Delayed Completion of Pneumococcal Conjugate Vaccination among Children 0 – 4 years in Rural Uganda: A Socio-Demographic Inquiry

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Igwe, and 4 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-5306351/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 14 Jan, 2025 Read the published version in BMC Pediatrics → Version 1 posted 18 You are reading this latest preprint version Abstract In spite of the commendable global Pneumococcal Conjugate Vaccine (PCV) coverage in the last two decades, full completion is still below target; and in Uganda, the 3 + 0 PCV regimen has been reported to have a steady decline in the completion rate. However, reasons for the delayed completion are unknown. Study aimed at assessing the influence of socio-demographic factors on delayed PCV completion among young children. A cross-sectional study design among 362 child/caretakers pairs in Bugongi Town Council was employed and using stratified sampling – Allocation Proportional to Size, data was collected using pretested questionnaires; entered and analysed using STATA v14 and significant statistical association was considered at P ≤ 0.05. Of the 362 children, majority (53.87%) were boys. Child mean age was 25.1 ± 14.3 months. 87.57% caretakers were females and majorities of them were aged 20–29yrs (47.8%), peasant farmers (79.8%), married (90.6%), attained primary education (63.5%) and earned average monthly income of UGX 10,000 – UGX 50,000 (41.4%). Of the 362 children, 92 (25.41%) had delayed to receive their PCV-3 doses. Only boy child [cOR = 1.65, (95%CI: 1.03–2.66); P = 0.039) and caretaker’s age 30–39 [cOR = 2.12 (95%CI: 1.06–4.24); P = 0.033) showed statistical significance at bivariate analysis. The multivariate model found parent’s age 20–29 years [aOR = 2.39 (1.14–5.01); P = 0.021] and 30–39 years [aOR = 2.51 (1.16–5.45); P = 0.020] as positively associated factors whereas being married [aOR = 0.20 (0.04–0.96); P = 0.044] was the only negatively associated factors to delayed completion of PCV vaccination among young children. Among children who complete the last dose of PCV vaccination, a considerable proportion are actually receiving it late resulting into eventual failure to curb the intended bacterial respiratory tract infections. Thus, concerted efforts in terms of sensitization is un-doubtfully desired especially among caretakers aged 20–39 years as well as those who are not married. PCV-3 Delayed Completion Socio-demographic Factors Young Children Western Uganda Figures Figure 1 Introduction Since their invention, vaccines have been reported to be an integral tool especially regarding the control and prevention of infectious diseases for more than two centuries [ 1 ]. Globally, coverage and number of vaccines against vaccine preventable diseases have generally increased with almost full coverage in developed countries to near target coverage in developing countries [ 2 ] however timely completion or age-appropriate receipt of the vaccine doses is still a major concern [ 3 – 4 ]. This delayed completion is more prevalent among the multi-dose vaccines with potential predictors ranging from child’s birth order, caretakers’ socio-demographic variations to cultural, religious, political and institutional factors [ 5 – 7 ]. Immunization as a public health intervention provides protection through inducing immunity but also through prevention of person-to-person disease transmission through herd immunity whereby there is unlikely disease transmission in a community because the biggest majority of the population is immunized [ 8 ]. Delayed or non-vaccination leads to significant breaks in herd immunity leading to increased risk of outbreaks due to these vaccine preventable diseases [ 9 ]. Pneumococcal Conjugate Vaccine (PCV) is one of the major routine vaccines as recommended and approved by the World Health Organization (WHO) in 2010 [ 10 ] It is a recombinant vaccine made of polysaccharides from the capsule of the Streptococcus pneumonia bacterium conjugated to a carrier protein generally indicated for children below two years of age for protection against pneumococcal disease such as pneumonia, meningitis, otitis media among others. The vaccine was introduced as early as 2000 in the United States as a heptavalent conjugate through 2010 when the 13-valent combination was officially integrated in the routine immunization [ 10 ]. In Uganda, the deca-valent Conjugate was integrated in Uganda National Expanded Program for Immunization (UNEPI) in 2014 and it is offered in 3 doses, initiated at 6weeks of life with an interval of 4 weeks until when the next dose is given [ 11 ]. Worldwide, PCV gained exponential increase in vaccine coverage in the ten years preceding 2017 from 4–44% coverage but still with great variations in the different WHO regions where South-east Asia recorded as low as 12% coverage and the American region registered 82% coverage [ 12 ]. On the other hand, among the 69 Gavi-supported countries, 56 countries had reached 50% coverage of PCV by the year 2016 but 46 countries (67%) had reached the target level for last dose (PCV-3) in the same year [ 13 ]. In a systematic review of PCV vaccine failure among children, only 30.6% were found to have received all the required doses of the vaccine [ 14 ] whereas in another study on the vaccine coverage and compliance to the recommended schedules of PCV, vaccination coverage was found to be 54.6% with a 16.8% compliance rate [ 15 ]. In Uganda, according to WHO and UNICEF Estimated National Immunization Coverage (WUENIC), completion of PCV vaccination has shown a decreasing trend (93–59%) from 2016 to 2019 [ 16 ] and data from the Uganda Demographic and Health Survey (UDHS) [ 17 ], completion of PCV vaccination rates 64%. Recent local data from Sheema District Health Information System shows PCV completion to be 76% but 2 in every 10 children are reported to receive the last dose past the recommended age. Various studies have found correlation between delayed vaccination for PCV and the number of children at home whereby as the number increases, the likelihood of delayed vaccination also increases for instance in Israel delayed vaccination was highly correlated with high child’s birth order [ 18 ] as compared to low birth order. This was also observed among under-fives in Australia [ 19 ] where delayed receipt of the vaccine significantly co-variated with presence of many children at home. Similarly, the age of the infant has also been linked to delays in routine vaccination where children aged 12–15 months have been reported to have more compliance to vaccine as compared to younger infants [ 15 ]. The employment status of the mother or primary caretaker has shown significant association to the timeliness of PCV vaccination but with slightly contradictory findings where some literature affirms that an employed mother will most likely delay to go immunization [ 20 ] while other findings assert that unemployed primary caretakers were more likely to delay in taking their children for PCV vaccination [ 19 ]. In the same regard, findings from Yaounde Cameroon still indicated that father’s profession was found to be among the factors contributing to the completeness of immunization [ 21 ]. As a factor which influences knowledge and awareness, maternal education has by far shown great association towards timeliness of immunization including recent studies which have indicated that increase in the education of the mother directly correlates to timely and complete immunization for PCV [ 21 ] and others have deducted that lower level of maternal education poses a greater risk of infant to be not fully vaccinated and also receive the vaccine late [ 20 ] To attain the intended immunity from the multi-dose vaccines, vaccine doses should be received within the recommended ages [ 22 ] however delayed or non-vaccination leads to detrimental effects including significant breaks in herd immunity, increased risk of outbreaks and increased prevalence of these vaccine preventable diseases [ 9 ]. The study examined the socio-demographic factors associated with delayed completion of PCV vaccination among young children; and the findings should inform immunization policy especially implementation of vaccination. Materials and Methods 2.1 Study Setting and Population The study was conducted in Bugongi Town Council, Sheema South Constituency Sheema District South-western Uganda. Bugongi Town council consists of 4 Wards and 27 Cells. It located at 00 0 38’08”S; 30 0 15’10”E coordinates and 1,545m (5,069ft) elevation above sea level. It is a rural areas with about 2,732 households with an average size of 4.2 individuals. It has a total population of about 11, 825 with the female proportion slightly higher than the male. Approximately 22.1% of the households in the town council live 5 or more kilometres away from the nearest public health facility. About 15.1% of the town council population is children 0–4 years of age [ 23 ]. The main socio-economic activities include subsistence agriculture and livestock farming. The study population was children 4–48 months of age in the town council. Study units included child/caretaker pairs who consent to participate. 