and scary to the care givers. “… saying that warning his wife not to take a child for vaccination because the child was going through pain, fever was too high…………….” [II CT 7]. “From that time, when the baby disturbed me, he felt sick. I was like, no, I'm not taking my child for vaccination……………. ” [II CT 11]. Some caregivers expressed dissatisfaction on the vaccination as they expected the vaccine to protect their children, yet the children fell sick after vaccination. “… vaccination to be good like to protect the child from illness but instead the child falls sick, and the child was over crying …………….” [II CT 12]. Subtheme two: Transportation difficulties to the health facility Participants expressed that the health facilities were far from their homes. Therefore, the caregivers would plan to travel long distances before they can reach the facility. Some care givers felt demotivated to bring the children to the facility for vaccination. “…………………The health facilities are very far from our homes because due to long distances, it is very hard for us as parents to take children………………. . ” [II CT 10]. Participants also stated that alongside the far distance, the care givers were not able to afford other means of transport like boda Bodas. The parents did not have the finances, and this made them postpone their appointment dates. “………………Sometimes when my bicycle is spoilt, it is difficult for me to take the child and the mother to hospital for vaccination …you don’t have money. We try sometimes to wait, to get some money which may take some time and then be able to buy……………” [II CT 08]. The caregivers also discussed that the weather conditions prevented them from bring their children for vaccination. The care givers said that it would rain the whole day at times making it hard for them to bring their children for vaccination. “… also the weather changes, sometimes it would rain the whole day and there is no way for you to go for vaccination…………….” [II CT 10]. Subtheme three: Health workers’ attitude Health workers have been found to be very rude and tough towards the caregivers when the care takers come for vaccination. Participants reported that the health workers harass women to the extent of abusing them. “……………….The Musawo was tough. Musawo was very tough. She would abuse … Because you go to the hospital, you find they are shouting at you. It's not nice. From that time …I was like, no, I'm not taking my child for vaccination again……………….” [II CT 11]. Subtheme 4: Poor quality of care The participants noted that caregivers would wait for a long time before receiving the services while in the facility. At times the health workers would come late to the facility and would tell the clients to wait for their colleagues who were still coming from home. “……………………Because sometimes we go to the hospital in the morning, the nurse tells you that you are going to wait till your friends come, maybe up to midday. That the drug is not going to be opened until your friends come.so u wait for a long time ……………..” [II CT 08]. “……….So, the people have to wait, and they will begin vaccination late, at times, vaccination is started at midday………………..” [II CT 04]. On the occasions where vaccination started late like at midday, it would be hot already. Some care givers continued to raise concerns on the safety of the vaccines since vaccines are maintained at cold temperatures. This left them with concerns of safety of these vaccines and at times made them not to bring their children for vaccination. “…vaccination is started at midday. So, we wonder even if the vaccines are still cold or they have become warm. Because we know that the drugs are maintained by ice, so when the nurse begins vaccinating at midday, is this vaccine still cold or it has gotten heated up………………” [II CT 04]. Other participants also said that the care givers were not given information regarding the vaccines being administered. Unaddressed concerns and doubts would demotivate the care givers from bringing their children for vaccination. “And also, the nurse who was vaccinating babies did not highlight to us the benefits or did not tell us about the benefits of immunizing or vaccinating babies……………..” [II CT 2]. Participants also stated that the health facilities at times lacked the vaccines. The care givers moved to the facilities and were sent back home. Since some care givers travel long distances, some of them have lost the zeal to keep bringing the children to the facility. “…………….Even the vaccines, at times you go to the hospital, and you are told they are not there ……………….” [II CT 01]. Subtheme five: Child’s health condition Participants noted that care givers did not bring the child for vaccination when the children are sick. Sometimes, the children were admitted in other health facilities making it hard for them to come for vaccination. Children ended up missing their appointments. “… the child can fall sick, you take the child, and they put on drip, and you cannot take that child now for what, immunization…...” [ II CT08]. Subtheme six: Number of injections Caregivers have raised concerns on the number of injections given to the children during vaccination. Some care takers did not even know why the vaccines were many. This made fear to bring their children for vaccination. “… and they give a child also very many injections. So, those things can hinder….” [II CT 5]. Subtheme seven: Peer influence Participants have identified that some caregivers do not also bring their children for vaccination because some colleagues of theirs do not vaccinate the children. So, the care givers feel comforted that they are not alone who do not bring their children for vaccination. “………………..Society says that vaccination of children is bad. It is just my fellow mothers were talking about it because they were saying that even them they don't take their children for vaccination …………………. ” [II CT5]. Subtheme eight: Lack of partner support Care givers, especially mothers, have not been supported by their partners. At times the mothers are denied from taking the children for vaccination due to fear of side effects. “…………………..The father of the child did not allow the wife to take the child for vaccine. When that child reached two years, the child became crippled……………... ” [II CT 7]. Mothers may not be facilitated to take their children to school for example by providing money or even a means of transport. This at times makes them to fail to bring their children for vaccination. “……………..The facilities are far and sometimes you are not even given transport to go there…………………” [II CT 09]. Subtheme nine: Busy schedules Participants have noted that care givers either have busy schedules or ‘tend to be very busy.’ Being busy with other responsibilities, the care givers at times forget to bring their children to hospital for vaccination. Others elaborated that some of the care givers just claimed to be busy, yet they were not in actual sense. This in turn contributes to zero dose vaccination among children . “… we forget the scheduled date to return the child. We also tend to be busy with our own duties and we fail to take the children to hospital…………….” [II CT 04]. Theme six: Ending incomplete vaccination of children Subtheme one: Training of VHTs Care givers suggested that the government should train more village health teams in order to increase awareness and be able to participate in the vaccination of the children within the community. “………………Me, what I want the government to do, is to make sure that they train, we have these people here that the government trains, what, VHTs, we have one here, the lady, if the government can give those people the vaccinate so that we also give our children here at home…………...” [II CT 08]. Subtheme two: Intensive sensitization Care givers noted that having intensive sensitization of the community on the importance of complete vaccination, its side effects and management of side effects would be necessary in ending zero dose vaccination. There is also need to clarify on the different myths and misconceptions present in the community about vaccination “………………I think some sensitization should be done. People should be educated on the benefits and the values of vaccinating children……….” [II CT 7]. “…clarifies on our doubts whether the vaccines are duplicate, Museveni has brought these drugs to kill our children … And also inform us why the child gets fever after vaccination………… .. ” [II CT 04] This could be done through utilization of social media platforms like WhatsApp, televisions and radios. “……………………..I think sometimes they can even go to the radio stations, and they tell them the importance of vaccinating their children so that they will also understand……………. .” [II CT3]. Subtheme three: Improving the quality of care The care givers also suggested that reducing the long waiting time at the facility, providing enough information on vaccination to the care givers and an improvement on the health workers’ attitude towards care givers would encourage care givers to bring children for vaccination. “…………………….So, maybe you tell the people from hospital that when we go there, they serve us very fast, they inject my child, and I come back home very fast. So that we don’t wait for a long time, children will become hungry ………………….” [II CT 08]. “They should be teaching us, giving us the information about vaccination and nurses should also tell us why they are giving the child many injections……………” [II CT5]. “….and they also be good to us mothers, not being tough. Okay……………. .” [II CT5]. Intensified follow up for children who have started vaccination may also be necessary. This could be by giving phone calls to the caregivers as reminders to bring their children for the next appointments. “………………………Like I said, because some people are too busy, maybe you can find mechanisms of providing reminders for these people. I could call them alarms, like when we take time for the vaccination, maybe a day before, something pops up………………..” [II CT 12]. Subtheme four: Increasing accessibility of services Others mentioned that increasing accessibility to vaccination services improves the turn up of the care givers for vaccination. This can be done through having outreaches to the far to reach areas and to ensure that all children are vaccinated. “………………..Then they should also bring those services closer to us because sometimes it’s very hard……………..” [II CT O9]. Subtheme six: Male partner involvement Participants noted that involvement of the partners in the vaccination of the children would contribute to ending zero dose children. The male partners would play a role in reminding the partners of next appointments and offering financial support. “…………….And also, it would be very important if their husband has attended with their wife, they attend two. And you tell both of them, because one can forget and then the other can see. Okay ………” [CT 12]. Health workers perspective on the factors contributing to incomplete vaccination among the children aged 12 to 59months in Mbale City. Theme one: Misconceptions on vaccination Subtheme one: Myths on vaccination Participants noted the caregivers believed that vaccines make the children sick and associated disabilities such as lameness to vaccination. “………………They'll be like, if you take the child to the hospital, they'll inject the child with drugs that will make the kids become sick, become lame …………………” [KII HW 04]. Others mentioned that vaccination has a negative impact on fertility of the people. Many participants agreed that vaccination makes one impotent. They further noted that this was a move from the Whites to reduce on the population of the Africans. “………These vaccines will harm the children in the future. They may become infertile, or they may not be able to erect………” [KII HW23]. Other participants said that the vaccines had a great impact on memory. The participants added that the vaccines made one to lose memory and therefore one becomes stupid. “……………………………They'll be like, if you take the child to the hospital, they'll inject the child with drugs .. . Then others say that you lose memory, you become stupid, that is the way they say…………………..” [KII HW 04]. Participants also shared that the vaccines are meant to kill people. Vaccines were introduced to reduce the population of the Africans. “…………………..They don't believe in injections and what have you. They believe the government wants to kill them. They talk of world new order that vaccines are meant to kill them………………….” [KII HW 07]. Participants stated vaccination is a political move and a way of obtaining funding. The participants believed that the more children are vaccinated, the more the funding to the leaders. “…………………..Some people think that it's political, they attach it on political status, that those ones they want to eat money from us, when we take our children for vaccination, they are going to get more numbers, and they claim for money……………….. ” [KII HW 09]. Subtheme two: Religious beliefs In some religions, it was noted that vaccination was not allowed because it was a sin. Vaccination was considered artificial, and God is all to solve all ones problems. “………………..They were saying you don't need artificial things. All you need is God to solve all your problems. In their religion, vaccination was a sin…………...” [KII HW 011]. In other religions, prayer and healing from God has replaced the role played by vaccination. People are encouraged to take their children for healing to be protected from such illnesses rather than coming for vaccination. “…………….So, for them they say, instead of going for vaccination, just come and we pray, God will what? Will make you, will heal the child, the child will be healthy among others…………….” [KII HW09]. Subtheme three: Cultural beliefs Participants noted that some cultures within Uganda believe that injection of the children will lead to their death. Participants noted some illnesses such as severe diarrhea, commonly known as ‘owenyanjja’ in Luganda were not to be managed by introducing an injection. This would kill the children. This has made some people not to bring their children for vaccination. “………………..Like I heard in Karamoja, there's somewhere in Karamoja where they say if somebody is injected that the person dies. That is what they believe………………..” [KII HW25]. Other participants noted that care givers opted to use local herbs for management of the vaccine preventable diseases in place for the injections given during vaccination. “…………..Those ones, they have their herbs, they trust. They imagine when they inject a baby, the baby will live and just die………………………...” [KII HW 07]. In some cultures, people believe that men are supposed to do everything. Women are supposed to stay home and take care of children. Men ended up getting too busy with other engagements and thereby not taking the children for vaccination. “There are some cultural beliefs whereby ... it is a man who does everything. A woman, for you, just sit at home. So, you find that maybe the man can become too busy in that they cannot even take their child for vaccination ………………..” [KII HW 010]. Some participants stated that care givers would just say that they are not meant to vaccinate in their culture. “………………….Then the others, some of them have cultural beliefs. According to their culture, that our children are not meant to be vaccinated…………….” [KII HW 06]. Theme two: Information gaps Subtheme one : Misinformation on vaccination Even though VHTs participated in the education of people about vaccination, participants alluded that some VHTs at times spread false information. VHTs being so influential in the community, caregivers would feel demotivated to take their children for vaccination. “……………………….Yes, lack of knowledge because even some VHTs can give false information. I think that thing is now. If a VHT gives false information, people will have to follow all that person has said because they believe in that person…………………..” [KII HW5]. Care givers have also been misinformed that there is an extortion of money while at the facility and yet this is not true. Some care givers being poor, believed that they would not be able to afford. This has demotivated the care givers from bringing their children for immunization. “Then some people used to spread propaganda that there is extortion of money at immunization facilities, which is not true. That propaganda is still there … So people will be there, that if you go, they'll ask money from you, like you don't want to go…….” [KII HW 05]. Subtheme two: Ignorance among society Participants stated that some care givers did not know about the importance of vaccination. Lack of knowledge with regards to the importance of vaccination often made the care givers to take vaccination for granted. “………………But what I've come to understand, some parents don't really understand the value, the importance, the significance of vaccination, so they end up taking it for granted……………...” [KII HW22]. Perceived barriers Theme five: Perceived barriers Subtheme one: Fear for side effects Many caregivers had received early vaccination doses. However, concerns about the side effects have been noted. Side effects such as fever, crying all through the night, the pain has been found uncomfortable and scary to the caregivers. “……………….Some of them fear the side effects of the vaccines, you know, a lot of things, they heat up children a lot. Those babies cry so much. So, most mothers fear that. And then there is also fear for that fever that the vaccine brings…………….. ” [KII HW 24]. Subtheme two: Transportation difficulties to the health facility Participants expressed that the health facilities were far from their homes. Therefore, the caregivers would plan to travel long distances before they can reach the facility. Some caretakers felt demotivated to bring the children to the facility for vaccination. Participants also stated that alongside the far distance, the caregivers were not able to afford other means of transport like boda Bodas. The parents did not have the finances, and this made them postpone their appointment dates. Participants noted that some caretakers come from either hilly or mountainous places. Such places did not favor the movement of the care givers to the facilities and thus made the children miss some doses. “………………..As I told you earlier, the terrain of that area where I am working. It's a hilly place. Yes, when it rains it's not easy to slope down and it's not easy to climb up. Because the facility is down and the community surrounding the facility others come from up……..” [KII HW 22]. Weather conditions have also impacted negatively. Participants admitted that during rainy seasons, mothers either did not bring their children or did not keep the appointment dates for vaccination because of fear for rain. “Like maybe during rain seasons, the mother fears rain to take the children. That maybe rain will get me there at the facility…….” [KII HW 04]. Rainy seasons also made transportation to the health facilities difficult. Mothers ended up postponing the appointments until they ended up not taking the child for vaccination. “Or even the seasons, like maybe it's a rainy season, making their transportation very hard. Now the parent will continue postponing, I'll take the other day, I'll take the other day. And at the end of it all, ends up not taking the child for vaccination……” [KW HW 010]. Subtheme three: Health workers’ attitude Health workers have been found to be very rude and tough towards the caregivers when the care givers come for vaccination. Participants reported that the health workers harass women to the extent of abusing them such mistreatment has prohibited the care givers from coming back for other appointments. In case one loses the immunization card, or misses an appointment for one or more reasons, such an attitude instills fear in the care givers not to bring their children for immunization. Some ended up sending children to bring their young ones to facility when immunization cards were lost. “There are health workers, they are tough on mothers when they have missed. Yes, others, they go when the cards are not there. Others, maybe the mothers have lost their card, and the mother will fear to come and get the vaccination … ………” [KII HW 04]. “So, you will find that they send small children to bring for us the children and then the children come without immunization cards.” [K II HW01]. Subtheme 4: Poor quality of care The participants noted that caregivers would wait for a long time before receiving the services while in the facility. Other participants attributed this to either inadequate staff or poor client care. On the occasions where vaccination started late like at midday, it would be hot already. Some care givers continued to raise concerns on the safety of the vaccines since vaccines are maintained at cold temperatures. “So, I think even the way we health workers handle the vaccines and violate the whole chain, how should I term it? Criteria. Criteria, yes. We contribute to these parents not bringing their children………………..” [KII HW 010]. Other participants also said that the care givers were not given information regarding the vaccines being administered. Others alluded that this was because of the high numbers of clients and making it hard to address personal concerns regarding vaccination. Unaddressed concerns and doubts would demotivate the care givers from bringing their children for vaccination. “……….Then other things, health workers don't give, because remember, in medical, before doing anything, you must explain to the client the reason as to why you're doing it. Yes. Now, because of the high population, you may not take time to explain to people … ….” [KII HW5]. Participants also stated that the health facilities at times lacked the vaccines. The care givers moved to the facilities and were sent back home. Since some care givers travel long distances, some of them have lost the zeal to keep bringing the children to the facility. “…..You can go, someone can come, when the government has not supplied the drugs, and then when the children come, we keep on telling them to come next time, whereby it will not be good for the mothers. Maybe that time will come and then when the mothers also lost morale of coming……” [KII HW 4]. Subtheme five: Child’s health condition Participants noted that care givers did not bring the child for vaccination when the children are sick. Sometimes, the children were admitted in other health facilities making it hard for them to come for vaccination. Children ended up missing their appointments. “Maybe the time for the scheduled appointment has reached but when the child is very sick and now the parent cannot take such a child for immunization or the vaccination ……” [KII HW010]. Subtheme six: Number of injections Caretakers have raised concerns on the number of injections given to the children during vaccination. Participants mentioned the injections were too many and the caretakers fear for their children. With the many injections, babies tend to feel a lot of pain and some takers perceived this as suffering. This has made them not to bring the children for vaccination. “They have also that fear. Babies get a lot of injections on their body … The baby cries the whole night. So, the baby feels really inconvenienced. So, for them also they feel the pain. And those are some of the reasons why they don't bring this baby timely…..” [KII HW 22]. Subtheme eight: Lack of partner support Participants have stated that care givers are not supported by their partners to come for vaccination. At times, the partners have denied care givers from bringing their children for immunization because of fear of side effects. Sometimes, when mothers took the children for vaccination, the partners end up quarrelling to them and blaming them when the baby suffers the side effects of vaccines. “Others, they say maybe the husband has refused them to take their kids for immunization. Sometimes the husband can tell you that I don't want my child to be vaccinated. When they take him, the baby cries and she keeps quarreling with the husband. Why did you take my kid ?” [KII HW 04] . Subtheme ten: Migration of care givers When the care givers left one place for another for example transfers at places of work, it is more likely that the children do not continue to get their due vaccines. “Others, when they move away from their initial position, let me say when she is married in Mbale and she goes to another place like maybe Iganga.” [KII HW07]. When care givers are faced with conflicts at home for example gender based violence, some care givers tend to separate from spouses and children. Now, the children may be left in the hands of an inexperienced spouse or even relatives who may not take full responsibility of the child’s vaccination schedules. “… some like wrangles at home, maybe their mothers run away, only the father taking care of the children, someone can miss the what? The vaccination.” [KII HW03]. Subtheme eleven: Lack of parent figure Participants stated that the children that were not staying with their biological parents were more likely to miss vaccination. Children who had lost their parents (orphans), children with separated parents and staying with grandparents and children living with their stepparents. The participants attributed this to probably the uncaring attitude of these care givers, negligence by the corresponding care givers or they had one or two hindrances. Care givers may not feel responsible to take these children for vaccination and at the end of the day, children do not receive vaccination. “At times the attitudes of the caretakers may also affect. More so if this person is just a caretaker, not a biological parent of this child, may not feel the importance or may not feel in for that baby, that let me take this baby to be protected against this ……” [KII HW 22]. “But those who are there, maybe their mother passed on, Then the children who are parentless, as I can see. The people that have left them with cannot bother to do what? To bring them for vaccination. You realize the other one of them is staying with a stepmom, who is not bothered to bring the child for vaccination ….” [KII HW 07]. Subtheme twelve: Busy schedules Participants have noted that caregivers either have busy schedules or ‘tend to be very busy.’ Being busy with other responsibilities, the care takers at times forget to bring their children to hospital for vaccination. Others elaborated that some of the care givers just claimed to be busy, yet they were not in actual sense. This in turn contributes to zero dose vaccination among children . “And then those mothers, most of them claim they don't have time to come to the facility. They are busy. They are busy, actually. They are busy.” [KII HW 07]. Theme six: Ending incomplete vaccination Subtheme one: Continuous medical education of health workers Continuous medical education for health workers with the VHTs inclusive was perceived as a way of ending zero dose vaccination. When health workers are educated and updated on current knowledge, they will be able to correctly and clearly inform the community on vaccination. “I think the first thing starts with having kind of a continuous medical education for the staff, for the health workers .” [KII HW 06]. Subtheme two: Motivation of VHTs Participants have noted that the VHTs have played a very important role in the sensitization of the community on vaccination. Motivation of the VHTs through giving rewards or money would be vital. This also means the vaccination programmes needed to be funded to achieve zero dose vaccination. “And even motivation of VHTs because they are the ones who are helping us.” [KII HW 01]. Subtheme three: Intensive sensitization Participants noted that having intensive sensitization of the community on the importance of complete vaccination, its side effects and management of side effects would be necessary in ending zero dose vaccination. There is also need to clarify on the different myths and misconceptions present in the community about vaccination. “So some of them still have, we still have health education gaps to clear the myths, the misunderstandings, and what people perceive from social media.” [KII HW010]. There is also a call for health education of mothers from the Antenatal care, even before the children are born all through to postnatal care on the importance of vaccination of children. Having prior knowledge enables one to ensure that their children are vaccinated. “…but they should start from antenatal teaching models … and the postnatal services that are there. Then you have to tell them, actually they have to tell mothers from the antenatal side before delivery from the first day. You have to fully immunize your kids. They teach them the advantages…” [KII HW 06]. Subtheme four: Improving the quality of care Other participants noted that stocking of the vaccines in the facilities would motivate the care givers to bring their children for vaccination. “… government should ensure that all vaccinations are in facilities so that those mothers, when they come, they don't miss.” [KII HW 04]. Subtheme four: Increasing accessibility of services Other participants mentioned that increasing accessibility to vaccination services improves the turn up of the care givers for vaccination. This can be done through having outreaches to the far to reach areas and also door to door vaccination to ensure that all children are vaccinated. “…………………….Moving door to door, it will be better. Because no one is going to escape from that………………..” [KII HW02]. Discussion The study explored the perspective of health workers and care givers towards the factors contributing to zero dose vaccination in Mbale City. This study identified the perceived misconceptions on vaccination, perceived susceptibility and severity of zero dose vaccination, perceived benefits of vaccination and perceived barriers to vaccination. Recommendations regarding ways of ending zero dose vaccination in Mbale city were also made. Misconceptions as to vaccination were identified in this study. Myths such as the effects of vaccination for example infertility, disabilities like lameness and weakened immunity were noted. This could be because some of these myths have not been addressed in different platforms that are easily accessed by the community. The noted misconceptions have also been noted in a Uganda study where vaccination was associated with infertility and reducing the population [ 26 , 27 ]. The researcher recommends that the highlighted myths and misconceptions are addressed through different platforms to clear doubts and existing concerns with relation to vaccination. The data from this study suggested that cultural beliefs also contributed to incomplete vaccination in Mbale City. This is because culture has a strong influence on the attitude on its members towards vaccination. This finding is consistent with the findings in Western Uganda, exploring the perspectives of vaccination among the Batwa Community which identified that culture hard a strong influence on vaccine attitudes [ 28 ]. The researcher believes that collaboration of the health teams and the traditional healers will improve on vaccination coverage. Religious beliefs were also noted in this study to contribute to incomplete vaccination. Different religious affiliations perceived vaccination differently whereby some declared vaccination as a sin before God. Due to the strong influence of the religious leaders upon their followers, it has been found that it has been seen to guide one’s decision to seek vaccination services. In one previous study by Gordana in Criotia, there are mixed opinions about religion and vaccination [ 27 , 29 ]. In Islam, vaccination was initially described as ‘haram’ or something wrong but later perceived as a way of saving lives [ 29 ]. This study now provides evidence to the role of the religious associations on vaccination, a factor that should not be taken for granted. The study also identified that there were mixed ideas regarding the susceptibility and severity of the children to vaccine preventable diseases. Some care givers, with partially vaccinated children noted that there were associated complications related to incomplete vaccination among children. This implies that factors contributing to incomplete vaccination are multi facet. This means that the occurrence of partially vaccinated children cannot be exclusively attributed to ignorance of perceived susceptibility or severity of vaccine preventable diseases. Other participants also noted that vaccination may not reduce the likelihood of occurrence of vaccine preventable diseases among children ages 0 to 59 months of age. This particular finding is congruent with those studied by Daniel. A where low perceived susceptibility and severity is a contributing factor to refusal of childhood vaccines among parents of school aged children [ 30 , 31 ]. This study finding provides back up to the evidence of how low susceptibility may contribute to partially vaccinated children. Ignorance associated with the vaccine safety, its side effects have been noted to make care takers not to bring their children for vaccination. Ignorance has been attributed to the low educational levels and the far to reach areas in this study. However, basing on existing literature, it seems that society had embraced vaccination despite having limited knowledge about it [ 32 , 33 ]. In a study conducted in Uganda, the correlation between the knowledge of vaccination and the increasing uptake of the vaccine was debatable [ 26 ] .These findings are similar with those assessing why children are not vaccinated as it showed that the less knowledgeable people often took their children for vaccination as compared to the more knowledgeable ones [ 34 ]. This means that having positive attitude towards vaccination may be worth more than having knowledge of how it works. This study also mentioned transportation difficulties as a barrier to vaccination of children in Mbale city. Transportation difficulties such as long distances, lack of finances, the poor weather conditions and the difficult terrain were noted. These findings have been found congruent with many previous studies [ 27 ]. In a study assessing the reasons why children have not been vaccinated, geographical access is among the key findings [ 27 , 34 ]. These results reveal the challenges faced by the many populations in not only attaining vaccination services, but also other health care services. There is a need to address these barriers with potential solutions such as outreaches, door to door vaccination and mobile vaccination clinics. Addressing the above challenges will increase the vaccination coverage and thereby ending zero dose vaccination. The health workers’ attitude was also described as a barrier that would hinder the mothers from bringing their children for vaccination. Health workers have been noted to be disrespectful and even abusing the care givers. Many other studies in Ethiopia, Zimbabwe, Kenya identify similar findings [ 35 ]. The facilitators of such ill treatment include mothers that missed the scheduled appointments or those that lost the vaccination card [ 36 ]. This study findings are incongruent with a study conducted in Dominican Republic where the mothers reported being treated well by the health workers. This could be because the setting may not be comparable to the Ugandan setting [ 30 ]. The results show that vaccine stock outs also contributed to incomplete vaccination. Most participants missed their work, probably traveled long distances and ended up missing the services due to vaccine stock outs [ 34 ]. These findings are congruent with other findings in Uganda where the vaccine stock outs contributed to missed opportunities [ 37 ] The vaccine stock outs may be caused by lack of funding or maybe poor order. Lack of these vaccines at the health facility may demotivate one to come for vaccination at the facility [ 37 ]. Information gaps have also been identified on this study. Whereas this study identifies the spread of false information like extortion of money by the health workers at the facility, extortion of money is true for other studies carried out for example in Dominican Republic [ 34 , 38 ]. Studies have also revealed that care givers do not trust the public health sources of information [ 39 ]. In this study, it has also been noted that the village health teams spread false information, a finding that has been noted as peculiar. This therefore calls for intensive continuous medical education for village health teams and other health workers. Busy schedules were noted to prevent one from taking their children to facility for vaccination. Care givers mentioned that they were very busy with work and other businesses which made them to forget to bring their children for vaccination. This specific finding seems to have been noted as conflicting priorities where the care givers, who were poor, opted to work to provide food for the household that day rather than travel long distances, spend long waiting hours in the facility [ 28 , 34 ]. Migration of the care takers from one place to another. Care takers often leave one place to another due to one or two reasons, for example conflicts with spouses, work transfer and so forth. These findings are congruent with previous studies [ 40 ]. In a study conducted by in Guinea said that some mothers missed taking their children for vaccination because of seasonal migration or political conflicts in those areas [ 40 , 41 ]. In a study in Kenya among the Masai, missed opportunities is also associated with movement of nomadic pastoralists [ 40 ].Even though certain health workers put the blame on parents because of missed appointments related to such, they should put into consideration the social aspect of care givers in order to achieve 100% vaccination coverage. This study has revealed that the child’s health condition could be one of the reasons why the children end of missing the vaccination. Care givers elaborated that when the child is sick for example has malaria, the care givers would not bring them for vaccination. This finding has been true for many studies conducted in Kenya, Nigeria and Pakistan [ 42 ]. Health workers were said to that delayed vaccination of the sick child was because they did not want to attribute worsening of the child’s condition to vaccination [ 43 ]. In Quito, false information by the medical team was one of the reasons why vaccination goals have been missed [ 43 ]. Short comings in the quality of the vaccination services have been noted like long waiting time and not being given the information while at the facility would make one not to turn up for the vaccination of the child. The long waiting time may be attributed to the inadequate staff or high patient populations in the facility. Long waiting time has also been noted in many previous studies for example in Dominican Republic where patients stayed for long due to the unavailability of the vaccinator [ 38 ]. Addressing such concerns would by increasing staffing would facilitate the elimination of zero dose vaccination [ 34 ]. Lack of partner support was one of the findings contributing to incomplete vaccination. Men have been noted to deny their women an opportunity to take the children for vaccination [ 38 ]. According to this study, men do not offer any monetary assistance to these mothers making it hard for mothers that travel long distances to bring their children. This finding was similar to one assessing why children are not vaccinated as men did not grant permission to the wives to take children for vaccination [ 34 ]. This result provides strong evidence to back up male involvement in the vaccination of children. Negligence and lack of a parental figure were mentioned as one of the factors contributing to zero dose vaccination in Mbale city. Some care givers just did not want to take responsibility to take the children to the health facility for vaccination. At times, the orphans, children to separated parents also have been victims to such instances as no one took the initiative to take them for vaccination. Some of the care givers were concerned with providing care were more interested with providing food rather than vaccination. This particular finding has not been found in previously reviewed studies. It is necessary that considerations should be made to support such children so that they are fully vaccinated. Implication of the study The identification of multifaceted factors influencing incomplete vaccination underscores the need for integrated interventions that address individual, community, and health system determinants simultaneously rather than isolated strategies. From a practice perspective, the study highlights the critical role of effective communication and community engagement in improving vaccination completion. Health workers and community-based agents, including Village Health Teams, require continuous training to address misconceptions, counter misinformation, and provide clear, consistent, and culturally sensitive vaccination messages. Improving health worker attitudes and strengthening respectful care practices may enhance caregiver trust and willingness to complete vaccination schedules. At the policy level, the findings suggest the need for adaptive immunization delivery models that respond to contextual barriers such as transportation challenges and caregivers’ competing responsibilities. Policies supporting mobile vaccination clinics, outreach services, and flexible service hours could substantially improve access, particularly for vulnerable and hard-to-reach populations. Additionally, formalizing partnerships with religious and cultural institutions within national and district immunization strategies may strengthen community ownership and acceptance of vaccination programs. The documented influence of social media misinformation further indicates the necessity for regulatory and communication policies that promote accurate, timely dissemination of immunization information and counter vaccine-related myths. In terms of equity, the study draws attention to vulnerable groups, including children with absent or separated caregivers, who are at increased risk of incomplete vaccination. This highlights the need for inclusive immunization policies that incorporate social protection mechanisms and strengthen linkage between health services and community support systems to ensure no child is left behind. Study strengths and limitations The strengths of this study included the use of different participants for example the health workers like the nurses, midwives, doctors and clinical officers and two populations that is health workers and caregivers. This provided a diverse and comprehensive understanding of the phenomenon of interest which is the factors influencing incomplete vaccination of children. Despite the existing strengths, the study also puts in to account the limitations. The findings could have been affected by the fear for legal implications by care givers to give sufficient information. This was minimized ensuring that a comfortable atmosphere for care takers. Conclusion This study explored caregivers’ and health workers’ perspectives on factors contributing to incomplete vaccination among children. The findings indicate that incomplete vaccination is a multifaceted problem influenced by interrelated individual, community, and health system factors. Key themes identified included misconceptions about vaccination; perceived susceptibility to and severity of incomplete vaccination; perceived benefits; perceived barriers; information gaps; and strategies to end incomplete vaccination. Misconceptions were largely driven by myths surrounding vaccination and fears of vaccine-associated morbidity and mortality. Limited awareness and misbeliefs regarding the benefits of vaccination further undermined vaccine uptake. Information gaps exacerbated by misinformation from social media, delayed or unclear communication, and general ignorance played a significant role. Additional barriers included fear of side effects, transportation challenges, and negative health worker attitudes, lack of partner support, peer influence, multiple injections, child illness, and caregivers’ competing responsibilities. Recommendations There is a need for strengthened collaboration between health teams and cultural and religious institutions to promote vaccination acceptance and uptake within communities. Engaging community, cultural, and faith leaders as vaccination advocates should be institutionalized within routine immunization programs to enhance trust and counter persistent myths and misconceptions. The Ministry of Health and implementing partners should scale up alternative service delivery strategies, including mobile vaccination clinics, regular community outreaches, and door to door vaccination services. Policies and guidelines should be drafted/revised so as to promote positive health worker client interactions through continuous professional development, supportive supervision, and enforcement of respectful care standards. There is need for intensified community sensitization, tailored health education, and the use of trusted local communication channels in order to improve caregivers’ attitudes toward vaccination Given the growing influence of digital platforms, there is a need for policy-driven regulation and monitoring of health-related information disseminated through social media. The Ministry of Health, in collaboration with media regulators and communication agencies, should develop mechanisms to counter misinformation by providing timely, accurate, and culturally appropriate vaccination messages through both traditional and digital media. Special policy attention should be directed toward vulnerable children, including those who have lost parents or whose parents are separated. Targeted follow-up mechanisms such as linkage with social services, community health workers, and local leadership should be established to ensure that these children are identified, tracked, and fully vaccinated. Abbreviations WHO: World Health Organization MRRH: Mbale Regional Referral Hospital BUFHS: Busitema University Faculty of Health Sciences BUFHSREC: Busitema University Faculty of Health Sciences Research and Ethics committee Declarations Ethical approval and consent to participate Regarding ethical approval, the researcher obtained ethical clearance of the study from the administration of Busitema University, clearance from BUFHSREC with registration number: REF BUFHS-2025-808 . The administration of Mbale City was given an introductory letter from Busitema University introducing the researchers to conduct the study in the city. The city administration there after gave city administrative clearance. The researcher obtained informed consent from the respondents by informing the respondents about the purpose of the study and how they were expected to participate, the benefits of the study to them and the risks involved if any. Participation was voluntary basis. The researcher observed anonymity by keeping the identities of the respondents undisclosed and confidential by not using their names. The researcher ensured that the responses that were obtained were kept confidential under lock and key and were only used for academic purposes. Consent for publication Not applicable. Availability of data and materials Data from this study will be made available by the corresponding authors on a reasonable request. Funding The authors received no specific funding to conduct this study Acknowledgement We would like to extend our gratitude to the study participants and administration of Mbale city. Authors’ contributions MAB, A.N, LVNS, R.N, S.O IJS, P.R.A, R.CN, P.O conceptualized the study, MAB, A.N, LVNS, R.N, S.O IJS, participated in data collection and Analysis, MAB, A.N, E.N, LVNS, R.N, S.O IJS, P.R.A, R.CN, P.O drafted the manuscript MAB, A.N, E.N, LVNS, R.N, S.O IJS, P.R.A, R.CN, P.O revised the manuscript. All authors read and approved the final version of the submitted manuscript. References Organization WH. million children miss out on lifesaving measles, diphtheria and tetanus vaccines in 2018. Available from: Available from: https://www.who.int/news-room/detail/15-07-2019-20-million-children-miss-out-on-lifesaving-measles-diphtheria-and-tetanus-vaccines-in-2018 Organization WH. Global childhood vaccination coverage holds steady, yet over 14 million infants remain unvaccinated—WHO, UNICEF (2025) . Organization WH. Increases in Vaccine-Preventable Disease Outbreaks Threaten Years of Progress, Warn WHO, UNICEF, Gavi. Published April. 24. WHO. 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Equity in vaccine coverage in Uganda from 2000 to 2016: revealing the multifaceted nature of inequity. BMC Public Health. 2024;24(1):185. Wasswa R, et al. Subnational trends and inequalities of under-immunisation and zero-dose among children aged 12–23 months in Uganda: a national population-based cross-sectional study. BMJ open. 2025;15(1):e093619. Okello G et al. Two decades of regional trends in vaccination completion and coverage among children aged 12–23 months: an analysis of the Uganda Demographic Health Survey data from 1995 to 2016. BMC Health Services Research, 2022. 22(1): p. 40. Organization WH. Implementing the immunization agenda 2030: a framework for action through coordinated planning, monitoring & evaluation, ownership & accountability, and communications & advocacy. Genebra: World Health Organization [Internet]; 2021. Kamya C et al. Coverage and Drivers to reaching the last child with vaccination in Urban Settings: a mixed-methods study in Kampala, Uganda. Global Health: Science and Practice, 2022. 10(4). Walekhwa AW, et al. Gaps in measles vaccination coverage in Kasese district, Western Uganda: results of a qualitative evaluation. BMC Infect Dis. 2022;22(1):589. Magambo NK, Bajunirwe F, Bagenda F. Geographic location of health facility and immunization program performance in Hoima district, western Uganda: a health facility level assessment. BMC Public Health. 2020;20:1–10. Agumeneitwe H. A cross-sectional study examining the association between maternal education and childhood (12–23 months) immunization in Uganda . 2020. Ssebandeke S. Assessing the coverage and factors influencing the uptake of child immunisation in eastern region of Uganda. Makerere University; 2023. Nabwana BW, et al. Socio-demographic determinants of vaccine coverage for pneumococcus and Rotavirus among under five children in Busolwe Town Council, Butaleja District, Eastern Uganda: a cross sectional study. Int J Trop disease health. 2019;39(3):1. Francis O. Incidence of Diarrhea and Contributing Factors in Nakaloke Town Council, Eastern Uganda, among Children Below 5 Years of Age. IDOSR J Biol Chem Pharm. 2023;8(3):52–69. Agaba J. How Uganda’s immunisation programme helped reduce child mortality. 2024. Guest G, Namey E, Chen M. A simple method to assess and report thematic saturation in qualitative research. PLoS ONE. 2020;15(5):e0232076. Morrow R, Rodriguez A, King N. Colaizzi’s descriptive phenomenological method. Psychol. 2015;28(8):643–4. Lincoln YS, Guba EG. Criteria for Assessing Naturalistic Inquiries as Reports. 1988. Braka F, et al. A qualitative analysis of vaccine safety perceptions and concerns among caretakers in Uganda. Matern Child Health J. 2012;16:1045–52. Ezeofor S. Influence of parental knowledge and attitude on childhood immunization in a selected households of Bushenyi District. 2018. Kigongo E, et al. Perspectives of Pediatric Vaccination Among the Batwa Community in Western Uganda: A Qualitative Study. 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Knowledge, attitude and behaviours towards recommended vaccinations among healthcare workers . in Healthcare . MDPI; 2017. Paul AM, et al. The last stretch: Barriers to and facilitators of full immunization among children in Nepal’s Makwanpur District, results from a qualitative study. PLoS ONE. 2022;17(1):e0261905. Ninsiima M, et al. Vaccine wastage rates and attributed factors in rural and urban areas in Uganda: Case of Mukono and Kalungu districts. PLOS Global Public Health. 2025;5(6):e0003745. Garib Z, et al. Missed opportunities for vaccination in the Dominican Republic: results of an operational investigation. Biomed Res Int. 2016;2016(1):4721836. Migriño Jr J, et al. Factors affecting vaccine hesitancy among families with children 2 years old and younger in two urban communities in Manila, Philippines. Western Pacific surveillance and response journal. Volume 11. WPSAR; 2020. p. 20. 2. Pertet AM, et al. 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Tables Table 1 : The socio demographic characteristics of health workers Variable n % Gender Male 8 26.7 Female 22 73.3 Marital status 0.0 Married 22 73.3 Single 8 26.7 Religion Islam 5 16.7 Anglican and Pentecostal 11 36.7 SDA 4 13.3 Catholic 10 33.3 Occupation Midwives 10 33.3 Nurses 6 20.0 clinical officers 3 10.0 medical doctors 3 10.0 VHTs 8 26.7 Years of experience 0.0 1 to 5 5 16.7 6 to 10 25 83.3 Table 2 : A key summary of the socio-demographic features of caregivers Variable n % Sex Female 14 77.8 Male 4 22.2 Marital status Married 12 66.7 Single 6 33.3 Age 16-20 1 5.6 21-25 5 27.8 26 -30 6 33.3 31-35 1 5.6 36-40 2 11.1 41-45 1 5.6 51-55 1 5.6 Educational level Uneducated 1 5.6 Primary 8 44.4 Secondary 7 38.9 Tertiary 2 11.1 Tribes 0.0 Gishu 6 33.3 Munyole 3 16.7 Mugwere 2 11.1 Lugbara 2 11.1 Others 5 27.8 Religion SDA 3 16.7 Islam 6 33.3 Anglican and Pentecostal 5 27.8 Catholic 4 22.2 Table 3 : A summary of key findings from the health workers’ perspective on factors contributing to incomplete vaccination of children MEANINGFUL UNIT CODES SECONDARY CODES SUBTHEME THEME “… they don't believe in injections and what have you. They believe the government wants to kill them. They talk of world new order that vaccines are meant to kill them ….” [KII HW 07] weakens immunity, infertility, stupidity, lameness, blindness reduced morbidity, associated disabilities Myths on vaccination misconceptions on vaccination “……They were saying you don't need artificial things. All you need is God to solve all your problems. In their religion, vaccination was a sin ……” [KII HW 011] spirituality, beliefs on vaccination perceived religious beliefs religious beliefs “…Like I heard in Karamoja, there's somewhere in Karamoja where they say if somebody is injected that the person dies. That is what they believe…” [KII HW25] herbal use, beliefs on injection, gender role herbal use, beliefs on vaccines cultural beliefs “……..Some of them fear the side effects of the vaccines, you know, a lot of things, they heat up children a lot. Those babies cry so much. So, most mothers fear that. And then there is also fear for that fever that the vaccine brings….” [ KII HW 24] excessive crying, fear for pain, fevers side effects of vaccines Fear for side effects Perceived barriers “……And then those mothers, most of them claim they don't have time to come to the facility. They are busy. They are busy, actually. They are busy……..” [KII HW 07]. businesses, just tend to be busy need for basic needs for survival Busy schedules “……..Or even the seasons, like maybe it's a rainy season, making their transportation very hard. Now the parent will continue postponing, I'll take the other day, I'll take the other day. And at the end of it all, ends up not taking the child for vaccination……” [KII HW 010] weather conditions, distant facilities, no finances transportation difficulties to facility Transportation difficulties to facility “…….Some of us will be rude to the clients who come. So if I be rude to you, first encounter, you can't come back if I'm there…….. .” [KII HW 05] tough health workers, rude perceived negative attitude of health workers Health workers' attitude “……..So long waiting time. Which could be maybe the health workers there not doing their job as expected or there is inadequate staffing…...” [KII HW 06] long waiting time, out stocks of vaccines, challenges with care poor quality of care “……..Maybe the time for the scheduled appointment has reached but when the child is very sick and now the parent cannot take such a child for immunization or the vaccination…….” [KII HW010]. sick children, unwell state of child unwell state of child Child's health condition “……They have also that fear. Babies get a lot of injections on their body … The baby cries the whole night. So baby feels really inconvenienced. So for them also they feel the pain. And those are some of the reasons why they don't bring this baby timely……” [KII HW 22] many injections increased injections Number of injections “……And then also, on the side of the poor support from the fathers. Some of these fathers have refused to support these mothers……” [KII HW24] denied vaccination, no monetary support no male involvement in vaccination Lack of partner support “……Sometimes, maybe negligence. Because a mother knows she is supposed to bring her child or her child for immunization, but the parent just decides not to bring…….” [KII HW 23 ] stubbornness, complacency, negligence negligence and stubbornness Parental negligence “…….At times the attitudes of the caretakers may also affect. More so if this person is just a caretaker, not a biological parent of this child, may not feel the importance or may not feel in for that baby, that let me take this baby to be protected against this……” [KII HW 22] orphans, children of separated parents, abandoned children, no responsible figure lack of parental figure “… some like wrangles at home, maybe their mothers run away, only the father taking care of the children, someone