2.2 Study Design, Variables and Sampling The study employed a cross sectional study design using quantitative approach. Timeliness of PCV-3 vaccination was the outcome variable and this was obtained from secondary data (children’s immunisation cards) while socio-demographic factors of both the child and caretaker were the predictor variables. The desired sample size of 381 was obtained using Kish and Leslie formula (1965) using the proportion (45%) of children who miss out on immunization as reported by the 2016 UDHS [ 17 ]. However after data collection, fully completed questionnaires were 362 (95% full response rate). A stratified sampling technique was employed using Allocation Proportional to Size (APS) where a proportionate sub-sample was obtained from each of the four strata (Wards). 2.3 Data Collection Tools A pre-tested (on 5 participants) researcher administered questionnaire was used to collect data whose reliability was done by checking for Internal Consistency of the Questionnaire using Cronbach’s Alpha (0.79). This was obtained by calculating the variance of each questions in the questionnaire and also the variance of the entire tool. 2.4 Data Analysis Data was analyzed using STATA v17 statistical software. Both descriptive analyses and logistic regression analyses (bi-variate and multi-variate) were done; and results presented as frequencies, percentages, cross-tabulations and odds ratios at 95% level of confidence. Statistical significance was considered at P ≤ 0.05. Results As illustrated below (see Table 1 ) out of the 362 Child-Parent/Caretaker pairs, majority of the children were males (53.87%) and nearly all (353) of the children were reported to have been born from a health facility. Most (211) of the children were 2nd through 4th born followed those who were first-borns (93) and lastly those who were 5th born or above (58). Majority of the children had 1–4 siblings (70.44%). Approximately eight in every ten (87.57%) caretakers/parents were females with only 12.43% of them being males. Majority (173) were aged 20–29 years and the biggest proportion (79.83%) were peasant farmer. Over 90% of them were married with just 14 and 20 who reported to be single and separated respectively. Regarding the highest level of education attained, majority (230) of the parents/caretakers had attained primary level. Regarding timelines of PCV-3 vaccination (see Fig. 1 ), out of the 362 sampled young children, 92 (25.41%) had delayed to receive their PCV3 doses while 270 (74.59%) had received their PCV3 doses within the recommended time. Table 1 showing Socio-demographic description of the participants VARIABLE FREQUENCY (n = 362) PERCENTAGE (%) PARAMETER Number of Siblings None 70 19.34 1–4 255 70.44 5 or more 37 10.22 Gender of the child Male 195 53.87 Female 167 46.13 Birth Order First Born 93 25.69 2nd – 4th Born 211 58.29 5th Born or above 58 16.02 Place of Birth Health Facility 353 97.51 Home/Community/TBA 9 2.49 Age of Parent Less than 20 years 6 1.66 20–29 173 47.79 30–39 129 35.64 40 years and older 54 14.92 Gender Male 45 12.43 Female 317 87.57 Occupation Peasant Farmer 289 79.83 Civil Servant 12 3.31 Self Employed 48 13.26 Other Occupations 13 3.39 Average Monthly Income Less than UGX 10,000 123 33.98 UGX 10,000 – UGX 50,000 150 41.44 UGX 60,000 – UGX 100,000 44 12.15 Greater than UGX 100,000 45 12.43 Highest Education Level No Formal Education 12 3.31 Primary 230 63.54 Secondary 96 26.52 Tertiary 24 6.63 Marital Status Single 14 3.87 Married 328 90.61 Divorced/Separated 20 5.52 In bivariate analysis of the socio-demographic factors (see Table 2 ), boys were 1.65 times more likely to delay PCV3 vaccination compared to girls (cOR: 1.65. 95%CI: 1.03–2.66, P = 0.039). Relative to those aged 40 years and above, mothers aged 30 to 39 years have more than twice the odds of delayed PCV3 vaccination (cOR:2.12, 95%CI: 1.06–4.24, P = 0.033). Other factors like number of siblings, birth order, birth place, parent gender, occupation, monthly income, level of education and not being married were not significantly associated with delayed PCV3 vaccination. The adjusted multivariate model (see Table 3 ) only found parent’s age 20–29 years [aOR = 2.39 (1.14–5.01); P = 0.021] and 30–39 years [aOR = 2.51 (1.16–5.45); P = 0.020] as well as being married [aOR = 0.20 (0.04–0.96); P = 0.044] that were significantly associated with delayed PCV3 vaccination whereas child’s gender didn’t show any statistical significance. Further tests of this final model included Multicollinearity and Hosmer-Lemeshow Goodness of Fit which showed no collinearity (Tolerance > 0.1) and with good fit (Chi2 = 0.74; P = 0.863) respectively. Table 2 showing Bivariate Logistic Regression Analysis of the Socio-demographic Characteristics VARIABLE DELAYED PCV3 COMPLETION PARAMETER Yes, No, cOR (95% CI) P-value Number of Siblings, n (%) None 20 (28.57) 50 (71.43) 0.58 (0.22–1.54) 0.277 1–4 65 (25.49) 190 (74.51) 0.68 (0.29–1.63) 0.388 5 or more 7 (18.92) 30 (81.08) Ref. Child Gender, n (%) Male 41 (21.03) 154 (78.97) 1.65 (1.03–2.66) 0.039* Female 51 (30.54) 116 (69.46) Ref. Child Birth Order, n (%) 1st Born 26 (27.96) 67 (72.04) Ref. 2nd – 4th born 48 (22.75) 163 (77.25) 1.32 (0.76–2.30) 0.330 5th born or more 18 (31.03) 40 (68.97) 0.86 (0.42–1.77) 0.686 Child Place of Birth, n (%) Health Facility 89 (25.21) 264 (74.79) Ref. Home/Community 3 (33.33) 6 (66.67) 0.67 (0.17–2.75) 0.583 Parent’s Age, n (%) < 20 years 1 (16.67) 5 (83.33) 2.94 (0.32–26. 99) 0.340 20–29 43 (24.86) 130 (75.14) 1.78 (0.93–3.41) 0.083 30–39 28 (21.71) 101 (78.29) 2.12 (1.06–4.24) 0.033* ≥ 40 years 20 (37.04) 34 (62.96) Ref. Parent’s Gender, n (%) Male 14 (31.11) 31 (68.89) 0.72 (0.37–1.43) 0.350 Female 78 (24.61) 239 (75.39) Ref. Parent’s Occupation, n (%) Peasant Farmer 75 (25.95) 214 (74.05) 1.78 (0.57–5.62) 0.323 Civil Servant 3 (25.00) 9 (75.00) 1.88 (0.34–10.46) 0.474 Self Employed 9 (18.75) 39 (81.25) 2.71 (0.72–10.26) 0.143 Other occupations 5 (38.46) 8 (61.54) Ref. Monthly Income Category, n (%) UGX 100,000 8 (17.78) 37 (82.22) 1.18 (0.49–2.85) 0.713 Parent’s Level of Education No Formal Education 2 (16.67) 10 (83.33) 1.93 (0.41–9.040) 0.405 Primary Level 64 (27.83) 166 (72.17) Ref. Secondary Level 20 (20.83) 76 (79.17) 1.47 (0.83–2.59) 0.190 Tertiary Level 6 (25.00) 18 (75.00) 1.16 (0.44–3.46) 0.768 Marital Status, n (%) Single 4 (28.57) 10 (71.43) 0.28 (0.04–1.79) 0.178 Married 86 (26.22) 242 (73.78) 0.31 (0.07–1.38) 0.124 Divorced/Separated 2 (10.00) 18 (90.00) Ref. Total 92 270 Table 3 showing Multivariate Logistic Regression Analysis of Factors associated with Delayed PCV-3 VARIABLE MULTIVARIATE ANALYSIS PARAMETER aOR (95% Confidence Interval) P-value Child Gender Male 1.52 (0.91–2.54) 0.107 Female Ref. Parent Age Category < 20 years 3.56 (0.37–34.56) 0.274 20–29 2.39 (1.14–5.01) 0.021 30–39 2.51 (1.16–5.45) 0.020 ≥ 40 years Ref. Parent Occupation Peasant Farmer 2.05 (0.57–7.33) 0.271 Civil Servant 1.64 (0.23–11.74) 0.620 Self Employed 2.45 (0.58–10.31) 0.222 Other occupations Ref. Monthly Income Category UGX 100,000 1.22 (0.39–3.82) 0.733 Parents Highest Level of Education No Formal Education 3.65 (0.71–18.75) 0.122 Primary Level Ref. Secondary Level 1.34 (0.74–2.58) 0.313 Tertiary Level 0.95 (0.26–3.46) 0.942 Marital Status Single 0.17 (0.02–1.22) 0.078 Married 0.20 (0.04–0.96) 0.044 Divorced/Separated Ref. Discussion 4.1 Timeliness of PCV-3 Vaccination among Children 0–4 years World Health Organization recommends that all children should receive their last dose of the 3 + 0 regimen of PCV vaccine within 95–126 days of life [ 22 ] giving an allowance even to some children who delay to start vaccination especially due to medical reasons. However if delayed, the vaccine impact on mortality prevention through all levels is greatly reduced resulting into greater difficulty to prevent deaths [ 24 ]. Delayed PCV-3 receipt is considered when a child receive his/her last dose past 126 days of life. In this current study, a biggest proportion (74.59%) of the sampled young children (0–4 years) had received their PCV-3 within the recommended age (see Table 1 ); but this rate is still below the “all-appropriate-age” vaccination target [ 25 ]. Moreover, the remaining 25.41% (1 in every 4) (see Table 1 ) is a remarkable proportion which needs stringent attention and intervention. This is because, whereas the overall national PCV-3 coverage is still below target [ 16 – 17 ] even the age-appropriateness of the received PCV-3 is now revealing to be sub-optimal. This current rate (1 in 4 children) of delayed completion of PCV is way higher as compared to a 10.1% (1 in 10 children) recorded delay in Israel [ 26 ] and a 15.2% delay in Saudi Arabia [ 27 ]. However, it is comparable to a 40.2% delay as observed in Australia [ 19 ], 42.8% in Michigan – United States [ 28 ] and 53.7% in Germany [ 29 ]. This observed delayed completion could be due to the fact that much as the WHO recommendation sets an age bracket for receipt of PCV3, locally on numerous occasions great focus by the vaccination implementers is put on coverage of the vaccine dose with less attention to timeliness of its receipt. This implies that with the already excellent vaccination acceptance rate, timely receipt of vaccine doses is equally so possible if vaccination services providers always make it a point to provide the vaccination doses within the recommended time. 4.2 Socio-demographic Factors Associated with Delayed Completion of PCV-3 These findings (see Table 3 ) have shown that age of parent/caretaker had a significant association to delayed completion of PCV, specifically age 20–29 years [aOR = 2.39 (1.14–5.01); P = 0.021] and 30–39 years [aOR = 2.51 (1.16–5.45); P = 0.020] have shown 2.39 times and 2.51 times increased chances of delayed completion respectively as compared to a caretaker aged 40 years and above. Similar observation had earlier been reported in Saudi Arabia where mother’s age > 26 years was strongly associated with delayed vaccination [ 27 ] as well as in Malawi where maternal age > 30 years was associated with increased risk of delayed vaccination [ 20 ]. This tendency may be explained by the fact that most of the caretakers were in this age bracket and were working (occupied); and so busy at work to spare time or even to remember taking their children for immunization in time or at all. Furthermore, the study has discovered that caretakers who are married [aOR = 0.20 (0.04–0.96); P = 0.044] are less likely to delay taking their children for PCV3 as compared to caretakers who are not married. Earlier findings had also seen similar associations including the one in Jerusalem where married caretakers (P = 0.006) were more likely to take their children for the last dose of the vaccine in time as compared to non-married ones [ 26 ]. This protective phenomenon expressed by married caretakers could be sourced from the family support from the spouse but also most married couples have a stationed home which thus provide a stable location to both allow same site vaccination and also timeliness of the receipt of the doses as compared to the single or separated parents who are most likely to have changed locations. Conclusions This survey has confirmed that among the few children who complete the last dose of PCV vaccination, a considerable proportion are actually receiving it late. This double burden if not addressed will eventually lead to failures to curb the bacterial respiratory tract infection especially among both the non-vaccinated and also those who delay to complete the doses. It has also been witnessed that tripled emphasis in terms of sensitization is un-doubtfully desired among caretakers who are aged 20–39 years as well as those who are not married. Declarations Ethical Approval and Consent to Participate Ethical clearance was sought from Institutional Research Ethics Committee of Bishop Stuart University – Uganda (BSU-REC). Ethical approval number: BSU-REC-2023-166. Voluntary informed consent and proxy consent to participate was both written and verbal. This was done with reference to the Helsinki guidelines were; respect for individuals (both caretakers and children), right to make informed decisions (caretakers) and recognition of vulnerable groups (children) were considered throughout the data collection process. Consent for Publication This manuscript does not have personal identifying information; thus consent for publication was not applicable. Data Availability The dataset used to support the findings of this study are included within the related information files. Competing Interests The authors declare that there is no conflict of interest either financial or non-financial regarding the publication of this paper. Funding The study was funded by Kampala International University under the Staff Development Scheme Scholarship (Ref No. KIU/HR/APPT/01.04.21-036). Authors’ Contributions H. M analysed the data and wrote the manuscript. I. A checked for grammar in the manuscript. A. T, P. K, M. C. I, M. G. A, S. A. M, I. A, and D. R. M reviewed the manuscript. Acknowledgments Special thanks are conveyed to the Dean School of Allied Health Sciences, Assistant District Health Officer – Sheema District and the Head of Public Health Department – School of Allied Health Science; for their technical, professional and parental guidance rendered during the entire research process. Supplementary Materials All necessary analyses, figures and tables have been submitted within the manuscript. No supplementary materials are added. References Karafillakis E, Dinca I, Apfel F, Cecconi S, Würz A, Takacs J, Suk J, Velentano LP, Kramarz P, Larson HJ. 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Laurenz M, Eiff C, Von, Borchert K, Jacob C, Seidel K, Schley K. Vaccination rates and adherence in pneumococcal conjugate vaccination in mature born infants before and after vaccination schedule change – A claims database analysis. Vaccine. 2021;39(24):3287–95. https://doi.org/10.1016/j.vaccine.2021.04.029 . Additional Declarations No competing interests reported. Cite Share Download PDF Status: Published Journal Publication published 14 Jan, 2025 Read the published version in BMC Pediatrics → Version 1 posted Editorial decision: Revision requested 26 Nov, 2024 Reviews received at journal 22 Nov, 2024 Reviews received at journal 21 Nov, 2024 Reviews received at journal 19 Nov, 2024 Reviewers agreed at journal 18 Nov, 2024 Reviewers agreed at journal 14 Nov, 2024 Reviewers agreed at journal 14 Nov, 2024 Reviewers agreed at journal 14 Nov, 2024 Reviews received at journal 09 Nov, 2024 Reviewers agreed at journal 31 Oct, 2024 Reviewers agreed at journal 30 Oct, 2024 Reviewers agreed at journal 26 Oct, 2024 Reviewers agreed at journal 26 Oct, 2024 Reviewers invited by journal 26 Oct, 2024 Editor invited by journal 23 Oct, 2024 Editor assigned by journal 23 Oct, 2024 Submission checks completed at journal 23 Oct, 2024 First submitted to journal 21 Oct, 2024 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-5306351","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":372867336,"identity":"c2b83e3e-58fd-48f7-981f-3c9fda4d890f","order_by":0,"name":"Herbert Malemo","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAABAElEQVRIiWNgGAWjYFAC5gYQmcDAwAOibQzYCGthRNaSkEa6lsMGBDXoth9sfHSjgiGPX/rswceVP84b80kkMH74wXDYrgGHFrMzic3GOWcYiiX78pINzyTcNmOTSGCW7GE4nIxTy4HENuncNobEDWd4zCQbEm7bALUwSDMAteBymNn5h+2/QVr2n+Ex/9mQcA6khfk3Xi03EtuYwbbw8JgxNiQcADmMDWSLHW4tD5ulc85IJM44w5cs2ZCWbMzG87DNsscgPQG3w5IPfs6psEns7+E9+LHBxs5wfnvy4Rs/KqztcWmBAglkDiimDBgSGwjowQSEbBkFo2AUjIKRAwBAVFS0esHC/QAAAABJRU5ErkJggg==","orcid":"","institution":"Kampala International University Western Campus","correspondingAuthor":true,"prefix":"","firstName":"Herbert","middleName":"","lastName":"Malemo","suffix":""},{"id":372867337,"identity":"d80d21ef-9aa3-44f7-b940-7972fd3b7789","order_by":1,"name":"Andrew