can miss the what? The vaccination ……” [KII HW03] home conflicts, work, businesses moving from place to place Migration of care takers “…….Yes, lack of knowledge because even some VHTs can give false information. I think that thing is now. If a VHT gives false information, people will have to follow all that person has said because they believe in that person……” [KII HW5] wrong information, social media platforms lack of proper information Misinformation on vaccination Information gaps “……But what I've come to understand, some parents don't really understand the value, the importance, the significance of vaccination, so they end up taking it for granted……” [KII HW22] lack of knowledge, limited knowledge ignorance of society ignorance of perceived benefits Table 4 : A summary of the care takers perspective factors contributing to incomplete vaccination of children MEANINGFUL UNIT INITIAL CODES SECONDARY CODES SUBTHEME THEME “…they are brought for trials for our children. The vaccines are being brought by the whites and sold to give our children. That is why you see that these children fall sick……” [II CT 04] clinical trials, infertility, lameness, blindness associated disabilities, testing effectiveness of vaccine Myths on vaccination misconceptions on vaccination “……I think it is a 50 50. Maybe, maybe not … I feel like my child will not have any complication when they are not vaccinated. On the other hand, in my village, I saw someone in the village whose child has not been vaccinated, and the child is crippled……..” [ II CT 09] sickness, disabilities like lameness, blindness morbidity rate associated morbidity Perceived susceptibility and severity of incomplete vaccination "…… They can die because now when the child is failing sick every time, the child can easily die. That is another problem we face sometimes……." [II CT 08] Associated with death mortality rate associated mortality “….. Me, I don't know anything that can happen to the child who has not gotten vaccinated……...” [II CT 06] lack of knowledge, low educational status, remote areas, illiteracy lack of knowledge, low educational status ignorance of perceived benefits Perceived benefits “…… I don't think because the other one that did not complete I saw that the child was fine. So, I think if the child is vaccinated or not vaccinated the child is fine……….” [CT 05] ineffective vaccines, issues with vaccines, concerns on safety ineffective and harmful vaccines misbelief of perceived benefits “……As you talked, if you take the children at three months, you can cry at the night. And you lose morale……….” [CT 06] fear for excessive crying, fevers, disturbed sleeping pattern, child is crying side effects associated with vaccination Fear for side effects Perceived barriers “… we forget the scheduled date to return the child. We also tend to be busy with our own duties, and we fail to take the children to hospital…….” [II CT 04] tend to be busy garden work', forgetfulness, business work Busy schedules hence forgetfulness busy schedules “…also the weather changes, sometimes it would rain the whole day and there is no way for you to go for vaccination……” [II CT 10] rainy season, far facilities, no financial support Challenges of transportation Transportation difficulties to facility “ Sometimes we get scared of health workers yeah, when it reaches the time ...the first thing the nurses do is to harass you and us……...” [II CT 10] shouting at clients, abusing clients, harassment mistreatment of clients Health workers' attitude “……… Because sometimes we go to the hospital in the morning, the nurse tells you that you are going to wait till your friends come, maybe up to midday. That the drug is not going to be opened until your friends come.so u wait for a long time……...” [II CT 08] long waiting time, out stocks of vaccines, lack of informed decisions poor quality of health worker nurse relationship poor quality of care “.. the child can fall sick, you take the child and they put on drip and you cannot take that child now for what, immunization…” [II CT08] sick child, child with malaria poor health condition of child Child's health condition “… and they give a child also very many injections. So, those things can hinder…..” [II CT 5]. many injections, very painful, perceived suffering many injections Number of injections “…….Society says that vaccination of children is bad. It is just my fellow mothers were talking about it because they were saying that even them they don't take their children for vaccination……..” [II CT5]. influence from mothers, community scaring peer influence Peer influence “……….The father of the child did not allow the wife to take the child for vaccine. When that child reached two years, the child became crippled………” [II CT 7] denial from child vaccination, no monetary support fathers are not engaged Lack of partner support “……. The other day I was watching a video, and they were saying, for example, that malaria vaccine that has come out. I was seeing a video, and they said, that's how those guys just want to control the number of the population in Africa here. So I am very skeptical about it……….” II CT11 social media as a source of false information misinformation of clients Misinformation on vaccination Information gaps “……normally, we get our information from churches, from VHTs and sometimes those VHTs they don’t provide us with the information early. That can make us not to take our children for immunization……….” [II CT 10]. Client dissatisfaction, late information late and poor communication late communication “……..And sometimes, we get scared, which medicine they administer for our children. Sometimes if we ask these nurses, they cannot explain for us clearly that thing can make us not to take our children for vaccination……..” [II CT10] client unsatisfaction, unprepared caretakers, late communication poor and unclear information unclear communication “……..if there is a lack of knowledge on the good things or advantage, it's the cause. So the parents lack knowledge ……” [II CT 05] lack of knowledge, unaddressed concerns knowledge deficit ignorance of perceived benefits Table 5 : A table of key findings on recommendations by the health workers on ending incomplete vaccination of children MEANINGFUL UNIT INITIAL CODES SECONDARY CODES SUBTHEMES THEME “……..I think the first thing starts with having kind of a continuous medical education for the staff, for the health workers…….. .” [KII HW 06] CMEs for health workers, training of VHTs Improving knowledge Continuous medical education Ending incomplete vaccination “………..So some of them still have, we still have health education gaps to clear the myths, the misunderstandings, and what people perceive from social media……...” [KII HW010] creating awareness, teaching from ANC, YCC Use of media platforms, creating awareness Intensive sensitization “…….then another thing is if it comes to our side, maybe just improving on the quality care. If you also improve on care, you improve on quality care…….” [KII HW 05] reduced waiting time, improvement of attitude Improving the quality of care offered to clients Improving quality of care “………..For example, they can say we are going for door-to-door mass vaccination, and………..” [KII HW 09] outreaches, door to door immunization, increasing accessibility Increasing accessibility of services “……And even motivation of VHTs because they are the ones who are helping us…….” [KII HW 01] Financial motivation, rewards motivation of VHTs Motivation of VHTs Table 6 : A summary of the recommendations by care givers on ending incomplete vaccination of children MEANINGFUL UNIT INITIAL CODES SECONDARY CODES SUBTHEMES THEME “……….I think, when the mothers are pregnant, it would be very important to start teaching them such things………..” [II CT12] teaching from ANC, teaching at YCC, teaching on social platforms health education on social platforms Intensive sensitization Ending incomplete vaccination “……….. So, maybe you tell the people from hospital that when we go there, they serve us very fast, they inject my child, and I come back home very fast. So that we don’t wait for a long time, children will become hungry………..” [II CT 08] reduced waiting time, reduced expenses, redeemed time for other activities reduced waiting time and benefits improving quality of care “…………Then they should also bring those services closer to us because sometimes it’s very hard………….” [II CT 09] bringing health services to community, more health facilities, Services to community Increasing accessibility of services “…………… And also, it would be very important if their husband has attended with their wife, they attend two. And you tell both of them, because one can forget and then the other can see. Okay………..” [II CT 12] attending of ANC as partners, reminding each other bringing male partners on board Male partner involvement Additional Declarations No competing interests reported. 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Despite significant progress in expanding vaccination programs, millions of children remain partly vaccinated, with an estimated 20\u0026nbsp;million children worldwide missing out on basic vaccines each year [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e] and over 14\u0026nbsp;million remain unvaccinated [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. The WHO and UNICEF emphasize that vaccine-preventable diseases continue to claim numerous lives, particularly in low-and middle-income countries where access to immunization services is often limited [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. Partly vaccinated children are a critical focus of global health initiatives, such as Immunization Agenda 2030, which aims to halve the number of unvaccinated children by the end of the decade [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. Factors contributing to incomplete vaccination globally include logistical challenges, vaccine hesitancy, and inequalities in healthcare access, which are compounded by socioeconomic disparities and weak health systems [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eIn sub-Saharan Africa, the burden of vaccine-preventable diseases remains disproportionately high, accounting for a significant portion of global childhood mortality. Approximately 30\u0026nbsp;million children under five in the region suffer from these diseases annually, with over 500,000 deaths attributed to inadequate vaccination coverage [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. Despite efforts to improve immunization through programs like the Expanded Program on Immunization (EPI), the region struggles with low vaccination rates, with many countries failing to meet the Global Vaccine Action Plan targets [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. Barriers such as poor infrastructure, limited health worker capacity, and cultural beliefs contribute to incomplete vaccination [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. Within East Africa, childhood vaccination coverage remains suboptimal, with an average of 69.21% of children aged 12\u0026ndash;23 months receiving all recommended vaccines [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. This figure varies widely across the 19 countries in the region, including Uganda, Kenya, Tanzania, and Ethiopia. Children who are partially vaccinated are particularly prevalent in hard-to-reach communities, where factors such as distance to health facilities, low maternal education, and traditional practices influence vaccination uptake [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eIn Uganda, according to findings of an equity analysis demonstrated that the national immunization program has made strides in increasing vaccine coverage, yet significant gaps persist [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]. Available evidence demonstrate that no region within Uganda achieved an under-vaccination rate below 20% [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. More reports from Uganda based on a national Demographic and Health Survey analysis shows that overall vaccination completion among children aged 12\u0026ndash;23 months in Uganda was 48.6% nationally, with further affirmation of regional variation across sub-regions in Uganda [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]. Additional evidence from Uganda in a subnational trend analysis demonstrated that from 2006 to 2016, the under-vaccination rate decreased by 21%, but remained high at 40.8% [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. These indicate significant challenges in reaching the Sustainable Development Goal target of at least 80% immunization coverage [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]. The country provides free childhood vaccination through the EPI, but barriers such as inadequate health infrastructure, sockets of vaccines, and limited awareness among caretakers contribute to low uptake [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]. More factors include limited access to health facilities, poor road networks, and reliance on subsistence agriculture contribute to missed vaccination opportunities [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]. Uganda\u0026rsquo;s diverse geography and population density further complicate service delivery, with rural areas experiencing greater challenges than urban centers [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]. The government\u0026rsquo;s efforts to achieve universal primary and secondary education also play a role, maternal education has been linked to improved vaccination rates [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]. The national and subnational variation of vaccination completion in resource constrained settings call for a diverse understanding of the possible factors that can explain these variations.\u003c/p\u003e \u003cp\u003eAvailable evidence show that Eastern Uganda, a region characterized by rural landscapes and socioeconomic challenges, reports lower completion of vaccination compared to other regions [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]. A study from Butaleja district in Eastern Uganda demonstrated a declining trend in completion of vaccination including the doses of Pneumococcal vaccine (PCV) and Rotavirus vaccine [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]. The study reported that, in quarter 1 of 2019, out of the 312 children who started immunization, only 2 completed Rota virus immunization and only 117 completed PCV vaccinations a trend that has been observed since 2016 [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eMbale city, located in Eastern Uganda, serves as a key urban center in the region but still grapples with incomplete vaccination among children aged 12\u0026ndash;59 months. A study conducted in Nakaloke a suburb within Mbale city found that over 65 (55.08%) of the children were not vaccinated against Rota virus and were likely to have diarrheal diseases compared to the fully vaccinated [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e]. This incomplete vaccination of children could explain the high infant mortality rate and under five mortality rates which is between 34.6 to 45 in Elgon region where Mbale city falls [\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e]. The reasons for incomplete vaccination of children in this region are not clearly established. Therefore, the purpose of this research was to explore caregivers and health workers\u0026rsquo; perspective on factors contributing to incomplete vaccination among children aged 12 to 59 months in Mbale City, Eastern Uganda.\u003c/p\u003e"},{"header":"Materials and methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eStudy area\u003c/h2\u003e \u003cp\u003eThis study was conducted in Nakaloke, northern division and Namatala, Industrial Division, all located in Mbale City, Eastern Uganda. Mbale City is located about 225 kilometers northeast of Kampala. The city is bordered by Sironko District to the north, Bududa District to the northeast, Manafwa District to the southeast, Tororo District to the south, Butaleja District to the southwest, and Budaka District to the west (Geonames. org). As of the 2024 national population and housing census, the city has a population of 290,414. Mbale Regional Referral Hospital served as the primary regional referral facility in the area.\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eStudy design\u003c/h3\u003e\n\u003cp\u003e The research utilized a descriptive qualitative study design to explore and understand the perspectives of caregivers and healthcare workers regarding factors contributing to incomplete vaccination. This approach allowed for an in-depth examination of the personal, social, and contextual factors that influence their attitudes, beliefs, and behaviors related to vaccination. By focusing on the meanings participants attach to their experiences, the study aimed to uncover the underlying barriers and motivations that contribute to vaccine hesitancy, providing valuable insights that can inform future interventions and policy development in the context of vaccination.\u003c/p\u003e\n\u003ch3\u003eStudy population\u003c/h3\u003e\n\u003cp\u003eThis study consisted of caregivers of children aged 12 to 59 months in Mbale City and key informant Health workers involved in immunization and vaccination of children and related programs. These key informants included In-charge of Young Child Clinic (YCC), Village Health Teams (VHTs), City Health Officer (CHO) and staffs directly involved in immunization programs.\u003c/p\u003e\n\u003ch3\u003eSample size estimation\u003c/h3\u003e\n\u003cp\u003e We recruited 18 caregivers and 30 health workers which was determined by saturation of data. Saturation of data refers to a point when no new information or themes emerge, suggesting that further data collection did not yield new ideas [\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e].\u003c/p\u003e\n\u003ch3\u003eSampling procedure\u003c/h3\u003e\n\u003cp\u003eThis study utilized purposive sampling, which is a form of non-probability sampling in which decisions concerning the individuals to be included in the sample are taken by the researcher, based upon a variety of criteria, which may include specialist knowledge of the research issue, or capacity and willingness to participate in the research. It was used to intentionally select care givers of partially vaccinated children aged 12\u0026ndash;59 months in Mbale City and key informant health workers involved in vaccination programs were selected to ensure rich, focused data collection.\u003c/p\u003e \u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003ePre-testing the tool\u003c/h2\u003e \u003cp\u003e A survey was conducted prior to the data collection to identify the children aged 12 to 59 months who have missed vaccination by checking their immunization cards, and then their caregivers were recruited in the study. The in-depth interview and key informant interview guide refined by an iterative pilot testing process. Six participants, including 3 Caregivers of partially vaccinated children, and 3 health workers involved in vaccination programs from Mbale District were identified in an interview to assess whether the questions are understandable, culturally appropriate and were capable of eliciting meaningful responses. Participants from Mbale District were used in pre-testing because it has similar characteristics concerning vaccination of children as study area.\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eData collection procedure\u003c/h3\u003e\n\u003cp\u003eData collection for this study involved in-depth interviews of care givers of partially vaccinated children and key informant interviews for health workers involved in vaccination programs. This guide was adopted from articles reviewed and was modified by the investigators based on study objectives to be achieved. It consisted of open-ended questions followed by specific prompts based on their individual experiences and perceptions. Face-to-face interviews were conducted by the researchers in English; participants who don\u0026rsquo;t understand English questions were translated into their local language. The interviews were one-on-one, conducted by the researchers. Interviews were carried out in private and quiet settings to ensure confidentiality. Before interviews, the purpose, risks, and benefits of participation were explained to the participants. Written informed consent were obtained from all participants. The interviews were audio recorded with a digital audio recorder after permission from the prospective participants. Notes were also taken for the non-verbal cues.\u003c/p\u003e\n\u003ch3\u003eData management\u003c/h3\u003e\n\u003cp\u003eData management for this study involved careful organization, storage, and protection of interview data to ensure confidentiality and accuracy. All interview transcripts were securely stored in encrypted digital files, and access was restricted to authorized research team members only. The data was organized by participant type (caregiver or healthcare worker) and categorized based on the identified themes during analysis. Any identifying information was anonymized to maintain privacy.\u003c/p\u003e \u003cdiv id=\"Sec11\" class=\"Section2\"\u003e \u003ch2\u003eData analysis and presentation\u003c/h2\u003e \u003cp\u003eThe data collected from caregivers and healthcare workers regarding incomplete vaccinations was analyzed using thematic analysis. Colaizzi\u0026rsquo;s seven step approach [\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e] was used to analyze data collected from caregivers and health workers to understand the reasons why some children miss their vaccinations. The process began with reading and re-reading the data to fully understand it. Next, significant statements related to incomplete vaccinations were identified, and these were translated into meanings that capture the core ideas. These meanings were then be grouped into clusters to form broader themes. A thematic map was created to visualize the experiences of caregivers and health workers in relation to unvaccinated children. Finally, the results were validated by sharing them with participants to ensure accuracy. Colaizzi\u0026rsquo;s approach provided a clear framework for understanding the challenges involved in ensuring children receive their vaccines. Data will be presented in the form of tables and thematic map.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec12\" class=\"Section2\"\u003e \u003ch2\u003eTrustworthiness of the study\u003c/h2\u003e \u003cp\u003eThe study applied the four criteria by Lincoln and Gubba [\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e] which are: Credibility, Transferability, Dependability and conformability. Credibility was ensured by allowing participants to review and confirm the accuracy of the thematic map and the identified meanings. Transferability was achieved by providing rich, detailed descriptions of the research context, participants, and methodology so that others can assess the applicability of the findings to similar settings. Dependability was ensured through a clear and systematic audit trail, where all decisions made during data collection and analysis were documented. Finally, conformability was ensured by maintaining a reflexive approach, where the researcher continuously reflects on their potential biases and seeks feedback from supervisors or experts in the field to enhance objectivity in the interpretation of data. These measures contributed to the overall trustworthiness of the study, ensuring the results are credible and accurate.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec13\" class=\"Section2\"\u003e \u003ch2\u003eCommunity engagement\u003c/h2\u003e \u003cp\u003eIn Mbale City, a community engagement plan was implemented during data collection by collaborating closely with local health centers, vaccination clinics, and community leaders. An introduction letter from Busitema University was presented to the local authorities, health workers, and community leaders to ensure they are aware of the study and its objectives. Local leaders, including family heads, were engaged to help spread awareness and encourage caregivers to participate. Informational sessions were held at local health centers, where the study\u0026rsquo;s purpose, benefits, and procedures will be explained. During these sessions, caregivers were invited to share their experiences and challenges related to missed vaccinations. Informed consent forms were provided to all participants, ensuring they understand their rights and agree voluntarily to take part in the study. This process fostered trust, ensure active community participation, and ensure the data collected is both accurate and representative of the community\u0026rsquo;s concerns.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec14\" class=\"Section2\"\u003e \u003ch2\u003eEthical considerations\u003c/h2\u003e \u003cp\u003eRegarding ethical approval, the researcher obtained ethical clearance of the study from the administration of Busitema University, clearance from BUFHSREC with registration number: \u003cb\u003eREF BUFHS-2025-808\u003c/b\u003e. The administration of Mbale City was given an introductory letter from Busitema University introducing the researchers to conduct the study in the city. The city administration there after gave city administrative clearance. The researcher obtained informed consent from the respondents by informing the respondents about the purpose of the study and how they were expected to participate, the benefits of the study to them and the risks involved if any. Participation was voluntary basis. The researcher observed anonymity by keeping the identities of the respondents undisclosed and confidential by not using their names. The researcher ensured that the responses that were obtained were kept confidential under lock and key and were only used for academic purposes.\u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003ch2\u003eSocio demographic characteristics of the participants\u003c/h2\u003e\n\u003cp\u003eThe socio demographic features of the participants are presented in\u0026nbsp;Table 1\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003eand Table 2. The care givers characteristics included age, sex, tribes, religions and educational level\u0026nbsp;Table 1. The relevant demographic information of the health workers included the age, sex, working\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eCare givers\u0026rsquo; and health workers\u0026rsquo; perspective towards factors contributing to zero dose vaccination in Mbale City\u003c/p\u003e\n\u003cp\u003eThe qualitative findings of this study are presented according to the themes generated. The themes include perceived susceptibility and severity of incomplete vaccination, perceived benefits of vaccination, misconceptions on vaccination, perceived barriers, and information gaps among others Table 3 and Table 4.\u0026nbsp;\u003c/p\u003e\n\u003ch2 id=\"_Toc213109189\"\u003eCare givers\u0026rsquo; perspective regarding the factors contributing to incomplete vaccination among children aged 12 to 59months in Mbale City\u003c/h2\u003e\n\u003cp\u003eTheme one: \u003cstrong\u003eMisconceptions on vaccination\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eSubtheme one: \u003cstrong\u003eMyths about vaccination\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eParticipants also admitted that the vaccines weaken the immunity of the children. Some agreed that the vaccinated children had a weaker immunity as compared to the non-vaccinated. Others shared that the vaccines brought illnesses upon their children. Disabilities like lameness was also associated with vaccination.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026ldquo;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;.Society talks about vaccination as it is something that they put on the babies and it weakens their immunity, unlike those days when babies were not vaccinated and they stay stronger\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;...\u0026rdquo;\u003c/em\u003e\u0026nbsp; [CT2].\u003c/p\u003e\n\u003cp\u003eOthers attributed vaccination to clinical trials. The participants noted that the vaccines had not been tested and therefore had to be tried on the African race. Others said that the vaccines were duplicate.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026ldquo;They are brought for trials for our children. The vaccines are being brought by the whites and sold to give our children. That is why you see that these children fall sick\u003c/em\u003e\u003cstrong\u003e\u0026hellip;\u003c/strong\u003e\u0026hellip;\u0026hellip;\u0026hellip;..\u0026rdquo;\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e[II CT12].