Tamale","email":"","orcid":"","institution":"Kampala International University Western Campus","correspondingAuthor":false,"prefix":"","firstName":"Andrew","middleName":"","lastName":"Tamale","suffix":""},{"id":372867339,"identity":"e32daca2-2844-48fa-9b7a-afa86957cd43","order_by":2,"name":"Paul Kakwangire","email":"","orcid":"","institution":"Kampala International University Western Campus","correspondingAuthor":false,"prefix":"","firstName":"Paul","middleName":"","lastName":"Kakwangire","suffix":""},{"id":372867340,"identity":"6eb1b387-5de9-4cb9-b360-f843f6f2e924","order_by":3,"name":"Matthew C. Igwe","email":"","orcid":"","institution":"Kampala International University Western Campus","correspondingAuthor":false,"prefix":"","firstName":"Matthew","middleName":"C.","lastName":"Igwe","suffix":""},{"id":372867342,"identity":"88163a3b-b775-4ea4-bf05-b8010d3096fa","order_by":4,"name":"Dickens R. Mwine","email":"","orcid":"","institution":"Bugongi Town Council, Sheema District Local Government","correspondingAuthor":false,"prefix":"","firstName":"Dickens","middleName":"R.","lastName":"Mwine","suffix":""},{"id":372867343,"identity":"5f271199-cd59-4d0c-b33b-0239b341cf0b","order_by":5,"name":"Isa Asiimwe","email":"","orcid":"","institution":"Kampala International University Western Campus","correspondingAuthor":false,"prefix":"","firstName":"Isa","middleName":"","lastName":"Asiimwe","suffix":""},{"id":372867344,"identity":"c4317704-6ad6-45bf-93e7-3fc3eb843d90","order_by":6,"name":"Solomon A. Mbina","email":"","orcid":"","institution":"Kampala International University Western Campus","correspondingAuthor":false,"prefix":"","firstName":"Solomon","middleName":"A.","lastName":"Mbina","suffix":""},{"id":372867345,"identity":"53ed262b-930d-4d05-bd7e-d2a5470b0100","order_by":7,"name":"Mary G. Abalinda","email":"","orcid":"","institution":"Kampala International University Western Campus","correspondingAuthor":false,"prefix":"","firstName":"Mary","middleName":"G.","lastName":"Abalinda","suffix":""}],"badges":[],"createdAt":"2024-10-21 17:38:21","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-5306351/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-5306351/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1186/s12887-025-05388-z","type":"published","date":"2025-01-14T15:57:52+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":69078468,"identity":"487631ab-9873-4198-8897-b3e3ebd2bf4b","added_by":"auto","created_at":"2024-11-15 11:30:36","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":26545,"visible":true,"origin":"","legend":"\u003cp\u003eshowing Timeliness of PCV-3 vaccination among children 0 – 4 years in Bugongi Town Council.\u003c/p\u003e","description":"","filename":"floatimage1.png","url":"https://assets-eu.researchsquare.com/files/rs-5306351/v1/e4a1de2e7c1c8f9acc67f412.png"},{"id":74284881,"identity":"f043a13b-6941-4ae0-95bf-2976a7413035","added_by":"auto","created_at":"2025-01-20 16:13:27","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1066164,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-5306351/v1/08dfe296-fb57-4188-8d48-b819b663a1c9.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Delayed Completion of Pneumococcal Conjugate Vaccination among Children 0 – 4 years in Rural Uganda: A Socio-Demographic Inquiry","fulltext":[{"header":"Introduction","content":"\u003cp\u003eSince their invention, vaccines have been reported to be an integral tool especially regarding the control and prevention of infectious diseases for more than two centuries [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. Globally, coverage and number of vaccines against vaccine preventable diseases have generally increased with almost full coverage in developed countries to near target coverage in developing countries [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e] however timely completion or age-appropriate receipt of the vaccine doses is still a major concern [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. This delayed completion is more prevalent among the multi-dose vaccines with potential predictors ranging from child\u0026rsquo;s birth order, caretakers\u0026rsquo; socio-demographic variations to cultural, religious, political and institutional factors [\u003cspan additionalcitationids=\"CR6\" citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eImmunization as a public health intervention provides protection through inducing immunity but also through prevention of person-to-person disease transmission through herd immunity whereby there is unlikely disease transmission in a community because the biggest majority of the population is immunized [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. Delayed or non-vaccination leads to significant breaks in herd immunity leading to increased risk of outbreaks due to these vaccine preventable diseases [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e].\u003c/p\u003e \u003cp\u003ePneumococcal Conjugate Vaccine (PCV) is one of the major routine vaccines as recommended and approved by the World Health Organization (WHO) in 2010 [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e] It is a recombinant vaccine made of polysaccharides from the capsule of the Streptococcus pneumonia bacterium conjugated to a carrier protein generally indicated for children below two years of age for protection against pneumococcal disease such as pneumonia, meningitis, otitis media among others. The vaccine was introduced as early as 2000 in the United States as a heptavalent conjugate through 2010 when the 13-valent combination was officially integrated in the routine immunization [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]. In Uganda, the deca-valent Conjugate was integrated in Uganda National Expanded Program for Immunization (UNEPI) in 2014 and it is offered in 3 doses, initiated at 6weeks of life with an interval of 4 weeks until when the next dose is given [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eWorldwide, PCV gained exponential increase in vaccine coverage in the ten years preceding 2017 from 4\u0026ndash;44% coverage but still with great variations in the different WHO regions where South-east Asia recorded as low as 12% coverage and the American region registered 82% coverage [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. On the other hand, among the 69 Gavi-supported countries, 56 countries had reached 50% coverage of PCV by the year 2016 but 46 countries (67%) had reached the target level for last dose (PCV-3) in the same year [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eIn a systematic review of PCV vaccine failure among children, only 30.6% were found to have received all the required doses of the vaccine [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e] whereas in another study on the vaccine coverage and compliance to the recommended schedules of PCV, vaccination coverage was found to be 54.6% with a 16.8% compliance rate [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]. In Uganda, according to WHO and UNICEF Estimated National Immunization Coverage (WUENIC), completion of PCV vaccination has shown a decreasing trend (93\u0026ndash;59%) from 2016 to 2019 [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e] and data from the Uganda Demographic and Health Survey (UDHS) [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e], completion of PCV vaccination rates 64%. Recent local data from Sheema District Health Information System shows PCV completion to be 76% but 2 in every 10 children are reported to receive the last dose past the recommended age.