\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026ldquo;That is all but at times, society knows that most drugs are brought for us in Uganda for trials so that they can detect whether they are working or not. That is what I usually hear from people\u003c/em\u003e\u0026hellip;\u0026hellip;\u0026hellip;.\u0026rdquo;\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e[II CT 4].\u003c/p\u003e\n\u003cp\u003eParticipants also shared that the vaccines are meant to kill people. Vaccines were introduced to reduce the population of the Africans.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026ldquo;\u0026hellip; the people were saying that it is not confirmed that they want to eliminate Africans, \u0026hellip;\u0026rdquo;\u0026nbsp;\u003c/em\u003e[II CT12].\u003c/p\u003e\n\u003cp\u003eOther care takers believed the vaccines were not effective and that there was something wrong with them.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026lsquo;\u0026hellip;\u0026hellip;.me as me I claim that maybe there is something wrong with the vaccine after all\u0026hellip; we feel like that thing just came to take our children\u0026apos;s lives\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u003c/em\u003e...\u0026rdquo; [II CT 09].\u003c/p\u003e\n\u003cp\u003eTheme two:\u003cstrong\u003e\u0026nbsp;Perceived susceptibility and severity of incomplete vaccination\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eSubtheme one: Associated morbidity\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eSome of the care givers mentioned that the children were at a risk of getting the vaccine preventable diseases like the polio, diphtheria and others if they were not vaccinated. Others discussed that children were at a risk of obtaining complications related to the vaccine preventable diseases like lameness and blindness if children were not vaccinated.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026ldquo;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;When you vaccinate your children very well, you will also make sure that your children do not get blind, they will see very well at night, even at daytime, they don\u0026rsquo;t become blind\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;.\u0026rdquo;\u0026nbsp;\u003c/em\u003e[II CT 08].\u003c/p\u003e\n\u003cp\u003eOther caretakers stated that zero dose vaccination may or may not predispose one to vaccine preventable diseases.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026ldquo;\u0026hellip;\u0026hellip;.I think it is a 50 50. Maybe, maybe not \u0026hellip; I feel like my child will not have any complication when they are not vaccinated. On the other hand, in my village, I saw someone in the village whose child has not been vaccinated, and the child is crippled\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026rdquo;\u0026nbsp;\u003c/em\u003e[II CT 09].\u003c/p\u003e\n\u003cp\u003eOthers have based on past successful experiences where despite being not vaccinated, many people did not succumb to the vaccine preventable diseases like polio, diphtheria and tetanus.\u003c/p\u003e\n\u003cp\u003eThis ideology has made the care takers believe that their children are less likely to get vaccine preventable diseases even when they have not been vaccinated. This is contributing to more zero dose children.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026ldquo;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip; you find yourself saying, aaah kasita we did not die yet we did not get all the doses, this child won\u0026rsquo;t die if he does not get all the doses. So, let me just stay home, this child will survive like me\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;.\u0026rdquo;\u0026nbsp;\u003c/em\u003e[II CT 08].\u003c/p\u003e\n\u003cp\u003eSome care givers have perceived that the vaccines are ineffective and therefore even those who are vaccinated suffer from vaccine preventable diseases. This means according to some care givers, vaccination does not reduce the risk of obtaining vaccine preventable diseases.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026ldquo;\u0026hellip;those that are vaccinated, they also get issues, I can say, like some rare issues which we have never seen yet they have been vaccinated. so, me as me I claim that maybe there is something wrong with the vaccine after all\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u003c/em\u003e.\u0026rdquo;\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e[II CT 08].\u003c/p\u003e\n\u003cp\u003eSubtheme two: \u003cstrong\u003eAssociated mortality\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eSome participants also noted that the children were likely to end up dying if they were not vaccinated. Others did not know what would happen to children if they were not vaccinated.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026quot;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;..They can die because now when the child is failing sick every time, the child can easily die. That is another problem we face sometimes\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;.\u0026quot;\u0026nbsp;\u003c/em\u003e[II CT 08].\u003c/p\u003e\n\u003cp\u003eTheme three: \u003cstrong\u003ePerceived benefits\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eSubtheme one: \u003cstrong\u003eIgnorance on benefits of vaccination\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWhen asked about the benefits of vaccination, there were mixed ideas. Some care givers identified some benefits of vaccination such as boosting immunity, protection from vaccine preventable diseases and protection from disabilities such as being lame and being blind. Others discussed that vaccination helped the parents to save money as children did not fall sick so frequently.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026ldquo;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;.Improves the immunity of our children, aah sometimes we as parents we are saving money because your child will not be sick all the time. There, there is somewhere where you are going to save money\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;.\u0026rdquo;\u0026nbsp;\u003c/em\u003e[II CT 10].\u003c/p\u003e\n\u003cp\u003eHowever, some care givers did not know of any benefits of vaccinating their children. Ignorance on the benefits of vaccination prohibited some of them from taking their children for vaccination.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026ldquo;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;..Me, I don\u0026apos;t know anything that can happen to the child who has not gotten vaccinated\u003c/em\u003e\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;..\u0026rdquo;\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e[II CT 06].\u003c/p\u003e\n\u003cp\u003eSubtheme two: \u003cstrong\u003eMisbelief on perceived benefits\u003c/strong\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eSome care givers believed that there were no benefits of immunization. Some participants stated that whether vaccinated or not, the children all lived healthy lives. Others stated that the vaccinated children often got illnesses as compared to the unvaccinated children.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026ldquo;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;..I don\u0026apos;t think because the other one that did not complete I saw that the child was fine. So, I think if the child is vaccinated or not vaccinated the child is fine\u003c/em\u003e\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026rdquo; II [CT 05].\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026ldquo;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;I have seen a lot of kids in my place; they have not been vaccinated but those kids are all very okay\u003c/em\u003e.\u003cem\u003e\u0026nbsp;Choka those that are vaccinated, they also get issues\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026rdquo;\u0026nbsp;\u003c/em\u003e[II CT 09].\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTheme four: Information gaps\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eSubtheme one: \u003cstrong\u003eMisinformation from social media\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eCare givers were also noted that they received information from media that made them skeptical about vaccination. One of the care givers noted that they had watched a video stating that vaccines are meant to control population of Africans. This has made care givers skeptical about taking their children for vaccination.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026ldquo;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;The other day I was watching a video, and they were saying, for example, that malaria vaccine that has come out. I was seeing a video, and they said, that\u0026apos;s how those guys just want to control the number of the population in Africa here. So I am very skeptical about it\u003c/em\u003e\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;..\u0026rdquo;\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e[II CT11].\u003c/p\u003e\n\u003cp\u003eSubtheme 2: \u003cstrong\u003eLate communication from health teams\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eSome participants have admitted that care takers received late communication from the health workers. Health workers would communicate about the vaccination program late, finding that the care givers were not prepared to bring children for vaccination.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026ldquo;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;..Normally, we get our information from churches, from VHTs and sometimes those VHTs they don\u0026rsquo;t provide us with the information early. That can make us not to take our children for immunization\u003c/em\u003e\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;.\u0026rdquo;\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e[II \u0026nbsp; CT 10].\u003c/p\u003e\n\u003cp\u003eSubtheme 3: \u003cstrong\u003eUnclear communication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eIn an attempt to seek knowledge about the vaccination, the care givers posed questions to the health workers. Participants noted that the health workers provided unclear information with regards to vaccination, its side effects and management of side effects. This left the care givers with doubts regarding the vaccination of their children.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026ldquo;And sometimes, we get scared, which medicine they administer for our children. Sometimes if we ask these nurses, they cannot explain for us clearly. that thing can make us not to take our children for vaccination.\u0026rdquo;\u0026nbsp;\u003c/em\u003eII CT10.\u003c/p\u003e\n\u003cp\u003eSubtheme four: \u003cstrong\u003eIgnorance among society\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eCare givers noted that some of them did not know the importance of vaccination. The care givers noted that the nurses did not tell them the importance of vaccination. Some others said that they did not know the specific vaccines being given to the children, how the vaccines work and their possible expected side effects. The side effects of the vaccines being administered to the children made the care givers so uncomfortable and this raised doubts on the necessity of vaccination.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026ldquo;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;..And also, the nurse who was vaccinating babies did not highlight to us the benefits or did not tell us about the benefits of immunizing or vaccinating babies\u0026hellip;\u0026hellip;\u0026hellip;...\u003c/em\u003e\u0026rdquo; [CT 2]\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026nbsp;\u0026ldquo;\u0026hellip; we don\u0026rsquo;t know whether it is the vaccine that they inject the baby that makes the baby cry, or it is the changes that the drug brings to the child\u0026apos;s body that bring those problems. But we don\u0026rsquo;t know why again the person gets such a problem after being vaccinated\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;.\u003c/em\u003e\u0026rdquo; [II CT 04]\u003c/p\u003e\n\u003cp\u003eParticipants also stated that the caregivers did not know how to manage the side effects from vaccination of children. Identified side effects include fever, excessive crying and at times swelling of the injection site. Meanwhile some participants admitted that they were given paracetamol at the facility, others stated that they were not aware of the ways to manage the side effects. The care givers ended up using remedies like onions which they were not even certain of the effectiveness and also its possible interactions with the vaccine.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026ldquo;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;They just tell us that Panadol can work very first. That is why after injection, we always go to the nearby pharmacy o nearby clinic to access those, Panadol. Sometimes, they give us direct from the health centers\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;..\u0026rdquo;\u0026nbsp;\u003c/em\u003e[II CT 10].\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026ldquo;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;.And we end up putting onions on the site to reduce the swelling\u0026hellip;\u003cu\u003e\u0026nbsp;\u003c/u\u003eonions ...which we even don\u0026rsquo;t know whether it is safe for use. Maybe, those things even spoil the medicine\u003c/em\u003e\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;..\u0026rdquo; [II CT 4].\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTheme five: Perceived barriers\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eSubtheme one: \u003cstrong\u003eFear for side effects\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eMany caregivers had received early vaccination doses. However, concerns about the side effects have been noted. Side effects such as fever, crying all through the night, the pain has been found uncomfortable and scary to the care givers.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026ldquo;\u0026hellip; saying that warning his wife not to take a child for vaccination because the child was going through pain, fever was too high\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;.\u0026rdquo;\u0026nbsp;\u003c/em\u003e[II CT 7].\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026ldquo;From that time, when the baby disturbed me, he felt sick. I was like, no, I\u0026apos;m not taking my child for vaccination\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;.\u003c/em\u003e\u0026rdquo; [II CT 11].\u003c/p\u003e\n\u003cp\u003eSome caregivers expressed dissatisfaction on the vaccination as they expected the vaccine to protect their children, yet the children fell sick after vaccination.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026ldquo;\u0026hellip; vaccination to be good like to protect the child from illness but instead the child falls sick, and the child was over crying\u003c/em\u003e\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;.\u0026rdquo;\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e[II CT 12].\u003c/p\u003e\n\u003cp\u003eSubtheme two: \u003cstrong\u003eTransportation difficulties to the health facility\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eParticipants expressed that the health facilities were far from their homes. Therefore, the caregivers would plan to travel long distances before they can reach the facility. Some care givers felt demotivated to bring the children to the facility for vaccination.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026ldquo;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;The health facilities are very far from our homes because due to long distances, it is very hard for us as parents to take children\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;.\u003c/em\u003e\u003cstrong\u003e.\u003c/strong\u003e\u0026rdquo;\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e[II CT 10].\u003c/p\u003e\n\u003cp\u003eParticipants also stated that alongside the far distance, the care givers were not able to afford other means of transport like boda Bodas. The parents did not have the finances, and this made them postpone their appointment dates.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026ldquo;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;Sometimes when my bicycle is spoilt, it is difficult for me to take the child and the mother to hospital for vaccination \u0026hellip;you don\u0026rsquo;t have money. We try sometimes to wait, to get some money which may take some time and then be able to buy\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026rdquo;\u003c/em\u003e [II CT 08].\u003c/p\u003e\n\u003cp\u003eThe caregivers also discussed that the weather conditions prevented them from bring their children for vaccination. The care givers said that it would rain the whole day at times making it hard for them to bring their children for vaccination.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026ldquo;\u0026hellip; also the weather changes, sometimes it would rain the whole day and there is no way for you to go for vaccination\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;.\u0026rdquo;\u0026nbsp;\u003c/em\u003e[II CT 10].\u003c/p\u003e\n\u003cp\u003eSubtheme three: \u003cstrong\u003eHealth workers\u0026rsquo; attitude\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eHealth workers have been found to be very rude and tough towards the caregivers when the care takers come for vaccination. Participants reported that the health workers harass women to the extent of abusing them.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026ldquo;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;.The Musawo was tough. Musawo was very tough. She would abuse \u0026hellip; Because you go to the hospital, you find they are shouting at you. It\u0026apos;s not nice.\u003c/em\u003e\u003cem\u003e\u0026nbsp;From that time \u0026hellip;I was like, no, I\u0026apos;m not taking my child for vaccination\u0026nbsp;\u003c/em\u003eagain\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;.\u0026rdquo;\u003cstrong\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003c/strong\u003e[II CT 11].\u003c/p\u003e\n\u003cp\u003eSubtheme 4: \u003cstrong\u003ePoor quality of care\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe participants noted that caregivers would wait for a long time before receiving the services while in the facility. At times the health workers would come late to the facility and would tell the clients to wait for their colleagues who were still coming from home.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026ldquo;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;Because sometimes we go to the hospital in the morning, the nurse tells you that you are going to wait till your friends come, maybe up to midday. That the drug is not going to be opened until your friends come.so u wait for a long time\u003c/em\u003e\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;..\u0026rdquo; [II CT 08].\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026ldquo;\u0026hellip;\u0026hellip;\u0026hellip;.So, the people have to wait, and they will begin vaccination late, at times, vaccination is started at midday\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;..\u0026rdquo;\u0026nbsp;\u003c/em\u003e[II CT 04].\u003c/p\u003e\n\u003cp\u003eOn the occasions where vaccination started late like at midday, it would be hot already. Some care givers continued to raise concerns on the safety of the vaccines since vaccines are maintained at cold temperatures. This left them with concerns of safety of these vaccines and at times made them not to bring their children for vaccination.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026ldquo;\u0026hellip;vaccination is started at midday. So, we wonder even if the vaccines are still cold or they have become warm. Because we know that the drugs are maintained by ice, so when the nurse begins vaccinating at midday, is this vaccine still cold or it has gotten heated up\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026rdquo;\u0026nbsp;\u003c/em\u003e[II CT 04].\u003c/p\u003e\n\u003cp\u003eOther participants also said that the care givers were not given information regarding the vaccines being administered. Unaddressed concerns and doubts would demotivate the care givers from bringing their children for vaccination.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026ldquo;And also, the nurse who was vaccinating babies did not highlight to us the benefits or did not tell us about the benefits of immunizing or vaccinating babies\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;..\u0026rdquo;\u0026nbsp;\u003c/em\u003e[II CT 2].\u003c/p\u003e\n\u003cp\u003eParticipants also stated that the health facilities at times lacked the vaccines. The care givers moved to the facilities and were sent back home. Since some care givers travel long distances, some of them have lost the zeal to keep bringing the children to the facility.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026ldquo;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;.Even the vaccines, at times you go to the hospital, and you are told they are not there\u003c/em\u003e\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;.\u0026rdquo;\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e[II CT 01].\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eSubtheme five: Child\u0026rsquo;s health condition\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eParticipants noted that care givers did not bring the child for vaccination when the children are sick. Sometimes, the children were admitted in other health facilities making it hard for them to come for vaccination. Children ended up missing their appointments.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026ldquo;\u0026hellip; the child can fall sick, you take the child, and they put on drip, and you cannot take that child now for what, immunization\u0026hellip;...\u0026rdquo;\u0026nbsp;\u003c/em\u003e[ II CT08].\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eSubtheme six: Number of injections\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eCaregivers have raised concerns on the number of injections given to the children during vaccination. Some care takers did not even know why the vaccines were many. This made fear to bring their children for vaccination.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026ldquo;\u0026hellip; and they give a child also very many injections. So, those things can hinder\u0026hellip;.\u0026rdquo;\u0026nbsp;\u003c/em\u003e[II CT 5].\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eSubtheme seven: Peer influence\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eParticipants have identified that some caregivers do not also bring their children for vaccination because some colleagues of theirs do not vaccinate the children. So, the care givers feel comforted that they are not alone who do not bring their children for vaccination.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026ldquo;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;..Society says that vaccination of children is bad. It is just my fellow mothers were talking about it because they were saying that even them they don\u0026apos;t take their children for vaccination\u003c/em\u003e\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;.\u003cstrong\u003e\u0026rdquo;\u0026nbsp;\u003c/strong\u003e[II CT5].\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eSubtheme eight: Lack of partner support\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eCare givers, especially mothers, have not been supported by their partners. At times the mothers are denied from taking the children for vaccination due to fear of side effects.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026ldquo;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;..The father of the child did not allow the wife to take the child for vaccine. When that child reached two years, the child became crippled\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;...\u003c/em\u003e\u0026rdquo; \u0026nbsp;[II CT 7].\u003c/p\u003e\n\u003cp\u003eMothers may not be facilitated to take their children to school for example by providing money or even a means of transport. This at times makes them to fail to bring their children for vaccination.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026ldquo;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;..The facilities are far and sometimes you are not even given transport to go there\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026rdquo;\u003c/em\u003e [II CT 09].\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eSubtheme nine:\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eBusy schedules\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eParticipants have noted that care givers either have busy schedules or \u0026lsquo;tend to be very busy.\u0026rsquo; Being busy with other responsibilities, the care givers at times forget to bring their children to hospital for vaccination. Others elaborated that some of the care givers just claimed to be busy, yet they were not in actual sense. This in turn contributes to zero dose vaccination among children\u003cem\u003e.\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026ldquo;\u0026hellip; we forget the scheduled date to return the child. We also tend to be busy with our own duties and we fail to take the children to hospital\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;.\u0026rdquo;\u0026nbsp;\u003c/em\u003e[II CT 04].\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTheme six: Ending incomplete vaccination of children\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eSubtheme one: Training of VHTs\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eCare givers suggested that the government should train more village health teams in order to increase awareness and be able to participate in the vaccination of the children within the community.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026ldquo;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;Me, what I want the government to do, is to make sure that they train, we have these people here that the government trains, what, VHTs, we have one here, the lady, if the government can give those people the vaccinate so that we also give our children here at home\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;...\u0026rdquo;\u0026nbsp;\u003c/em\u003e[II CT 08].\u003c/p\u003e\n\u003cp\u003eSubtheme two: \u003cstrong\u003eIntensive sensitization\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eCare givers noted that having intensive sensitization of the community on the importance of complete vaccination, its side effects and management of side effects would be necessary in ending zero dose vaccination. There is also need to clarify on the different myths and misconceptions present in the community about vaccination\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026ldquo;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;I think some sensitization should be done. People should be educated on the benefits and the values of vaccinating children\u0026hellip;\u0026hellip;\u0026hellip;.\u0026rdquo;\u0026nbsp;\u003c/em\u003e[II \u0026nbsp;CT 7].\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026ldquo;\u0026hellip;clarifies on our doubts whether the vaccines are duplicate, Museveni has brought these drugs to kill our children \u0026hellip; And also inform us why the child gets fever after vaccination\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u003c/em\u003e..\u003cem\u003e\u0026rdquo;\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/em\u003e[II CT 04]\u003c/p\u003e\n\u003cp\u003eThis could be done through utilization of social media platforms like WhatsApp, televisions and radios.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026ldquo;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;..I think sometimes they can even go to the radio stations, and they tell them the importance of vaccinating their children so that they will also understand\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;.\u003c/em\u003e.\u0026rdquo;\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e[II CT3].\u003c/p\u003e\n\u003cp\u003eSubtheme three: \u003cstrong\u003eImproving the quality of care\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe care givers also suggested that reducing the long waiting time at the facility, providing enough information on vaccination to the care givers and an improvement on the health workers\u0026rsquo; attitude towards care givers would encourage care givers to bring children for vaccination.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026ldquo;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;.So, maybe you tell the people from hospital that when we go there, they serve us very fast, they inject my child, and I come back home very fast. So that we don\u0026rsquo;t wait for a long time, children will become hungry\u003c/em\u003e\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;.\u0026rdquo;\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e[II CT 08].\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026ldquo;They should be teaching us, giving us the information about vaccination and nurses should also tell us why they are giving the child many injections\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026rdquo;\u0026nbsp;\u003c/em\u003e[II CT5].\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026ldquo;\u0026hellip;.and they also be good to us mothers, not being tough. Okay\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;.\u003c/em\u003e.\u0026rdquo;\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e[II CT5].\u003c/p\u003e\n\u003cp\u003eIntensified follow up for children who have started vaccination may also be necessary. This could be by giving phone calls to the caregivers as reminders to bring their children for the next appointments.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026ldquo;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;Like I said, because some people are too busy, maybe you can find mechanisms of providing reminders for these people. I could call them alarms, like when we take time for the vaccination, maybe a day before, something pops up\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;..\u0026rdquo;\u0026nbsp;\u003c/em\u003e[II CT 12].\u003c/p\u003e\n\u003cp\u003eSubtheme four: \u003cstrong\u003eIncreasing accessibility of services\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eOthers mentioned that increasing accessibility to vaccination services improves the turn up of the care givers for vaccination. This can be done through having outreaches to the far to reach areas and to ensure that all children are vaccinated.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026ldquo;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;..Then they should also bring those services closer to us because sometimes it\u0026rsquo;s very hard\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;..\u0026rdquo;\u0026nbsp;\u003c/em\u003e[II CT O9].\u003c/p\u003e\n\u003cp\u003eSubtheme six: \u003cstrong\u003eMale partner involvement\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eParticipants noted that involvement of the partners in the vaccination of the children would contribute to ending zero dose children. The male partners would play a role in reminding the partners of next appointments and offering financial support.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026ldquo;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;.And also, it would be very important if their husband has attended with their wife, they attend two. And you tell both of them, because one can forget and then the other can see. Okay\u003c/em\u003e\u0026hellip;\u0026hellip;\u0026hellip;\u0026rdquo; [CT 12].\u003c/p\u003e\n\u003ch2 id=\"_Toc213109190\"\u003eHealth workers perspective on the factors contributing to incomplete vaccination among the children aged 12 to 59months in Mbale City.\u003c/h2\u003e\n\u003cp\u003eTheme one: \u003cstrong\u003eMisconceptions on vaccination\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eSubtheme one: Myths on vaccination\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eParticipants noted the caregivers believed that vaccines make the children sick and associated disabilities such as lameness to vaccination.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026ldquo;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;They\u0026apos;ll be like, if you take the child to the hospital, they\u0026apos;ll inject the child with drugs that will make the kids become sick, become lame\u003c/em\u003e\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026rdquo; [KII HW 04].\u003c/p\u003e\n\u003cp\u003eOthers mentioned that vaccination has a negative impact on fertility of the people. Many participants agreed that vaccination makes one impotent. They further noted that this was a move from the Whites to reduce on the population of the Africans.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026ldquo;\u0026hellip;\u0026hellip;\u0026hellip;These vaccines will harm the children in the future. They may become infertile, or they may not be able to erect\u0026hellip;\u0026hellip;\u0026hellip;\u0026rdquo;\u0026nbsp;\u003c/em\u003e[KII HW23].\u003c/p\u003e\n\u003cp\u003eOther participants said that the vaccines had a great impact on memory. The participants added that the vaccines made one to lose memory and therefore one becomes stupid.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026ldquo;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;They\u0026apos;ll be like, if you take the child to the hospital, they\u0026apos;ll inject the child with drugs ..\u003c/em\u003e. \u003cem\u003eThen others say that you lose memory, you become stupid, that is the way they say\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;..\u0026rdquo;\u003c/em\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e[KII HW 04].\u003c/p\u003e\n\u003cp\u003eParticipants also shared that the vaccines are meant to kill people. Vaccines were introduced to reduce the population of the Africans.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026ldquo;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;..They don\u0026apos;t believe in injections and what have you. They believe the government wants to kill them. They talk of world new order that vaccines are meant to kill them\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;.\u0026rdquo;\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/em\u003e[KII HW 07].\u003c/p\u003e\n\u003cp\u003eParticipants stated vaccination is a political move and a way of obtaining funding. The participants believed that the more children are vaccinated, the more the funding to the leaders.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026ldquo;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;..Some people think that it\u0026apos;s political, they attach it on political status, that those ones they want to eat money from us, when we take our children for vaccination, they are going to get more numbers, and they claim for money\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;..\u003c/em\u003e\u0026rdquo; [KII HW 09].\u003c/p\u003e\n\u003cp\u003eSubtheme two: \u003cstrong\u003eReligious beliefs\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eIn some religions, it was noted that vaccination was not allowed because it was a sin. \u0026nbsp; Vaccination was considered artificial, and God is all to solve all ones problems.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026ldquo;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;..They were saying you don\u0026apos;t need artificial things. All you need is God to solve all your problems. In their religion, vaccination was a sin\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;...\u0026rdquo;\u0026nbsp;\u003c/em\u003e[KII HW 011].\u003c/p\u003e\n\u003cp\u003eIn other religions, prayer and healing from God has replaced the role played by vaccination. People are encouraged to take their children for healing to be protected from such illnesses rather than coming for vaccination.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026ldquo;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;.So, for them they say, instead of going for vaccination, just come and we pray, God will what? Will make you, will heal the child, the child will be healthy among others\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;.\u0026rdquo;\u003c/em\u003e [KII HW09].\u003c/p\u003e\n\u003cp\u003eSubtheme three: \u003cstrong\u003eCultural beliefs\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eParticipants noted that some cultures within Uganda believe that injection of the children will lead to their death. Participants noted some illnesses such as severe diarrhea, commonly known as \u0026lsquo;owenyanjja\u0026rsquo; in Luganda were not to be managed by introducing an injection. This would kill the children. This has made some people not to bring their children for vaccination.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026ldquo;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;..Like I heard in Karamoja, there\u0026apos;s somewhere in Karamoja where they say if somebody is injected that the person dies. That is what they believe\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;..\u0026rdquo;\u003c/em\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e[KII HW25].\u003c/p\u003e\n\u003cp\u003eOther participants noted that care givers opted to use local herbs for management of the vaccine preventable diseases in place for the injections given during vaccination.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026ldquo;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;..Those ones, they have their herbs, they trust. They imagine when they inject a baby, the baby will live and just die\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;...\u0026rdquo;\u003c/em\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e[KII HW 07].\u003c/p\u003e\n\u003cp\u003eIn some cultures, people believe that men are supposed to do everything. Women are supposed to stay home and take care of children. Men ended up getting too busy with other engagements and thereby not taking the children for vaccination.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026ldquo;There are some cultural beliefs whereby ... it is a man who does everything. A woman, for you, just sit at home. So, you find that maybe the man can become too busy in that they cannot even take their child for vaccination\u003c/em\u003e\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;..\u0026rdquo;\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e[KII HW 010].\u003c/p\u003e\n\u003cp\u003eSome participants stated that care givers would just say that they are not meant to vaccinate in their culture.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026ldquo;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;.Then the others, some of them have cultural beliefs. According to their culture, that our children are not meant to be vaccinated\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;.\u0026rdquo;\u0026nbsp;\u003c/em\u003e[KII HW 06].\u003c/p\u003e\n\u003cp\u003eTheme two: \u003cstrong\u003eInformation gaps\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003eSubtheme one\u003cstrong\u003e: Misinformation on vaccination\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eEven though VHTs participated in the education of people about vaccination, participants alluded that some VHTs at times spread false information. VHTs being so influential in the community, caregivers would feel demotivated to take their children for vaccination.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026ldquo;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;.Yes, lack of knowledge because even some VHTs can give false information. I think that thing is now. If a VHT gives false information, people will have to follow all that person has said because they believe in that person\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;..\u0026rdquo;\u0026nbsp;\u003c/em\u003e[KII HW5].\u003c/p\u003e\n\u003cp\u003eCare givers have also been misinformed that there is an extortion of money while at the facility and yet this is not true. Some care givers being poor, believed that they would not be able to afford. This has demotivated the care givers from bringing their children for immunization.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026ldquo;Then some people used to spread propaganda that there is extortion of money at immunization facilities, which is not true. That propaganda is still there \u0026hellip; So people will be there, that if you go, they\u0026apos;ll ask money from you, like you don\u0026apos;t want to go\u0026hellip;\u0026hellip;.\u0026rdquo;\u0026nbsp;\u003c/em\u003e[KII HW 05].\u003c/p\u003e\n\u003cp\u003eSubtheme two: \u003cstrong\u003eIgnorance among society\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eParticipants stated that some care givers did not know about the importance of vaccination. Lack of knowledge with regards to the importance of vaccination often made the care givers to take vaccination for granted.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026ldquo;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;But what I\u0026apos;ve come to understand, some parents don\u0026apos;t really understand the value, the importance, the significance of vaccination, so they end up taking it for granted\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;...\u0026rdquo;\u0026nbsp;\u003c/em\u003e[KII HW22].\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003ePerceived barriers\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTheme five: Perceived barriers\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eSubtheme one: \u003cstrong\u003eFear for side effects\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eMany caregivers had received early vaccination doses. However, concerns about the side effects have been noted. Side effects such as fever, crying all through the night, the pain has been found uncomfortable and scary to the caregivers.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026ldquo;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;.Some of them fear the side effects of the vaccines, you know, a lot of things, they heat up children a lot. Those babies cry so much. So, most mothers fear that. And then there is also fear for that fever that the vaccine brings\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;..\u003c/em\u003e\u0026rdquo; [KII HW 24].\u003c/p\u003e\n\u003cp\u003eSubtheme two: \u003cstrong\u003eTransportation difficulties to the health facility\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eParticipants expressed that the health facilities were far from their homes. Therefore, the caregivers would plan to travel long distances before they can reach the facility. Some caretakers felt demotivated to bring the children to the facility for vaccination.\u003c/p\u003e\n\u003cp\u003eParticipants also stated that alongside the far distance, the caregivers were not able to afford other means of transport like boda Bodas. The parents did not have the finances, and this made them postpone their appointment dates.\u003c/p\u003e\n\u003cp\u003eParticipants noted that some caretakers come from either hilly or mountainous places. Such places did not favor the movement of the care givers to the facilities and thus made the children miss some doses.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026ldquo;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;..As I told you earlier, the terrain of that area where I am working. It\u0026apos;s a hilly place. Yes, when it rains it\u0026apos;s not easy to slope down and it\u0026apos;s not easy to climb up. Because the facility is down and the community surrounding the facility others come from up\u0026hellip;\u0026hellip;..\u0026rdquo;\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/em\u003e[KII HW 22].\u003c/p\u003e\n\u003cp\u003eWeather conditions have also impacted negatively. Participants admitted that during rainy seasons, mothers either did not bring their children or did not keep the appointment dates for vaccination because of fear for rain.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026ldquo;Like maybe during rain seasons, the mother fears rain to take the children. That maybe rain will get me there at the facility\u0026hellip;\u0026hellip;.\u0026rdquo;\u003c/em\u003e [KII HW 04].\u003c/p\u003e\n\u003cp\u003eRainy seasons also made transportation to the health facilities difficult. Mothers ended up postponing the appointments until they ended up not taking the child for vaccination.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026ldquo;Or even the seasons, like maybe it\u0026apos;s a rainy season, making their transportation very hard. Now the parent will continue postponing, I\u0026apos;ll take the other day, I\u0026apos;ll take the other day. And at the end of it all, ends up not taking the child for vaccination\u0026hellip;\u0026hellip;\u0026rdquo;\u0026nbsp;\u003c/em\u003e[KW HW 010].\u003c/p\u003e\n\u003cp\u003eSubtheme three: \u003cstrong\u003eHealth workers\u0026rsquo; attitude\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eHealth workers have been found to be very rude and tough towards the caregivers when the care givers come for vaccination. Participants reported that the health workers harass women to the extent of abusing them such mistreatment has prohibited the care givers from coming back for other appointments. In case one loses the immunization card, or misses an appointment for one or more reasons, such an attitude instills fear in the care givers not to bring their children for immunization. Some ended up sending children to bring their young ones to facility when immunization cards were lost.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026ldquo;There are health workers, they are tough on mothers when they have missed. Yes, others, they go when the cards are not there. Others, maybe the mothers have lost their card, and the mother will fear to come and get the vaccination\u003c/em\u003e\u003cstrong\u003e\u0026hellip;\u003c/strong\u003e\u0026hellip;\u0026hellip;\u0026hellip;\u0026rdquo;\u003cstrong\u003e\u0026nbsp;\u0026nbsp;\u003c/strong\u003e[KII HW 04].\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026ldquo;So, you will find that they send small children to bring for us the children and then the children come without immunization cards.\u0026rdquo;\u0026nbsp;\u003c/em\u003e[K II HW01].\u003c/p\u003e\n\u003cp\u003eSubtheme 4: \u003cstrong\u003ePoor quality of care\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe participants noted that caregivers would wait for a long time before receiving the services while in the facility. Other participants attributed this to either inadequate staff or poor client care. On the occasions where vaccination started late like at midday, it would be hot already. Some care givers continued to raise concerns on the safety of the vaccines since vaccines are maintained at cold temperatures.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026ldquo;So, I think even the way we health workers handle the vaccines and violate the whole chain, how should I term it? Criteria. Criteria, yes. We contribute to these parents not bringing their children\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;..\u0026rdquo;\u0026nbsp;\u003c/em\u003e[KII HW 010].\u003c/p\u003e\n\u003cp\u003eOther participants also said that the care givers were not given information regarding the vaccines being administered. Others alluded that this was because of the high numbers of clients and making it hard to address personal concerns regarding vaccination. Unaddressed concerns and doubts would demotivate the care givers from bringing their children for vaccination.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026ldquo;\u0026hellip;\u0026hellip;\u0026hellip;.Then other things, health workers don\u0026apos;t give, because remember, in medical, before doing anything, you must explain to the client the reason as to why you\u0026apos;re doing it. Yes. Now, because of the high population, you may not take time to explain to people\u003cstrong\u003e\u0026hellip;\u003c/strong\u003e\u0026hellip;.\u0026rdquo;\u0026nbsp;\u003c/em\u003e [KII HW5].\u003c/p\u003e\n\u003cp\u003eParticipants also stated that the health facilities at times lacked the vaccines. The care givers moved to the facilities and were sent back home. Since some care givers travel long distances, some of them have lost the zeal to keep bringing the children to the facility.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026ldquo;\u0026hellip;..You can go, someone can come, when the government has not supplied the drugs, and then when the children come, we keep on telling them to come next time, whereby it will not be good for the mothers. Maybe that time will come and then when the mothers also lost morale of coming\u0026hellip;\u0026hellip;\u0026rdquo;\u0026nbsp;\u003c/em\u003e[KII HW 4].\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eSubtheme five: Child\u0026rsquo;s health condition\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eParticipants noted that care givers did not bring the child for vaccination when the children are sick. Sometimes, the children were admitted in other health facilities making it hard for them to come for vaccination. Children ended up missing their appointments.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026ldquo;Maybe the time for the scheduled appointment has reached but when the child is very sick and now the parent cannot take such a child for immunization or the vaccination\u003c/em\u003e\u0026hellip;\u0026hellip;\u0026rdquo; [KII HW010].\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eSubtheme six: Number of injections\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eCaretakers have raised concerns on the number of injections given to the children during vaccination. Participants mentioned the injections were too many and the caretakers fear for their children. With the many injections, babies tend to feel a lot of pain and some takers perceived this as suffering. \u0026nbsp; This has made them not to bring the children for vaccination.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026ldquo;They have also that fear. Babies get a lot of injections on their body \u0026hellip; The baby cries the whole night. So, the baby feels really inconvenienced.\u003c/em\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003cem\u003eSo, for them also they feel the pain. And those are some of the reasons why they don\u0026apos;t bring this baby timely\u0026hellip;..\u0026rdquo;\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/em\u003e[KII HW 22].\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eSubtheme eight: Lack of partner support\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eParticipants have stated that care givers are not supported by their partners to come for vaccination. At times, the partners have denied care givers from bringing their children for immunization because of fear of side effects. Sometimes, when mothers took the children for vaccination, the partners end up quarrelling to them and blaming them when the baby suffers the side effects of vaccines.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026ldquo;Others, they say maybe the husband has refused them to take their kids for immunization. Sometimes the husband can tell you that I don\u0026apos;t want my child to be vaccinated. When they take him, the baby cries and she keeps quarreling with the husband. Why did you take my kid\u003c/em\u003e?\u0026rdquo; [KII HW 04]\u003cstrong\u003e.\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eSubtheme ten: Migration of care givers\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWhen the care givers left one place for another for example transfers at places of work, it is more likely that the children do not continue to get their due vaccines.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026ldquo;Others, when they move away from their initial position, let me say when she is married in Mbale and she goes to another place like maybe Iganga.\u0026rdquo;\u0026nbsp;\u003c/em\u003e[KII HW07].\u003c/p\u003e\n\u003cp\u003eWhen care givers are faced with conflicts at home for example gender based violence, some care givers tend to separate from spouses and children. Now, the children may be left in the hands of an inexperienced spouse or even relatives who may not take full responsibility of the child\u0026rsquo;s vaccination schedules.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026ldquo;\u0026hellip; some like wrangles at home, maybe their mothers run away, only the father taking care of the children, someone can miss the what? The vaccination.\u0026rdquo;\u0026nbsp;\u003c/em\u003e[KII HW03].\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eSubtheme eleven: Lack of parent figure\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eParticipants stated that the children that were not staying with their biological parents were more likely to miss vaccination. Children who had lost their parents (orphans), children with separated parents and staying with grandparents and children living with their stepparents. The participants attributed this to probably the uncaring attitude of these care givers, negligence by the corresponding care givers or they had one or two hindrances. \u0026nbsp;Care givers may not feel responsible to take these children for vaccination and at the end of the day, children do not receive vaccination.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026ldquo;At times the attitudes of the caretakers may also affect. More so if this person is just a caretaker, not a biological parent of this child, may not feel the importance or may not feel in for that baby, that let me take this baby to be protected against this\u003c/em\u003e\u0026hellip;\u0026hellip;\u0026rdquo;\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e[KII HW 22].\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026ldquo;But those who are there, maybe their mother passed on, Then the children who are parentless, as I can see. The people that have left them with cannot bother to do what? To bring them for vaccination. You realize the other one of them is staying with a stepmom, who is not bothered to bring the child for vaccination\u003c/em\u003e\u0026hellip;.\u0026rdquo;\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e[KII HW 07].\u003c/p\u003e\n\u003cp\u003eSubtheme twelve: \u003cstrong\u003eBusy schedules\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eParticipants have noted that caregivers either have busy schedules or \u0026lsquo;tend to be very busy.\u0026rsquo; Being busy with other responsibilities, the care takers at times forget to bring their children to hospital for vaccination. Others elaborated that some of the care givers just claimed to be busy, yet they were not in actual sense. This in turn contributes to zero dose vaccination among children\u003cem\u003e.\u003c/em\u003e\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026ldquo;And then those mothers, most of them claim they don\u0026apos;t have time to come to the facility. They are busy. They are busy, actually. They are busy.\u0026rdquo;\u0026nbsp;\u003c/em\u003e[KII HW 07].\u003c/p\u003e\n\u003cp\u003eTheme six: \u003cstrong\u003eEnding incomplete vaccination\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eSubtheme one: \u003cstrong\u003eContinuous medical education of health workers\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eContinuous medical education for health workers with the VHTs inclusive was perceived as a way of ending zero dose vaccination. When health workers are educated and updated on current knowledge, they will be able to correctly and clearly inform the community on vaccination.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026ldquo;I think the first thing starts with having kind of a continuous medical education for the staff, for the health workers\u003c/em\u003e.\u0026rdquo; [KII HW 06].\u003c/p\u003e\n\u003cp\u003eSubtheme two: \u003cstrong\u003eMotivation of VHTs\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eParticipants have noted that the VHTs have played a very important role in the sensitization of the community on vaccination. Motivation of the VHTs through giving rewards or money would be vital. This also means the vaccination programmes needed to be funded to achieve zero dose vaccination.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026ldquo;And even motivation of VHTs because they are the ones who are helping us.\u0026rdquo;\u003c/em\u003e [KII HW 01].\u003c/p\u003e\n\u003cp\u003eSubtheme three: \u003cstrong\u003eIntensive sensitization\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eParticipants noted that having intensive sensitization of the community on the importance of complete vaccination, its side effects and management of side effects would be necessary in ending zero dose vaccination. There is also need to clarify on the different myths and misconceptions present in the community about vaccination.