\u003c/p\u003e \u003cp\u003eVarious studies have found correlation between delayed vaccination for PCV and the number of children at home whereby as the number increases, the likelihood of delayed vaccination also increases for instance in Israel delayed vaccination was highly correlated with high child\u0026rsquo;s birth order [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e] as compared to low birth order. This was also observed among under-fives in Australia [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e] where delayed receipt of the vaccine significantly co-variated with presence of many children at home. Similarly, the age of the infant has also been linked to delays in routine vaccination where children aged 12\u0026ndash;15 months have been reported to have more compliance to vaccine as compared to younger infants [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThe employment status of the mother or primary caretaker has shown significant association to the timeliness of PCV vaccination but with slightly contradictory findings where some literature affirms that an employed mother will most likely delay to go immunization [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e] while other findings assert that unemployed primary caretakers were more likely to delay in taking their children for PCV vaccination [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]. In the same regard, findings from Yaounde Cameroon still indicated that father\u0026rsquo;s profession was found to be among the factors contributing to the completeness of immunization [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e]. As a factor which influences knowledge and awareness, maternal education has by far shown great association towards timeliness of immunization including recent studies which have indicated that increase in the education of the mother directly correlates to timely and complete immunization for PCV [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e] and others have deducted that lower level of maternal education poses a greater risk of infant to be not fully vaccinated and also receive the vaccine late [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]\u003c/p\u003e \u003cp\u003eTo attain the intended immunity from the multi-dose vaccines, vaccine doses should be received within the recommended ages [\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e] however delayed or non-vaccination leads to detrimental effects including significant breaks in herd immunity, increased risk of outbreaks and increased prevalence of these vaccine preventable diseases [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. The study examined the socio-demographic factors associated with delayed completion of PCV vaccination among young children; and the findings should inform immunization policy especially implementation of vaccination.\u003c/p\u003e"},{"header":"Materials and Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003e2.1 Study Setting and Population\u003c/h2\u003e \u003cp\u003eThe study was conducted in Bugongi Town Council, Sheema South Constituency Sheema District South-western Uganda. Bugongi Town council consists of 4 Wards and 27 Cells. It located at 00\u003csup\u003e0\u003c/sup\u003e38\u0026rsquo;08\u0026rdquo;S; 30\u003csup\u003e0\u003c/sup\u003e15\u0026rsquo;10\u0026rdquo;E coordinates and 1,545m (5,069ft) elevation above sea level. It is a rural areas with about 2,732 households with an average size of 4.2 individuals. It has a total population of about 11, 825 with the female proportion slightly higher than the male. Approximately 22.1% of the households in the town council live 5 or more kilometres away from the nearest public health facility. About 15.1% of the town council population is children 0\u0026ndash;4 years of age [\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e]. The main socio-economic activities include subsistence agriculture and livestock farming. The study population was children 4\u0026ndash;48 months of age in the town council. Study units included child/caretaker pairs who consent to participate.\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003e2.2 Study Design, Variables and Sampling\u003c/h3\u003e\n\u003cp\u003eThe study employed a cross sectional study design using quantitative approach. Timeliness of PCV-3 vaccination was the outcome variable and this was obtained from secondary data (children\u0026rsquo;s immunisation cards) while socio-demographic factors of both the child and caretaker were the predictor variables. The desired sample size of 381 was obtained using Kish and Leslie formula (1965) using the proportion (45%) of children who miss out on immunization as reported by the 2016 UDHS [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]. However after data collection, fully completed questionnaires were 362 (95% full response rate). A stratified sampling technique was employed using Allocation Proportional to Size (APS) where a proportionate sub-sample was obtained from each of the four strata (Wards).\u003c/p\u003e\n\u003ch3\u003e2.3 Data Collection Tools\u003c/h3\u003e\n\u003cp\u003eA pre-tested (on 5 participants) researcher administered questionnaire was used to collect data whose reliability was done by checking for Internal Consistency of the Questionnaire using Cronbach\u0026rsquo;s Alpha (0.79). This was obtained by calculating the variance of each questions in the questionnaire and also the variance of the entire tool.\u003c/p\u003e\n\u003ch3\u003e2.4 Data Analysis\u003c/h3\u003e\n\u003cp\u003eData was analyzed using STATA v17 statistical software. Both descriptive analyses and logistic regression analyses (bi-variate and multi-variate) were done; and results presented as frequencies, percentages, cross-tabulations and odds ratios at 95% level of confidence. Statistical significance was considered at P\u0026thinsp;\u0026le;\u0026thinsp;0.05.\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003eAs illustrated below (see Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e) out of the 362 Child-Parent/Caretaker pairs, majority of the children were males (53.87%) and nearly all (353) of the children were reported to have been born from a health facility. Most (211) of the children were 2nd through 4th born followed those who were first-borns (93) and lastly those who were 5th born or above (58). Majority of the children had 1\u0026ndash;4 siblings (70.44%). Approximately eight in every ten (87.57%) caretakers/parents were females with only 12.43% of them being males. Majority (173) were aged 20\u0026ndash;29 years and the biggest proportion (79.83%) were peasant farmer. Over 90% of them were married with just 14 and 20 who reported to be single and separated respectively. Regarding the highest level of education attained, majority (230) of the parents/caretakers had attained primary level.\u003c/p\u003e \u003cp\u003eRegarding timelines of PCV-3 vaccination (see Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e), out of the 362 sampled young children, 92 (25.41%) had delayed to receive their PCV3 doses while 270 (74.59%) had received their PCV3 doses within the recommended time.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eshowing Socio-demographic description of the participants\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"3\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVARIABLE\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFREQUENCY (n\u0026thinsp;=\u0026thinsp;362)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003ePERCENTAGE (%)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePARAMETER\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eNumber of Siblings\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNone\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e70\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e19.34\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e1\u0026ndash;4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003e255\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e70.44\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e5 or more\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e37\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e10.22\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eGender of the child\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003e195\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e53.87\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e167\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e46.13\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eBirth Order\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFirst Born\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e93\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e25.69\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e2nd \u0026ndash; 4th Born\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003e211\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e58.29\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e5th