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026ldquo;So some of them still have, we still have health education gaps to clear the myths, the misunderstandings, and what people perceive from social media.\u0026rdquo;\u0026nbsp;\u003c/em\u003e [KII HW010].\u003c/p\u003e\n\u003cp\u003eThere is also a call for health education of mothers from the Antenatal care, even before the children are born all through to postnatal care on the importance of vaccination of children. Having prior knowledge enables one to ensure that their children are vaccinated.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026ldquo;\u0026hellip;but they should start from antenatal teaching models \u0026hellip; and the postnatal services that are there. Then you have to tell them, actually they have to tell mothers from the antenatal side before delivery from the first day.\u003c/em\u003e \u003cem\u003eYou have to fully immunize your kids. They teach them the advantages\u0026hellip;\u0026rdquo;\u0026nbsp;\u003c/em\u003e[KII HW 06].\u003c/p\u003e\n\u003cp\u003eSubtheme four: \u003cstrong\u003eImproving the quality of care\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eOther participants noted that stocking of the vaccines in the facilities would motivate the care givers to bring their children for vaccination.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026ldquo;\u0026hellip; government should ensure that all vaccinations are in facilities so that those mothers, when they come, they don\u0026apos;t miss.\u0026rdquo;\u0026nbsp;\u003c/em\u003e[KII HW 04].\u003c/p\u003e\n\u003cp\u003eSubtheme four: \u003cstrong\u003eIncreasing accessibility of services\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eOther participants mentioned that increasing accessibility to vaccination services improves the turn up of the care givers for vaccination. This can be done through having outreaches to the far to reach areas and also door to door vaccination to ensure that all children are vaccinated.\u003c/p\u003e\n\u003cp\u003e\u003cem\u003e\u0026ldquo;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;.Moving door to door, it will be better. Because no one is going to escape from that\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;..\u0026rdquo;\u003c/em\u003e [KII HW02].\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eThe study explored the perspective of health workers and care givers towards the factors contributing to zero dose vaccination in Mbale City. This study identified the perceived misconceptions on vaccination, perceived susceptibility and severity of zero dose vaccination, perceived benefits of vaccination and perceived barriers to vaccination. Recommendations regarding ways of ending zero dose vaccination in Mbale city were also made.\u003c/p\u003e \u003cp\u003eMisconceptions as to vaccination were identified in this study. Myths such as the effects of vaccination for example infertility, disabilities like lameness and weakened immunity were noted. This could be because some of these myths have not been addressed in different platforms that are easily accessed by the community. The noted misconceptions have also been noted in a Uganda study where vaccination was associated with infertility and reducing the population [\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e, \u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e]. The researcher recommends that the highlighted myths and misconceptions are addressed through different platforms to clear doubts and existing concerns with relation to vaccination.\u003c/p\u003e \u003cp\u003eThe data from this study suggested that cultural beliefs also contributed to incomplete vaccination in Mbale City. This is because culture has a strong influence on the attitude on its members towards vaccination. This finding is consistent with the findings in Western Uganda, exploring the perspectives of vaccination among the Batwa Community which identified that culture hard a strong influence on vaccine attitudes [\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e]. The researcher believes that collaboration of the health teams and the traditional healers will improve on vaccination coverage.\u003c/p\u003e \u003cp\u003eReligious beliefs were also noted in this study to contribute to incomplete vaccination. Different religious affiliations perceived vaccination differently whereby some declared vaccination as a sin before God. Due to the strong influence of the religious leaders upon their followers, it has been found that it has been seen to guide one\u0026rsquo;s decision to seek vaccination services. In one previous study by Gordana in Criotia, there are mixed opinions about religion and vaccination [\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e, \u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e]. In Islam, vaccination was initially described as \u0026lsquo;haram\u0026rsquo; or something wrong but later perceived as a way of saving lives [\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e]. This study now provides evidence to the role of the religious associations on vaccination, a factor that should not be taken for granted.\u003c/p\u003e \u003cp\u003eThe study also identified that there were mixed ideas regarding the susceptibility and severity of the children to vaccine preventable diseases. Some care givers, with partially vaccinated children noted that there were associated complications related to incomplete vaccination among children. This implies that factors contributing to incomplete vaccination are multi facet. This means that the occurrence of partially vaccinated children cannot be exclusively attributed to ignorance of perceived susceptibility or severity of vaccine preventable diseases. Other participants also noted that vaccination may not reduce the likelihood of occurrence of vaccine preventable diseases among children ages 0 to 59 months of age. This particular finding is congruent with those studied by Daniel. A where low perceived susceptibility and severity is a contributing factor to refusal of childhood vaccines among parents of school aged children [\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e, \u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e]. This study finding provides back up to the evidence of how low susceptibility may contribute to partially vaccinated children.\u003c/p\u003e \u003cp\u003eIgnorance associated with the vaccine safety, its side effects have been noted to make care takers not to bring their children for vaccination. Ignorance has been attributed to the low educational levels and the far to reach areas in this study. However, basing on existing literature, it seems that society had embraced vaccination despite having limited knowledge about it [\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e, \u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e]. In a study conducted in Uganda, the correlation between the knowledge of vaccination and the increasing uptake of the vaccine was debatable [\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e] .These findings are similar with those assessing why children are not vaccinated as it showed that the less knowledgeable people often took their children for vaccination as compared to the more knowledgeable ones [\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e]. This means that having positive attitude towards vaccination may be worth more than having knowledge of how it works.\u003c/p\u003e \u003cp\u003eThis study also mentioned transportation difficulties as a barrier to vaccination of children in Mbale city. Transportation difficulties such as long distances, lack of finances, the poor weather conditions and the difficult terrain were noted. These findings have been found congruent with many previous studies [\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e]. In a study assessing the reasons why children have not been vaccinated, geographical access is among the key findings [\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e, \u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e]. These results reveal the challenges faced by the many populations in not only attaining vaccination services, but also other health care services. There is a need to address these barriers with potential solutions such as outreaches, door to door vaccination and mobile vaccination clinics. Addressing the above challenges will increase the vaccination coverage and thereby ending zero dose vaccination.\u003c/p\u003e \u003cp\u003eThe health workers\u0026rsquo; attitude was also described as a barrier that would hinder the mothers from bringing their children for vaccination. Health workers have been noted to be disrespectful and even abusing the care givers. Many other studies in Ethiopia, Zimbabwe, Kenya identify similar findings [\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e]. The facilitators of such ill treatment include mothers that missed the scheduled appointments or those that lost the vaccination card [\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e]. This study findings are incongruent with a study conducted in Dominican Republic where the mothers reported being treated well by the health workers. This could be because the setting may not be comparable to the Ugandan setting [\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThe results show that vaccine stock outs also contributed to incomplete vaccination. Most participants missed their work, probably traveled long distances and ended up missing the services due to vaccine stock outs [\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e]. These findings are congruent with other findings in Uganda where the vaccine stock outs contributed to missed opportunities [\u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e] The vaccine stock outs may be caused by lack of funding or maybe poor order. Lack of these vaccines at the health facility may demotivate one to come for vaccination at the facility [\u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eInformation gaps have also been identified on this study. Whereas this study identifies the spread of false information like extortion of money by the health workers at the facility, extortion of money is true for other studies carried out for example in Dominican Republic [\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e, \u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e]. Studies have also revealed that care givers do not trust the public health sources of information [\u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e]. In this study, it has also been noted that the village health teams spread false information, a finding that has been noted as peculiar. This therefore calls for intensive continuous medical education for village health teams and other health workers.\u003c/p\u003e \u003cp\u003eBusy schedules were noted to prevent one from taking their children to facility for vaccination. Care givers mentioned that they were very busy with work and other businesses which made them to forget to bring their children for vaccination. This specific finding seems to have been noted as conflicting priorities where the care givers, who were poor, opted to work to provide food for the household that day rather than travel long distances, spend long waiting hours in the facility [\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e, \u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eMigration of the care takers from one place to another. Care takers often leave one place to another due to one or two reasons, for example conflicts with spouses, work transfer and so forth. These findings are congruent with previous studies [\u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e40\u003c/span\u003e]. In a study conducted by in Guinea said that some mothers missed taking their children for vaccination because of seasonal migration or political conflicts in those areas [\u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e40\u003c/span\u003e, \u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e41\u003c/span\u003e]. In a study in Kenya among the Masai, missed opportunities is also associated with movement of nomadic pastoralists [\u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e40\u003c/span\u003e].Even though certain health workers put the blame on parents because of missed appointments related to such, they should put into consideration the social aspect of care givers in order to achieve 100% vaccination coverage.\u003c/p\u003e \u003cp\u003eThis study has revealed that the child\u0026rsquo;s health condition could be one of the reasons why the children end of missing the vaccination. Care givers elaborated that when the child is sick for example has malaria, the care givers would not bring them for vaccination. This finding has been true for many studies conducted in Kenya, Nigeria and Pakistan [\u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e42\u003c/span\u003e]. Health workers were said to that delayed vaccination of the sick child was because they did not want to attribute worsening of the child\u0026rsquo;s condition to vaccination [\u003cspan citationid=\"CR43\" class=\"CitationRef\"\u003e43\u003c/span\u003e]. In Quito, false information by the medical team was one of the reasons why vaccination goals have been missed [\u003cspan citationid=\"CR43\" class=\"CitationRef\"\u003e43\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eShort comings in the quality of the vaccination services have been noted like long waiting time and not being given the information while at the facility would make one not to turn up for the vaccination of the child. The long waiting time may be attributed to the inadequate staff or high patient populations in the facility. Long waiting time has also been noted in many previous studies for example in Dominican Republic where patients stayed for long due to the unavailability of the vaccinator [\u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e]. Addressing such concerns would by increasing staffing would facilitate the elimination of zero dose vaccination [\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eLack of partner support was one of the findings contributing to incomplete vaccination. Men have been noted to deny their women an opportunity to take the children for vaccination [\u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e]. According to this study, men do not offer any monetary assistance to these mothers making it hard for mothers that travel long distances to bring their children. This finding was similar to one assessing why children are not vaccinated as men did not grant permission to the wives to take children for vaccination [\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e]. This result provides strong evidence to back up male involvement in the vaccination of children.\u003c/p\u003e \u003cp\u003eNegligence and lack of a parental figure were mentioned as one of the factors contributing to zero dose vaccination in Mbale city. Some care givers just did not want to take responsibility to take the children to the health facility for vaccination. At times, the orphans, children to separated parents also have been victims to such instances as no one took the initiative to take them for vaccination. Some of the care givers were concerned with providing care were more interested with providing food rather than vaccination. This particular finding has not been found in previously reviewed studies. It is necessary that considerations should be made to support such children so that they are fully vaccinated.\u003c/p\u003e \u003cdiv id=\"Sec37\" class=\"Section2\"\u003e \u003ch2\u003eImplication of the study\u003c/h2\u003e \u003cp\u003eThe identification of multifaceted factors influencing incomplete vaccination underscores the need for integrated interventions that address individual, community, and health system determinants simultaneously rather than isolated strategies.\u003c/p\u003e \u003cp\u003eFrom a practice perspective, the study highlights the critical role of effective communication and community engagement in improving vaccination completion. Health workers and community-based agents, including Village Health Teams, require continuous training to address misconceptions, counter misinformation, and provide clear, consistent, and culturally sensitive vaccination messages. Improving health worker attitudes and strengthening respectful care practices may enhance caregiver trust and willingness to complete vaccination schedules.\u003c/p\u003e \u003cp\u003eAt the policy level, the findings suggest the need for adaptive immunization delivery models that respond to contextual barriers such as transportation challenges and caregivers\u0026rsquo; competing responsibilities. Policies supporting mobile vaccination clinics, outreach services, and flexible service hours could substantially improve access, particularly for vulnerable and hard-to-reach populations. Additionally, formalizing partnerships with religious and cultural institutions within national and district immunization strategies may strengthen community ownership and acceptance of vaccination programs. The documented influence of social media misinformation further indicates the necessity for regulatory and communication policies that promote accurate, timely dissemination of immunization information and counter vaccine-related myths.\u003c/p\u003e \u003cp\u003eIn terms of equity, the study draws attention to vulnerable groups, including children with absent or separated caregivers, who are at increased risk of incomplete vaccination. This highlights the need for inclusive immunization policies that incorporate social protection mechanisms and strengthen linkage between health services and community support systems to ensure no child is left behind.\u003c/p\u003e \u003cdiv id=\"Sec38\" class=\"Section3\"\u003e \u003ch2\u003eStudy strengths and limitations\u003c/h2\u003e \u003cp\u003eThe strengths of this study included the use of different participants for example the health workers like the nurses, midwives, doctors and clinical officers and two populations that is health workers and caregivers. This provided a diverse and comprehensive understanding of the phenomenon of interest which is the factors influencing incomplete vaccination of children. Despite the existing strengths, the study also puts in to account the limitations. The findings could have been affected by the fear for legal implications by care givers to give sufficient information. This was minimized ensuring that a comfortable atmosphere for care takers.\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThis study explored caregivers\u0026rsquo; and health workers\u0026rsquo; perspectives on factors contributing to incomplete vaccination among children. The findings indicate that incomplete vaccination is a multifaceted problem influenced by interrelated individual, community, and health system factors. Key themes identified included misconceptions about vaccination; perceived susceptibility to and severity of incomplete vaccination; perceived benefits; perceived barriers; information gaps; and strategies to end incomplete vaccination. Misconceptions were largely driven by myths surrounding vaccination and fears of vaccine-associated morbidity and mortality. Limited awareness and misbeliefs regarding the benefits of vaccination further undermined vaccine uptake. Information gaps exacerbated by misinformation from social media, delayed or unclear communication, and general ignorance played a significant role. Additional barriers included fear of side effects, transportation challenges, and negative health worker attitudes, lack of partner support, peer influence, multiple injections, child illness, and caregivers\u0026rsquo; competing responsibilities.\u003c/p\u003e \u003cdiv id=\"Sec40\" class=\"Section2\"\u003e \u003ch2\u003eRecommendations\u003c/h2\u003e \u003cp\u003eThere is a need for strengthened collaboration between health teams and cultural and religious institutions to promote vaccination acceptance and uptake within communities. Engaging community, cultural, and faith leaders as vaccination advocates should be institutionalized within routine immunization programs to enhance trust and counter persistent myths and misconceptions.\u003c/p\u003e \u003cp\u003eThe Ministry of Health and implementing partners should scale up alternative service delivery strategies, including mobile vaccination clinics, regular community outreaches, and door to door vaccination services.\u003c/p\u003e \u003cp\u003e Policies and guidelines should be drafted/revised so as to promote positive health worker client interactions through continuous professional development, supportive supervision, and enforcement of respectful care standards.\u003c/p\u003e \u003cp\u003eThere is need for intensified community sensitization, tailored health education, and the use of trusted local communication channels in order to improve caregivers\u0026rsquo; attitudes toward vaccination\u003c/p\u003e \u003cp\u003eGiven the growing influence of digital platforms, there is a need for policy-driven regulation and monitoring of health-related information disseminated through social media. The Ministry of Health, in collaboration with media regulators and communication agencies, should develop mechanisms to counter misinformation by providing timely, accurate, and culturally appropriate vaccination messages through both traditional and digital media.\u003c/p\u003e \u003cp\u003e Special policy attention should be directed toward vulnerable children, including those who have lost parents or whose parents are separated. Targeted follow-up mechanisms such as linkage with social services, community health workers, and local leadership should be established to ensure that these children are identified, tracked, and fully vaccinated.\u003c/p\u003e \u003c/div\u003e"},{"header":"Abbreviations","content":"\u003cp\u003eWHO: World Health Organization\u003c/p\u003e\n\u003cp\u003eMRRH: Mbale Regional Referral Hospital\u003c/p\u003e\n\u003cp\u003eBUFHS:\u0026nbsp;Busitema University Faculty of Health Sciences\u003c/p\u003e\n\u003cp\u003eBUFHSREC: Busitema University Faculty of Health Sciences Research and Ethics committee\u0026nbsp;\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthical approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eRegarding ethical approval, the researcher obtained ethical clearance of the study from the administration of Busitema University, clearance from BUFHSREC with registration number:\u003cstrong\u003eREF BUFHS-2025-808\u003c/strong\u003e. The administration of Mbale City was given an introductory letter from Busitema University introducing the researchers to conduct the study in the city. The city administration there after gave city administrative clearance. The researcher obtained informed consent from the respondents by informing the respondents about the purpose of the study and how they were expected to participate, the benefits of the study to them and the risks involved if any. Participation was voluntary basis. The researcher observed anonymity by keeping the identities of the respondents undisclosed and confidential by not using their names. The researcher ensured that the responses that were obtained were kept confidential under lock and key and were only used for academic purposes.\u0026nbsp;\u003c/p\u003e\n\u003ch2\u003eConsent for publication\u003c/h2\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003ch2\u003eAvailability of data and materials\u003c/h2\u003e\n\u003cp\u003eData from this study will be made available by the corresponding authors on a reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors received no specific funding to conduct this study\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgement\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWe would like to extend our gratitude to the study participants and administration of Mbale city.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors’ contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eMAB, A.N, LVNS, R.N, S.O IJS, P.R.A, R.CN, P.O conceptualized the study, MAB, \u0026nbsp;A.N, LVNS, R.N, S.O IJS, participated in data collection and Analysis, MAB, A.N, E.N, LVNS, R.N, S.O IJS, P.R.A, R.CN, P.O drafted the manuscript MAB, A.N, E.N, LVNS, R.N, S.O IJS, P.R.A, R.CN, P.O revised the manuscript. All authors read and approved the final version of the submitted manuscript.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eOrganization WH. \u003cem\u003emillion children miss out on lifesaving measles, diphtheria and tetanus vaccines in 2018.\u003c/em\u003e Available from: Available from: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.who.int/news-room/detail/15-07-2019-20-million-children-miss-out-on-lifesaving-measles-diphtheria-and-tetanus-vaccines-in-2018\u003c/span\u003e\u003cspan address=\"https://www.who.int/news-room/detail/15-07-2019-20-million-children-miss-out-on-lifesaving-measles-diphtheria-and-tetanus-vaccines-in-2018\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eOrganization WH. \u003cem\u003eGlobal childhood vaccination coverage holds steady, yet over 14 million infants remain unvaccinated\u0026mdash;WHO, UNICEF (2025)\u003c/em\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eOrganization WH. \u003cem\u003eIncreases in Vaccine-Preventable Disease Outbreaks Threaten Years of Progress, Warn WHO, UNICEF, Gavi.\u003c/em\u003e Published April. 24.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWHO. \u003cem\u003eImmunization Agenda 2030 A Global Strategy To Leave No One Behind.\u003c/em\u003e 2021.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWang Q, et al. 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Genebra: World Health Organization [Internet]; 2021.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKamya C et al. \u003cem\u003eCoverage and Drivers to reaching the last child with vaccination in Urban Settings: a mixed-methods study in Kampala, Uganda.\u003c/em\u003e Global Health: Science and Practice, 2022. 10(4).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWalekhwa AW, et al. Gaps in measles vaccination coverage in Kasese district, Western Uganda: results of a qualitative evaluation. BMC Infect Dis. 2022;22(1):589.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMagambo NK, Bajunirwe F, Bagenda F. Geographic location of health facility and immunization program performance in Hoima district, western Uganda: a health facility level assessment. BMC Public Health. 2020;20:1\u0026ndash;10.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAgumeneitwe H. \u003cem\u003eA cross-sectional study examining the association between maternal education and childhood (12\u0026ndash;23 months) immunization in Uganda\u003c/em\u003e. 2020.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSsebandeke S. Assessing the coverage and factors influencing the uptake of child immunisation in eastern region of Uganda. Makerere University; 2023.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eNabwana BW, et al. Socio-demographic determinants of vaccine coverage for pneumococcus and Rotavirus among under five children in Busolwe Town Council, Butaleja District, Eastern Uganda: a cross sectional study. Int J Trop disease health. 2019;39(3):1.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eFrancis O. 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BMC Public Health. 2018;18:1\u0026ndash;9.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHornsh\u0026oslash;j L, et al. Vaccination coverage and out-of-sequence vaccinations in rural Guinea-Bissau: an observational cohort study. BMJ open. 2012;2(6):e001509.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eOCHIENG CO. A multi-year analysis of trends in vaccination coverage, associated factors and effect on child growth in Kenya. Maseno university; 2024.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAndrade-Guerrero F, et al. False Contraindications for Vaccinations Result in Sub-Optimal Vaccination Coverage in Quito, Ecuador: A Cross-Sectional Study. Vaccines. 2022;11(1):60.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"},{"header":"Tables","content":"\u003cp\u003e\u003cstrong\u003eTable\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003e1\u003c/strong\u003e\u003cstrong\u003e:\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003eThe socio demographic characteristics of health workers\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"636\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 205px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eVariable\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 203px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;n\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 228px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; %\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 205px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eGender\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 203px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 228px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 205px;\"\u003e\n \u003cp\u003eMale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 203px;\"\u003e\n \u003cp\u003e8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 228px;\"\u003e\n \u003cp\u003e26.7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 205px;\"\u003e\n \u003cp\u003eFemale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 203px;\"\u003e\n \u003cp\u003e22\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 228px;\"\u003e\n \u003cp\u003e73.3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 205px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMarital status\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 203px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 228px;\"\u003e\n \u003cp\u003e0.0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 205px;\"\u003e\n \u003cp\u003eMarried\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 203px;\"\u003e\n \u003cp\u003e22\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 228px;\"\u003e\n \u003cp\u003e73.3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 205px;\"\u003e\n \u003cp\u003eSingle\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 203px;\"\u003e\n \u003cp\u003e8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 228px;\"\u003e\n \u003cp\u003e26.7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 205px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eReligion\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 203px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 228px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 205px;\"\u003e\n \u003cp\u003eIslam\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 203px;\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 228px;\"\u003e\n \u003cp\u003e16.7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 205px;\"\u003e\n \u003cp\u003eAnglican and Pentecostal\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 203px;\"\u003e\n \u003cp\u003e11\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 228px;\"\u003e\n \u003cp\u003e36.7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 205px;\"\u003e\n \u003cp\u003eSDA\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 203px;\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 228px;\"\u003e\n \u003cp\u003e13.3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 205px;\"\u003e\n \u003cp\u003eCatholic\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 203px;\"\u003e\n \u003cp\u003e10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 228px;\"\u003e\n \u003cp\u003e33.3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 205px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eOccupation\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 203px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 228px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 205px;\"\u003e\n \u003cp\u003eMidwives\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 203px;\"\u003e\n \u003cp\u003e10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 228px;\"\u003e\n \u003cp\u003e33.3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 205px;\"\u003e\n \u003cp\u003eNurses\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 203px;\"\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 228px;\"\u003e\n \u003cp\u003e20.0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 205px;\"\u003e\n \u003cp\u003eclinical officers\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 203px;\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 228px;\"\u003e\n \u003cp\u003e10.0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 205px;\"\u003e\n \u003cp\u003emedical doctors\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 203px;\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 228px;\"\u003e\n \u003cp\u003e10.0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 205px;\"\u003e\n \u003cp\u003eVHTs\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 203px;\"\u003e\n \u003cp\u003e8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 228px;\"\u003e\n \u003cp\u003e26.7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 205px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eYears of experience\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 203px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 228px;\"\u003e\n \u003cp\u003e0.0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 205px;\"\u003e\n \u003cp\u003e1 to 5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 203px;\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 228px;\"\u003e\n \u003cp\u003e16.7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"bottom\" style=\"width: 205px;\"\u003e\n \u003cp\u003e6 to 10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 203px;\"\u003e\n \u003cp\u003e25\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"bottom\" style=\"width: 228px;\"\u003e\n \u003cp\u003e83.3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003e2\u003c/strong\u003e\u003cstrong\u003e:\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003eA key summary of the socio-demographic features of caregivers\u003c/strong\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"684\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 273px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eVariable\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 175px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;n\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 236px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e%\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 273px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSex\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 175px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 236px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 273px;\"\u003e\n \u003cp\u003eFemale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 175px;\"\u003e\n \u003cp\u003e14\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 236px;\"\u003e\n \u003cp\u003e77.8\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 273px;\"\u003e\n \u003cp\u003eMale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 175px;\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 236px;\"\u003e\n \u003cp\u003e22.2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 273px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMarital status\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 175px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 236px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 273px;\"\u003e\n \u003cp\u003eMarried\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 175px;\"\u003e\n \u003cp\u003e12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 236px;\"\u003e\n \u003cp\u003e66.7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 273px;\"\u003e\n \u003cp\u003eSingle\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 175px;\"\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 236px;\"\u003e\n \u003cp\u003e33.3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 273px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAge\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 175px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 236px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 273px;\"\u003e\n \u003cp\u003e16-20\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 175px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 236px;\"\u003e\n \u003cp\u003e5.6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 273px;\"\u003e\n \u003cp\u003e21-25\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 175px;\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 236px;\"\u003e\n \u003cp\u003e27.8\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 273px;\"\u003e\n \u003cp\u003e26 -30\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 175px;\"\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 236px;\"\u003e\n \u003cp\u003e33.3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 273px;\"\u003e\n \u003cp\u003e31-35\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 175px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 236px;\"\u003e\n \u003cp\u003e5.6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 273px;\"\u003e\n \u003cp\u003e36-40\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 175px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 236px;\"\u003e\n \u003cp\u003e11.1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 273px;\"\u003e\n \u003cp\u003e41-45\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 175px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 236px;\"\u003e\n \u003cp\u003e5.6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 273px;\"\u003e\n \u003cp\u003e51-55\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 175px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 236px;\"\u003e\n \u003cp\u003e5.6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 273px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eEducational level\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 175px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 236px;\"\u003e\u003cbr\u003e\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 273px;\"\u003e\n \u003cp\u003eUneducated\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 175px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 236px;\"\u003e\n \u003cp\u003e5.6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 273px;\"\u003e\n \u003cp\u003ePrimary\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 175px;\"\u003e\n \u003cp\u003e8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 236px;\"\u003e\n \u003cp\u003e44.4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 273px;\"\u003e\n \u003cp\u003eSecondary\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 175px;\"\u003e\n \u003cp\u003e7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 236px;\"\u003e\n \u003cp\u003e38.9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 273px;\"\u003e\n \u003cp\u003eTertiary\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 175px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 236px;\"\u003e\n \u003cp\u003e11.1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 273px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTribes\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 175px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 236px;\"\u003e\n \u003cp\u003e0.0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 273px;\"\u003e\n \u003cp\u003eGishu\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 175px;\"\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 236px;\"\u003e\n \u003cp\u003e33.3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 273px;\"\u003e\n \u003cp\u003eMunyole\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 175px;\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 236px;\"\u003e\n \u003cp\u003e16.7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 273px;\"\u003e\n \u003cp\u003eMugwere\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 175px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 236px;\"\u003e\n \u003cp\u003e11.1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 273px;\"\u003e\n \u003cp\u003eLugbara\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 175px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 236px;\"\u003e\n \u003cp\u003e11.1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 273px;\"\u003e\n \u003cp\u003eOthers\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 175px;\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 236px;\"\u003e\n \u003cp\u003e27.8\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 273px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eReligion\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 175px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 236px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 273px;\"\u003e\n \u003cp\u003eSDA\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 175px;\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 236px;\"\u003e\n \u003cp\u003e16.7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 273px;\"\u003e\n \u003cp\u003eIslam\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 175px;\"\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 236px;\"\u003e\n \u003cp\u003e33.3\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 273px;\"\u003e\n \u003cp\u003eAnglican and Pentecostal\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 175px;\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 236px;\"\u003e\n \u003cp\u003e27.8\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 273px;\"\u003e\n \u003cp\u003eCatholic\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 175px;\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 236px;\"\u003e\n \u003cp\u003e22.2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003eTable\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003e3\u003c/strong\u003e\u003cstrong\u003e: A summary of key findings from the health workers\u0026rsquo; perspective on factors contributing to incomplete vaccination of children\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"752\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 209px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMEANINGFUL UNIT\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 176px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eCODES\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 126px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSECONDARY CODES\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 126px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSUBTHEME\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 114px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTHEME\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 209px;\"\u003e\n \u003cp\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n \u003cp\u003e\u003cem\u003e\u0026ldquo;\u0026hellip; they don\u0026apos;t believe in injections and what have you. They believe the government wants to kill them. They talk of world new order that vaccines are meant to kill them\u003c/em\u003e\u0026hellip;.\u0026rdquo;\u003cstrong\u003e\u0026nbsp;\u0026nbsp;\u003c/strong\u003e[KII HW 07]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 176px;\"\u003e\n \u003cp\u003eweakens immunity, infertility, stupidity, lameness, blindness\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 126px;\"\u003e\n \u003cp\u003ereduced morbidity, associated disabilities\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 126px;\"\u003e\n \u003cp\u003eMyths on vaccination\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"3\" style=\"width: 114px;\"\u003e\n \u003cp\u003emisconceptions on vaccination\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 209px;\"\u003e\n \u003cp\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n \u003cp\u003e\u003cem\u003e\u0026ldquo;\u0026hellip;\u0026hellip;They were saying you don\u0026apos;t need artificial things. All you need is God to solve all your problems. In their religion, vaccination was a sin\u003c/em\u003e\u0026hellip;\u0026hellip;\u0026rdquo;\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e [KII HW 011]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 176px;\"\u003e\n \u003cp\u003espirituality, beliefs on vaccination\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 126px;\"\u003e\n \u003cp\u003eperceived religious beliefs\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 126px;\"\u003e\n \u003cp\u003ereligious beliefs\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 209px;\"\u003e\n \u003cp\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n \u003cp\u003e\u003cem\u003e\u0026ldquo;\u0026hellip;Like I heard in Karamoja, there\u0026apos;s somewhere in Karamoja where they say if somebody is injected that the person dies. That is what they believe\u0026hellip;\u0026rdquo;\u003c/em\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e[KII\u003cem\u003e\u0026nbsp;\u003c/em\u003eHW25]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 176px;\"\u003e\n \u003cp\u003eherbal use, beliefs on injection, gender role\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 126px;\"\u003e\n \u003cp\u003eherbal use, beliefs on vaccines\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 126px;\"\u003e\n \u003cp\u003ecultural beliefs\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 209px;\"\u003e\n \u003cp\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n \u003cp\u003e\u003cem\u003e\u0026ldquo;\u0026hellip;\u0026hellip;..Some of them fear the side effects of the vaccines, you know, a lot of things, they heat up children a lot. Those babies cry so much. So, most mothers fear that. And then there is also fear for that fever that the vaccine brings\u0026hellip;.\u0026rdquo;\u0026nbsp;\u003c/em\u003e[ KII HW 24]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 176px;\"\u003e\n \u003cp\u003eexcessive crying, fear for pain, fevers\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 126px;\"\u003e\n \u003cp\u003eside effects of vaccines\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 126px;\"\u003e\n \u003cp\u003eFear for side effects\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"11\" style=\"width: 114px;\"\u003e\n \u003cp\u003ePerceived barriers\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 209px;\"\u003e\n \u003cp\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n \u003cp\u003e\u003cem\u003e\u0026ldquo;\u0026hellip;\u0026hellip;And then those mothers, most of them claim they don\u0026apos;t have time to come to the facility. They are busy. They are busy, actually. They are busy\u0026hellip;\u0026hellip;..\u0026rdquo;\u003c/em\u003e [KII HW 07].\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 176px;\"\u003e\n \u003cp\u003ebusinesses, just tend to be busy\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 126px;\"\u003e\n \u003cp\u003eneed for basic needs for survival\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 126px;\"\u003e\n \u003cp\u003eBusy schedules\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 209px;\"\u003e\n \u003cp\u003e\u003cem\u003e\u0026ldquo;\u0026hellip;\u0026hellip;..Or even the seasons, like maybe it\u0026apos;s a rainy season, making their transportation very hard. Now the parent will continue postponing, I\u0026apos;ll take the other day, I\u0026apos;ll take the other day. And at the end of it all, ends up not taking the child for vaccination\u0026hellip;\u0026hellip;\u0026rdquo;\u0026nbsp;\u003c/em\u003e[KII HW 010]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 176px;\"\u003e\n \u003cp\u003eweather conditions, distant facilities, no finances\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 126px;\"\u003e\n \u003cp\u003etransportation difficulties to facility\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 126px;\"\u003e\n \u003cp\u003eTransportation difficulties to facility\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 209px;\"\u003e\n \u003cp\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n \u003cp\u003e\u003cem\u003e\u0026ldquo;\u0026hellip;\u0026hellip;.Some of us will be rude to the clients who come. So if I be rude to you, first encounter, you can\u0026apos;t come back if I\u0026apos;m there\u0026hellip;\u0026hellip;..\u003c/em\u003e.\u0026rdquo;\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e[KII HW 05]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 176px;\"\u003e\n \u003cp\u003etough health workers, rude\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 126px;\"\u003e\n \u003cp\u003eperceived negative attitude of health workers\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 126px;\"\u003e\n \u003cp\u003eHealth workers\u0026apos; attitude\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 209px;\"\u003e\n \u003cp\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n \u003cp\u003e\u003cem\u003e\u0026ldquo;\u0026hellip;\u0026hellip;..So long waiting time. Which could be maybe the health workers there not doing their job as expected or there is inadequate staffing\u0026hellip;...\u0026rdquo;\u0026nbsp;\u003c/em\u003e[KII HW 06]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 176px;\"\u003e\n \u003cp\u003elong waiting time, out stocks of vaccines,\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 126px;\"\u003e\n \u003cp\u003echallenges with care\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 126px;\"\u003e\n \u003cp\u003epoor quality of care\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 209px;\"\u003e\n \u003cp\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n \u003cp\u003e\u003cem\u003e\u0026ldquo;\u0026hellip;\u0026hellip;..Maybe the time for the scheduled appointment has reached but when the child is very sick and now the parent cannot take such a child for immunization or the vaccination\u0026hellip;\u0026hellip;.\u0026rdquo;\u0026nbsp;\u003c/em\u003e[KII HW010].\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 176px;\"\u003e\n \u003cp\u003esick children, unwell state of child\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 126px;\"\u003e\n \u003cp\u003eunwell state of child\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 126px;\"\u003e\n \u003cp\u003eChild\u0026apos;s health condition\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 209px;\"\u003e\n \u003cp\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n \u003cp\u003e\u003cem\u003e\u0026ldquo;\u0026hellip;\u0026hellip;They have also that fear. Babies get a lot of injections on their body \u0026hellip; The baby cries the whole night. So baby feels really inconvenienced. So for them also they feel the pain. And those are some of the reasons why they don\u0026apos;t bring this baby timely\u0026hellip;\u0026hellip;\u0026rdquo;\u0026nbsp;\u003c/em\u003e[KII HW 22]\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 176px;\"\u003e\n \u003cp\u003e\u0026nbsp;many injections\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 126px;\"\u003e\n \u003cp\u003eincreased injections\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 126px;\"\u003e\n \u003cp\u003eNumber of injections\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 209px;\"\u003e\n \u003cp\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n \u003cp\u003e\u003cem\u003e\u0026ldquo;\u0026hellip;\u0026hellip;And then also, on the side of the poor support from the fathers. Some of these fathers have refused to support these mothers\u0026hellip;\u0026hellip;\u0026rdquo;\u0026nbsp;\u003c/em\u003e[KII HW24]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 176px;\"\u003e\n \u003cp\u003edenied vaccination, no monetary support\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 126px;\"\u003e\n \u003cp\u003eno male involvement in vaccination\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 126px;\"\u003e\n \u003cp\u003eLack of partner support\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 209px;\"\u003e\n \u003cp\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n \u003cp\u003e\u003cem\u003e\u0026ldquo;\u0026hellip;\u0026hellip;Sometimes, maybe negligence. Because a mother knows she is supposed to bring her child or her child for immunization, but the parent just decides not to bring\u0026hellip;\u0026hellip;.\u0026rdquo;\u003c/em\u003e\u003c/p\u003e\n \u003cp\u003e[KII\u003cem\u003e\u0026nbsp;HW 23\u003c/em\u003e]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 176px;\"\u003e\n \u003cp\u003estubbornness, complacency, negligence\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 126px;\"\u003e\n \u003cp\u003enegligence and stubbornness\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 126px;\"\u003e\n \u003cp\u003eParental negligence\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 209px;\"\u003e\n \u003cp\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n \u003cp\u003e\u003cem\u003e\u0026ldquo;\u0026hellip;\u0026hellip;.At times the attitudes of the caretakers may also affect. More so if this person is just a caretaker, not a biological parent of this child, may not feel the importance or may not feel in for that baby, that let me take this baby to be protected against this\u0026hellip;\u0026hellip;\u0026rdquo;\u0026nbsp;\u003c/em\u003e[KII HW 22]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 176px;\"\u003e\n \u003cp\u003eorphans, children of separated parents,\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 126px;\"\u003e\n \u003cp\u003eabandoned children, no responsible figure\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 126px;\"\u003e\n \u003cp\u003elack of parental figure\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 209px;\"\u003e\n \u003cp\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n \u003cp\u003e\u003cem\u003e\u0026ldquo;\u0026hellip; some like wrangles at home, maybe their mothers run away, only the father taking care of the children, someone can miss the what? The vaccination\u003c/em\u003e\u0026hellip;\u0026hellip;\u0026rdquo;\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e[KII HW03]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 176px;\"\u003e\n \u003cp\u003ehome conflicts, work, businesses\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 126px;\"\u003e\n \u003cp\u003emoving from place to place\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 126px;\"\u003e\n \u003cp\u003eMigration of care takers\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 209px;\"\u003e\n \u003cp\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n \u003cp\u003e\u003cem\u003e\u0026ldquo;\u0026hellip;\u0026hellip;.Yes, lack of knowledge because even some VHTs can give false information. I think that thing is now. If a VHT gives false information, people will have to follow all that person has said because they believe in that person\u0026hellip;\u0026hellip;\u0026rdquo;\u003c/em\u003e\u003c/p\u003e\n \u003cp\u003e[KII HW5]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 176px;\"\u003e\n \u003cp\u003ewrong information, social media platforms\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 126px;\"\u003e\n \u003cp\u003elack of proper information\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 126px;\"\u003e\n \u003cp\u003e\u0026nbsp;Misinformation on vaccination\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 114px;\"\u003e\n \u003cp\u003eInformation gaps\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 209px;\"\u003e\n \u003cp\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n \u003cp\u003e\u003cem\u003e\u0026ldquo;\u0026hellip;\u0026hellip;But what I\u0026apos;ve come to understand, some parents don\u0026apos;t really understand the value, the importance, the significance of vaccination, so they end up taking it for granted\u0026hellip;\u0026hellip;\u0026rdquo;\u0026nbsp;\u003c/em\u003e[KII HW22]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 176px;\"\u003e\n \u003cp\u003elack of knowledge, limited knowledge\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 126px;\"\u003e\n \u003cp\u003eignorance of society\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 126px;\"\u003e\n \u003cp\u003eignorance of perceived benefits\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003eTable\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003e4\u003c/strong\u003e\u003cstrong\u003e: A summary of the care takers\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003eperspective factors contributing to incomplete vaccination of children\u003c/strong\u003e\u003c/p\u003e\n\u003cdiv align=\"center\"\u003e\n \u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"757\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 281px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMEANINGFUL UNIT\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 116px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eINITIAL CODES\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 120px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSECONDARY CODES\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 120px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSUBTHEME\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 120px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTHEME\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 281px;\"\u003e\n \u003cp\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n \u003cp\u003e\u003cem\u003e\u0026ldquo;\u0026hellip;they are brought for trials for our children. The vaccines are being brought by the whites and sold to give our children. That is why you see that these children fall sick\u0026hellip;\u0026hellip;\u0026rdquo;\u003c/em\u003e [II CT 04]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 116px;\"\u003e\n \u003cp\u003eclinical trials, infertility, lameness, blindness\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 120px;\"\u003e\n \u003cp\u003eassociated disabilities, testing effectiveness of vaccine\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 120px;\"\u003e\n \u003cp\u003eMyths on vaccination\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 120px;\"\u003e\n \u003cp\u003emisconceptions on vaccination\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 281px;\"\u003e\n \u003cp\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n \u003cp\u003e\u003cem\u003e\u0026ldquo;\u0026hellip;\u0026hellip;I think it is a 50 50. Maybe, maybe not \u0026hellip; I feel like my child will not have any complication when they are not vaccinated. On the other hand, in my village, I saw someone in the village whose child has not been vaccinated, and the child is crippled\u0026hellip;\u0026hellip;..