Born or above\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e58\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e16.02\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003ePlace of Birth\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHealth Facility\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003e353\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e97.51\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHome/Community/TBA\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e2.49\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eAge of Parent\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLess than 20 years\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1.66\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e20\u0026ndash;29\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003e173\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e47.79\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e30\u0026ndash;39\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e129\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e35.64\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e40 years and older\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e54\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e14.92\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eGender\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e45\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e12.43\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003e317\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e87.57\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eOccupation\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePeasant Farmer\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003e289\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e79.83\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCivil Servant\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e3.31\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSelf Employed\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e48\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e13.26\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOther Occupations\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e3.39\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eAverage Monthly Income\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLess than UGX 10,000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e123\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e33.98\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eUGX 10,000 \u0026ndash; UGX 50,000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003e150\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e41.44\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eUGX 60,000 \u0026ndash; UGX 100,000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e44\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e12.15\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGreater than UGX 100,000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e45\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e12.43\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eHighest Education Level\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo Formal Education\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e3.31\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePrimary\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003e230\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e63.54\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSecondary\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e96\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e26.52\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTertiary\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e24\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e6.63\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eMarital Status\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSingle\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e14\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e3.87\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMarried\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003e328\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e90.61\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDivorced/Separated\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e20\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e5.52\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eIn bivariate analysis of the socio-demographic factors (see Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e), boys were 1.65 times more likely to delay PCV3 vaccination compared to girls (cOR: 1.65. 95%CI: 1.03\u0026ndash;2.66, P\u0026thinsp;=\u0026thinsp;0.039). Relative to those aged 40 years and above, mothers aged 30 to 39 years have more than twice the odds of delayed PCV3 vaccination (cOR:2.12, 95%CI: 1.06\u0026ndash;4.24, P\u0026thinsp;=\u0026thinsp;0.033). Other factors like number of siblings, birth order, birth place, parent gender, occupation, monthly income, level of education and not being married were not significantly associated with delayed PCV3 vaccination.\u003c/p\u003e \u003cp\u003eThe adjusted multivariate model (see Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e) only found parent\u0026rsquo;s age 20\u0026ndash;29 years [aOR\u0026thinsp;=\u0026thinsp;2.39 (1.14\u0026ndash;5.01); P\u0026thinsp;=\u0026thinsp;0.021] and 30\u0026ndash;39 years [aOR\u0026thinsp;=\u0026thinsp;2.51 (1.16\u0026ndash;5.45); P\u0026thinsp;=\u0026thinsp;0.020] as well as being married [aOR\u0026thinsp;=\u0026thinsp;0.20 (0.04\u0026ndash;0.96); P\u0026thinsp;=\u0026thinsp;0.044] that were significantly associated with delayed PCV3 vaccination whereas child\u0026rsquo;s gender didn\u0026rsquo;t show any statistical significance. Further tests of this final model included Multicollinearity and Hosmer-Lemeshow Goodness of Fit which showed no collinearity (Tolerance\u0026thinsp;\u0026gt;\u0026thinsp;0.1) and with good fit (Chi2\u0026thinsp;=\u0026thinsp;0.74; P\u0026thinsp;=\u0026thinsp;0.863) respectively.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eshowing Bivariate Logistic Regression Analysis of the Socio-demographic Characteristics\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVARIABLE\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"4\" nameend=\"c5\" namest=\"c2\"\u003e \u003cp\u003eDELAYED PCV3 COMPLETION\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePARAMETER\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes,\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eNo,\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003ecOR (95% CI)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eP-value\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eNumber of Siblings, n (%)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNone\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e20 (28.57)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e50 (71.43)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.58 (0.22\u0026ndash;1.54)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.277\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e1\u0026ndash;4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003e65\u003c/b\u003e (25.49)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e190 (74.51)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.68 (0.29\u0026ndash;1.63)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.388\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e5 or more\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e7 (18.92)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e30 (81.08)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eRef.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eChild Gender, n (%)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e41 (21.03)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e154 (78.97)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.65 (1.03\u0026ndash;2.66)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e0.039*\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003e51\u003c/b\u003e (30.54)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e116 (69.46)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eRef.