\u0026rdquo;\u003c/em\u003e [\u003cem\u003e\u0026nbsp;\u003c/em\u003eII CT 09]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 116px;\"\u003e\n \u003cp\u003esickness, disabilities like lameness, blindness\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 120px;\"\u003e\n \u003cp\u003emorbidity rate\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 120px;\"\u003e\n \u003cp\u003eassociated morbidity\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 120px;\"\u003e\n \u003cp\u003ePerceived susceptibility and severity of incomplete vaccination\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 281px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026quot;\u0026hellip;\u0026hellip;\u003cem\u003eThey can die because now when the child is failing sick every time, the child can easily die. That is another problem we face sometimes\u0026hellip;\u0026hellip;.\u0026quot;\u003c/em\u003e [II CT 08]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 116px;\"\u003e\n \u003cp\u003eAssociated with death\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 120px;\"\u003e\n \u003cp\u003emortality rate\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 120px;\"\u003e\n \u003cp\u003eassociated mortality\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 281px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026ldquo;\u0026hellip;..\u003cem\u003eMe, I don\u0026apos;t know anything that can happen to the child who has not gotten vaccinated\u0026hellip;\u0026hellip;...\u0026rdquo;\u003c/em\u003e [II CT 06]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 116px;\"\u003e\n \u003cp\u003elack of knowledge, low educational status, remote areas, illiteracy\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 120px;\"\u003e\n \u003cp\u003elack of knowledge, low educational status\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 120px;\"\u003e\n \u003cp\u003eignorance of perceived benefits\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" style=\"width: 120px;\"\u003e\n \u003cp\u003ePerceived benefits\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 281px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e\u0026ldquo;\u0026hellip;\u0026hellip;\u003cem\u003eI don\u0026apos;t think because the other one that did not complete I saw that the child was fine. So, I think if the child is vaccinated or not vaccinated the child is fine\u0026hellip;\u0026hellip;\u0026hellip;.\u0026rdquo;\u0026nbsp;\u003c/em\u003e[CT 05]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 116px;\"\u003e\n \u003cp\u003eineffective vaccines, issues with vaccines, concerns on safety\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 120px;\"\u003e\n \u003cp\u003eineffective and harmful vaccines\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 120px;\"\u003e\n \u003cp\u003emisbelief of perceived benefits\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 281px;\"\u003e\n \u003cp\u003e\u003cem\u003e\u0026ldquo;\u0026hellip;\u0026hellip;As you talked, if you take the children at three months, you can cry at the night. And you lose morale\u0026hellip;\u0026hellip;\u0026hellip;.\u0026rdquo;\u003c/em\u003e\u003c/p\u003e\n \u003cp\u003e[CT 06]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 116px;\"\u003e\n \u003cp\u003efear for excessive crying, fevers, disturbed sleeping pattern, child is crying\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 120px;\"\u003e\n \u003cp\u003eside effects associated with vaccination\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 120px;\"\u003e\n \u003cp\u003eFear for side effects\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"9\" style=\"width: 120px;\"\u003e\n \u003cp\u003ePerceived barriers\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 281px;\"\u003e\n \u003cp\u003e\u003cem\u003e\u0026ldquo;\u0026hellip; we forget the scheduled date to return the child. We also tend to be busy with our own duties, and we fail to take the children to hospital\u0026hellip;\u0026hellip;.\u0026rdquo;\u003c/em\u003e \u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e[II CT 04]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 116px;\"\u003e\n \u003cp\u003etend to be busy garden work\u0026apos;, forgetfulness, business work\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 120px;\"\u003e\n \u003cp\u003e\u0026nbsp;Busy schedules hence \u0026nbsp; \u0026nbsp; forgetfulness\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 120px;\"\u003e\n \u003cp\u003ebusy schedules\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 281px;\"\u003e\n \u003cp\u003e\u003cem\u003e\u0026ldquo;\u0026hellip;also the weather changes, sometimes it would rain the whole day and there is no way for you to go for vaccination\u0026hellip;\u0026hellip;\u0026rdquo;\u0026nbsp;\u003c/em\u003e[II CT 10]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 116px;\"\u003e\n \u003cp\u003erainy season, far facilities, no financial support\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 120px;\"\u003e\n \u003cp\u003e\u0026nbsp;Challenges of transportation\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 120px;\"\u003e\n \u003cp\u003eTransportation difficulties to facility\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 281px;\"\u003e\n \u003cp\u003e\u0026ldquo; \u003cem\u003eSometimes we get scared of health workers yeah, when it reaches the time ...the first thing the nurses do is to harass you and us\u0026hellip;\u0026hellip;...\u0026rdquo;\u003c/em\u003e \u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e[II CT 10]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 116px;\"\u003e\n \u003cp\u003eshouting at clients, abusing clients, harassment\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 120px;\"\u003e\n \u003cp\u003emistreatment of clients\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 120px;\"\u003e\n \u003cp\u003eHealth workers\u0026apos; attitude\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 281px;\"\u003e\n \u003cp\u003e\u0026ldquo;\u0026hellip;\u0026hellip;\u0026hellip;\u003cem\u003eBecause sometimes we go to the hospital in the morning, the nurse tells you that you are going to wait till your friends come, maybe up to midday. That the drug is not going to be opened until your friends come.so u wait for a long time\u0026hellip;\u0026hellip;...\u0026rdquo;\u003c/em\u003e\u0026nbsp; [II CT 08]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 116px;\"\u003e\n \u003cp\u003elong waiting time, out stocks of vaccines, lack of informed decisions\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 120px;\"\u003e\n \u003cp\u003epoor quality of health worker nurse relationship\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 120px;\"\u003e\n \u003cp\u003epoor quality of care\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 281px;\"\u003e\n \u003cp\u003e\u0026ldquo;..\u003cem\u003ethe child can fall sick, you take the child and they put on drip and you cannot take that child now for what, immunization\u0026hellip;\u0026rdquo;\u003c/em\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e[II CT08]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 116px;\"\u003e\n \u003cp\u003esick child, child with malaria\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 120px;\"\u003e\n \u003cp\u003epoor health condition of child\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 120px;\"\u003e\n \u003cp\u003eChild\u0026apos;s health condition\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 281px;\"\u003e\n \u003cp\u003e\u0026ldquo;\u0026hellip;\u003cem\u003eand they give a child also very many injections. So, those things can hinder\u0026hellip;..\u0026rdquo;\u003c/em\u003e [II CT 5].\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 116px;\"\u003e\n \u003cp\u003emany injections, very painful, perceived suffering\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 120px;\"\u003e\n \u003cp\u003emany injections\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 120px;\"\u003e\n \u003cp\u003eNumber of injections\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 281px;\"\u003e\n \u003cp\u003e\u003cem\u003e\u0026ldquo;\u0026hellip;\u0026hellip;.Society says that vaccination of children is bad. It is just my fellow mothers were talking about it because they were saying that even them they don\u0026apos;t take their children for vaccination\u0026hellip;\u0026hellip;..\u0026rdquo;\u003c/em\u003e [II CT5].\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 116px;\"\u003e\n \u003cp\u003einfluence from mothers, community scaring\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 120px;\"\u003e\n \u003cp\u003epeer influence\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 120px;\"\u003e\n \u003cp\u003ePeer influence\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 281px;\"\u003e\n \u003cp\u003e\u003cem\u003e\u0026ldquo;\u0026hellip;\u0026hellip;\u0026hellip;.The father of the child did not allow the wife to take the child for vaccine. When that child reached two years, the child became crippled\u0026hellip;\u0026hellip;\u0026hellip;\u0026rdquo;\u0026nbsp;\u003c/em\u003e[II CT 7]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 116px;\"\u003e\n \u003cp\u003edenial from child vaccination, no monetary support\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 120px;\"\u003e\n \u003cp\u003efathers are not engaged\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 120px;\"\u003e\n \u003cp\u003eLack of partner support\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 281px;\"\u003e\n \u003cp\u003e\u0026ldquo;\u0026hellip;\u0026hellip;.\u003cem\u003eThe other day I was watching a video, and they were saying, for example, that malaria vaccine that has come out. I was seeing a video, and they said, that\u0026apos;s how those guys just want to control the number of the population in Africa here. So I am very skeptical about it\u0026hellip;\u0026hellip;\u0026hellip;.\u0026rdquo;\u003c/em\u003e \u003cstrong\u003eII CT11\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 116px;\"\u003e\n \u003cp\u003esocial media as a source of false information\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 120px;\"\u003e\n \u003cp\u003emisinformation of clients\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 120px;\"\u003e\n \u003cp\u003e\u0026nbsp;Misinformation on vaccination\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"4\" style=\"width: 120px;\"\u003e\n \u003cp\u003eInformation gaps\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 281px;\"\u003e\n \u003cp\u003e\u003cem\u003e\u0026ldquo;\u0026hellip;\u0026hellip;normally, we get our information from churches, from VHTs and sometimes those VHTs they don\u0026rsquo;t provide us with the information early. That can make us not to take our children for immunization\u0026hellip;\u0026hellip;\u0026hellip;.\u0026rdquo;\u003c/em\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e[II CT 10].\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 116px;\"\u003e\n \u003cp\u003e\u0026nbsp;Client dissatisfaction, late information\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 120px;\"\u003e\n \u003cp\u003elate and poor communication\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 120px;\"\u003e\n \u003cp\u003elate communication\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 281px;\"\u003e\n \u003cp\u003e\u003cem\u003e\u0026ldquo;\u0026hellip;\u0026hellip;..And sometimes, we get scared, which medicine they administer for our children. Sometimes if we ask these nurses, they cannot explain for us clearly that thing can make us not to take our children for vaccination\u0026hellip;\u0026hellip;..\u0026rdquo;\u0026nbsp;\u003c/em\u003e[II CT10]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 116px;\"\u003e\n \u003cp\u003eclient unsatisfaction, unprepared caretakers, late communication\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 120px;\"\u003e\n \u003cp\u003epoor and unclear information\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 120px;\"\u003e\n \u003cp\u003eunclear communication\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 281px;\"\u003e\n \u003cp\u003e\u003cem\u003e\u0026nbsp;\u0026ldquo;\u0026hellip;\u0026hellip;..if there is a lack of knowledge on the good things or advantage, it\u0026apos;s the cause. So the parents lack knowledge\u003c/em\u003e\u0026hellip;\u0026hellip;\u0026rdquo;\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e[II CT 05]\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 116px;\"\u003e\n \u003cp\u003elack of knowledge, unaddressed concerns\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 120px;\"\u003e\n \u003cp\u003eknowledge deficit\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 120px;\"\u003e\n \u003cp\u003eignorance of perceived benefits\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n\u003c/div\u003e\n\n\n\u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003e5\u003c/strong\u003e\u003cstrong\u003e: A table of key findings on recommendations by the health workers on ending incomplete vaccination of children\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"793\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 296px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eMEANINGFUL UNIT\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 156px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eINITIAL CODES\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 116px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSECONDARY CODES\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 114px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSUBTHEMES\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 110px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTHEME\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 296px;\"\u003e\n \u003cp\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n \u003cp\u003e\u003cem\u003e\u0026ldquo;\u0026hellip;\u0026hellip;..I think the first thing starts with having kind of a continuous medical education for the staff, for the health workers\u0026hellip;\u0026hellip;..\u003c/em\u003e.\u0026rdquo;\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e[KII HW 06]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 156px;\"\u003e\n \u003cp\u003eCMEs for health workers, training of VHTs\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 116px;\"\u003e\n \u003cp\u003eImproving knowledge \u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 114px;\"\u003e\n \u003cp\u003eContinuous medical education\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"5\" style=\"width: 110px;\"\u003e\n \u003cp\u003eEnding incomplete vaccination\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 296px;\"\u003e\n \u003cp\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n \u003cp\u003e\u003cem\u003e\u0026ldquo;\u0026hellip;\u0026hellip;\u0026hellip;..So some of them still have, we still have health education gaps to clear the myths, the misunderstandings, and what people perceive from social media\u0026hellip;\u0026hellip;...\u0026rdquo;\u0026nbsp;\u003c/em\u003e[KII HW010]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 156px;\"\u003e\n \u003cp\u003ecreating awareness, teaching from ANC, YCC\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 116px;\"\u003e\n \u003cp\u003e\u0026nbsp;Use of media platforms, creating awareness\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 114px;\"\u003e\n \u003cp\u003eIntensive sensitization\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 296px;\"\u003e\n \u003cp\u003e\u003cem\u003e\u0026ldquo;\u0026hellip;\u0026hellip;.then another thing is if it comes to our side, maybe just improving on the quality care. If you also improve on care, you improve on quality care\u0026hellip;\u0026hellip;.\u0026rdquo;\u0026nbsp;\u003c/em\u003e[KII HW 05]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 156px;\"\u003e\n \u003cp\u003ereduced waiting time, improvement of attitude\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 116px;\"\u003e\n \u003cp\u003e\u0026nbsp;Improving the quality of care offered to clients\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 114px;\"\u003e\n \u003cp\u003eImproving quality of care\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 296px;\"\u003e\n \u003cp\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n \u003cp\u003e\u003cem\u003e\u0026ldquo;\u0026hellip;\u0026hellip;\u0026hellip;..For example, they can say we are going for door-to-door mass vaccination, and\u0026hellip;\u0026hellip;\u0026hellip;..\u0026rdquo;\u0026nbsp;\u003c/em\u003e[KII\u003cem\u003e\u0026nbsp;\u003c/em\u003eHW 09]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 156px;\"\u003e\n \u003cp\u003eoutreaches, door to door immunization,\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 116px;\"\u003e\n \u003cp\u003eincreasing accessibility\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 114px;\"\u003e\n \u003cp\u003eIncreasing accessibility of services\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 296px;\"\u003e\n \u003cp\u003e\u003cem\u003e\u0026ldquo;\u0026hellip;\u0026hellip;And even motivation of VHTs because they are the ones who are helping us\u0026hellip;\u0026hellip;.\u0026rdquo;\u0026nbsp;\u003c/em\u003e[KII HW 01]\u003c/p\u003e\n \u003cp\u003e\u003cem\u003e\u0026nbsp;\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 156px;\"\u003e\n \u003cp\u003eFinancial motivation, rewards\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 116px;\"\u003e\n \u003cp\u003emotivation of VHTs\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 114px;\"\u003e\n \u003cp\u003eMotivation of VHTs\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003e6\u003c/strong\u003e\u003cstrong\u003e: A summary of the recommendations by care givers on ending incomplete vaccination of children\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cdiv align=\"center\"\u003e\n \u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"757\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 281px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003eMEANINGFUL UNIT\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 116px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eINITIAL CODES\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 120px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSECONDARY CODES\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 120px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSUBTHEMES\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 120px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTHEME\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 281px;\"\u003e\n \u003cp\u003e\u003cem\u003e\u0026ldquo;\u0026hellip;\u0026hellip;\u0026hellip;.I think, when the mothers are pregnant, it would be very important to start teaching them such things\u0026hellip;\u0026hellip;\u0026hellip;..\u0026rdquo;\u0026nbsp;\u003c/em\u003e[II CT12]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 116px;\"\u003e\n \u003cp\u003eteaching from ANC, teaching at YCC, teaching on social platforms\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 120px;\"\u003e\n \u003cp\u003ehealth education on social platforms\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 120px;\"\u003e\n \u003cp\u003eIntensive sensitization\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"4\" style=\"width: 120px;\"\u003e\n \u003cp\u003eEnding incomplete vaccination\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 281px;\"\u003e\n \u003cp\u003e\u0026ldquo;\u0026hellip;\u0026hellip;\u0026hellip;..\u003cem\u003eSo, maybe you tell the people from hospital that when we go there, they serve us very fast, they inject my child, and I come back home very fast. So that we don\u0026rsquo;t wait for a long time, children will become hungry\u0026hellip;\u0026hellip;\u0026hellip;..\u0026rdquo;\u0026nbsp;\u003c/em\u003e [II CT 08]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 116px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003ereduced waiting time, reduced expenses, redeemed time for other activities\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 120px;\"\u003e\n \u003cp\u003ereduced waiting time and benefits\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 120px;\"\u003e\n \u003cp\u003eimproving quality of care\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 281px;\"\u003e\n \u003cp\u003e\u003cem\u003e\u0026ldquo;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;Then they should also bring those services closer to us because sometimes it\u0026rsquo;s very hard\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;.\u0026rdquo;\u0026nbsp;\u003c/em\u003e[II CT 09]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 116px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003ebringing health services to community, more health facilities,\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 120px;\"\u003e\n \u003cp\u003e\u0026nbsp;Services to community\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 120px;\"\u003e\n \u003cp\u003eIncreasing accessibility of services\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 281px;\"\u003e\n \u003cp\u003e\u0026ldquo;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u0026hellip;\u003cem\u003eAnd also, it would be very important if their husband has attended with their wife, they attend two. And you tell both of them, because one can forget and then the other can see. Okay\u0026hellip;\u0026hellip;\u0026hellip;..\u0026rdquo;\u0026nbsp;\u003c/em\u003e[II CT 12]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 116px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003cp\u003eattending of ANC as partners, reminding each other\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 120px;\"\u003e\n \u003cp\u003ebringing male partners on board\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 120px;\"\u003e\n \u003cp\u003eMale partner involvement\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n\u003c/div\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-pediatrics","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bped","sideBox":"Learn more about [BMC Pediatrics](http://bmcpediatr.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/bped/default.aspx","title":"BMC Pediatrics","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Caregivers, Health workers, Perspective, factors, Incomplete, Vaccination, Children, Uganda","lastPublishedDoi":"10.21203/rs.3.rs-8712475/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-8712475/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003eBackground:\u003cstrong\u003e \u003c/strong\u003eVaccination is one of the most effective public health interventions, substantially reducing morbidity, disability, and mortality among children under five years of age from vaccine-preventable diseases. Despite global progress, vaccination coverage remains suboptimal, with the highest burden of incomplete vaccination reported in sub-Saharan Africa. In 2020, an estimated 14 million infants worldwide did not receive the first dose of diphtheria pertussis tetanus (DPT1) vaccine. Partially vaccinated children remain highly vulnerable to vaccine-preventable diseases, contributing to outbreaks, morbidity, disability, and mortality. This study explored caregivers’ and health workers’ perspectives on factors contributing to incomplete vaccination among children aged 12–59 months in Mbale City, Eastern Uganda.\u003c/p\u003e\n\u003cp\u003eMaterials and methods:\u003cstrong\u003e \u003c/strong\u003eA descriptive qualitative study was conducted in Namatala (Industrial Division) and Nakaloke (Northern Division), Mbale City, Eastern Uganda. Ethical approval was obtained from the Busitema University Research and Ethics Committee. Participants were selected using purposive sampling. Data were collected from 18 caregivers and 30 health care workers and analyzed thematically using Colaizzi’s seven-step approach.\u003c/p\u003e\n\u003cp\u003eResults: Six major themes emerged: misconceptions about vaccination; perceived susceptibility to and severity of incomplete vaccination; perceived benefits of vaccination; perceived barriers to vaccination; information gaps; and strategies for ending incomplete vaccination. Misconceptions included myths surrounding vaccination, perceived vaccine-related morbidity, and mortality. Limited understanding and misbeliefs regarding the benefits of vaccination were common. Information gaps were driven by misinformation from social media, delayed, unclear, or inadequate communication, and general ignorance. Identified barriers included fear of side effects, transportation challenges, and negative health worker attitudes, lack of partner support, peer influence, multiple injections, child illness, and caregivers’ busy schedules. Proposed solutions included training village health teams (VHTs), continuing medical education (CMEs) for health workers, intensified community sensitization, male partner involvement, and improved accessibility to vaccination services.\u003c/p\u003e\n\u003cp\u003eConclusion: Factors contributing to incomplete vaccination are multifaceted, involving individual, community, and health system related challenges. Strengthening collaboration between health teams and religious and cultural leaders, alongside targeted interventions such as mobile vaccination clinics to address access barriers, is essential to improving vaccination completion rates in this setting.\u003c/p\u003e","manuscriptTitle":"Factors Contributing To Incomplete Vaccination among Children Aged 12 to 59 Months in Mbale City, Eastern Uganda: A Caregivers and Health Workers’ Perspective","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-02-09 06:22:46","doi":"10.21203/rs.3.rs-8712475/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2026-05-05T06:45:27+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-04-23T13:54:33+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-04-21T21:48:29+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"135293638104763776158731180652258482096","date":"2026-04-12T14:53:50+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"94000904192962205337789699826840090193","date":"2026-04-11T21:07:22+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"316157787449114910771639130435236793822","date":"2026-04-10T18:55:33+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"59315187856931664612770414761348797623","date":"2026-04-03T08:26:30+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"331203404564996943021166824359840427249","date":"2026-03-13T10:59:01+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"85596247138576272574081380642563016646","date":"2026-02-05T07:10:41+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2026-02-04T21:49:40+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2026-02-02T03:11:27+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2026-01-30T04:31:54+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2026-01-30T04:30:57+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Pediatrics","date":"2026-01-27T15:32:54+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-pediatrics","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bped","sideBox":"Learn more about [BMC Pediatrics](http://bmcpediatr.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/bped/default.aspx","title":"BMC Pediatrics","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"ce4061d2-f94e-4f3f-a922-cc979020a7bc","owner":[],"postedDate":"February 9th, 2026","published":true,"recentEditorialEvents":[{"type":"decision","content":"Revision requested","date":"2026-05-05T06:45:27+00:00","index":"","fulltext":""}],"rejectedJournal":[],"revision":"","amendment":"","status":"in-revision","subjectAreas":[],"tags":[],"updatedAt":"2026-05-05T06:55:33+00:00","versionOfRecord":[],"versionCreatedAt":"2026-02-09 06:22:46","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-8712475","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-8712475","identity":"rs-8712475","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}