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eChild Birth Order, n (%)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e1st Born\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e26 (27.96)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e67 (72.04)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eRef.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e2nd \u0026ndash; 4th born\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003e48\u003c/b\u003e (22.75)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e163 (77.25)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.32 (0.76\u0026ndash;2.30)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.330\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e5th born or more\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e18 (31.03)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e40 (68.97)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.86 (0.42\u0026ndash;1.77)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.686\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eChild Place of Birth, n (%)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHealth Facility\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003e89\u003c/b\u003e (25.21)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e264 (74.79)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eRef.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHome/Community\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3 (33.33)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e6 (66.67)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.67 (0.17\u0026ndash;2.75)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.583\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eParent\u0026rsquo;s Age, n (%)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;20 years\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1 (16.67)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5 (83.33)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2.94 (0.32\u0026ndash;26. 99)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.340\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e20\u0026ndash;29\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003e43\u003c/b\u003e (24.86)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e130 (75.14)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.78 (0.93\u0026ndash;3.41)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.083\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e30\u0026ndash;39\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e28 (21.71)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e101 (78.29)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2.12 (1.06\u0026ndash;4.24)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e0.033*\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026ge;\u0026thinsp;40 years\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e20 (37.04)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e34 (62.96)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eRef.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eParent\u0026rsquo;s Gender, n (%)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e14 (31.11)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e31 (68.89)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.72 (0.37\u0026ndash;1.43)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.350\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003e78\u003c/b\u003e (24.61)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e239 (75.39)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eRef.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eParent\u0026rsquo;s Occupation, n (%)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePeasant Farmer\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003e75\u003c/b\u003e (25.95)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e214 (74.05)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.78 (0.57\u0026ndash;5.62)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.323\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCivil Servant\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3 (25.00)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e9 (75.00)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.88 (0.34\u0026ndash;10.46)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.474\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSelf Employed\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e9 (18.75)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e39 (81.25)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2.71 (0.72\u0026ndash;10.26)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.143\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOther occupations\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e5 (38.46)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e8 (61.54)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eRef.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eMonthly Income Category, n (%)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026lt; UGX 10,000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e25 (20.33)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e98 (79.67)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eRef.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eUGX 10,000 \u0026ndash; UGX 50,000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003e44\u003c/b\u003e (29.33)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e106 (79.67)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.62 (0.35\u0026ndash;1.08)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.090\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eUGX 60,000 \u0026ndash; UGX 100,000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e15 (34.09)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e29 (70.67)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.49 (0.23\u0026ndash;1.06)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.069\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026gt;UGX 100,000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e8 (17.78)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e37 (82.22)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.18 (0.49\u0026ndash;2.85)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.713\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eParent\u0026rsquo;s Level of Education\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo Formal Education\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2 (16.67)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e10 (83.33)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.93 (0.41\u0026ndash;9.040)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.405\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePrimary Level\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003e64\u003c/b\u003e (27.83)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e166 (72.17)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eRef.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSecondary Level\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e20 (20.83)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e76 (79.17)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.47 (0.83\u0026ndash;2.59)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.190\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTertiary Level\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e6 (25.00)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e18 (75.00)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.16 (0.44\u0026ndash;3.46)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.768\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eMarital Status, n (%)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSingle\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4 (28.57)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e10 (71.43)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.28 (0.04\u0026ndash;1.79)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.178\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMarried\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003e86\u003c/b\u003e (26.22)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e242 (73.78)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.31 (0.07\u0026ndash;1.38)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.124\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDivorced/Separated\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2 (10.00)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e18 (90.00)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eRef.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eTotal\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003e92\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e270\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eshowing Multivariate Logistic Regression Analysis of Factors associated with Delayed PCV-3\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"3\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVARIABLE\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003eMULTIVARIATE ANALYSIS\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePARAMETER\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eaOR (95% Confidence Interval)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003eP-value\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eChild Gender\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.52 (0.91\u0026ndash;2.54)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.107\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eRef.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eParent Age Category\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;20 years\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3.56 (0.37\u0026ndash;34.56)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.274\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e20\u0026ndash;29\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2.39 (1.14\u0026ndash;5.01)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e0.021\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e30\u0026ndash;39\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2.51 (1.16\u0026ndash;5.45)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e0.020\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026ge;\u0026thinsp;40 years\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eRef.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eParent Occupation\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePeasant Farmer\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2.05 (0.57\u0026ndash;7.33)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.271\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCivil Servant\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.64 (0.23\u0026ndash;11.74)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.620\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSelf Employed\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2.45 (0.58\u0026ndash;10.31)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.222\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOther occupations\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eRef.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eMonthly Income Category\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026lt; UGX 10,000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eRef.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eUGX 10,000 \u0026ndash; UGX 50,000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.61 (0.34\u0026ndash;1.12)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.111\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eUGX 60,000 \u0026ndash; UGX 100,000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.52 (0.23\u0026ndash;1.20)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.127\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026gt;UGX 100,000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.22 (0.39\u0026ndash;3.82)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.733\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eParents Highest Level of Education\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo Formal Education\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3.65 (0.71\u0026ndash;18.75)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.122\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePrimary Level\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eRef.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSecondary Level\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.34 (0.74\u0026ndash;2.58)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.313\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTertiary Level\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.95 (0.26\u0026ndash;3.46)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.942\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eMarital Status\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSingle\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.17 (0.02\u0026ndash;1.22)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.078\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMarried\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.20 (0.04\u0026ndash;0.96)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e0.044\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDivorced/Separated\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eRef.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e"},{"header":"Discussion","content":"\u003cdiv id=\"Sec9\" class=\"Section2\"\u003e \u003ch2\u003e4.1 Timeliness of PCV-3 Vaccination among Children 0\u0026ndash;4 years\u003c/h2\u003e \u003cp\u003eWorld Health Organization recommends that all children should receive their last dose of the 3\u0026thinsp;+\u0026thinsp;0 regimen of PCV vaccine within 95\u0026ndash;126 days of life [\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e] giving an allowance even to some children who delay to start vaccination especially due to medical reasons. However if delayed, the vaccine impact on mortality prevention through all levels is greatly reduced resulting into greater difficulty to prevent deaths [\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e]. Delayed PCV-3 receipt is considered when a child receive his/her last dose past 126 days of life. In this current study, a biggest proportion (74.59%) of the sampled young children (0\u0026ndash;4 years) had received their PCV-3 within the recommended age (see Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e); but this rate is still below the \u0026ldquo;all-appropriate-age\u0026rdquo; vaccination target [\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e]. Moreover, the remaining 25.41% (1 in every 4) (see Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e) is a remarkable proportion which needs stringent attention and intervention. This is because, whereas the overall national PCV-3 coverage is still below target [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e] even the age-appropriateness of the received PCV-3 is now revealing to be sub-optimal.\u003c/p\u003e \u003cp\u003eThis current rate (1 in 4 children) of delayed completion of PCV is way higher as compared to a 10.1% (1 in 10 children) recorded delay in Israel [\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e] and a 15.2% delay in Saudi Arabia [\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e]. However, it is comparable to a 40.2% delay as observed in Australia [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e], 42.8% in Michigan \u0026ndash; United States [\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e] and 53.7% in Germany [\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e]. This observed delayed completion could be due to the fact that much as the WHO recommendation sets an age bracket for receipt of PCV3, locally on numerous occasions great focus by the vaccination implementers is put on coverage of the vaccine dose with less attention to timeliness of its receipt. This implies that with the already excellent vaccination acceptance rate, timely receipt of vaccine doses is equally so possible if vaccination services providers always make it a point to provide the vaccination doses within the recommended time.\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003e4.2 Socio-demographic Factors Associated with Delayed Completion of PCV-3\u003c/h3\u003e\n\u003cp\u003eThese findings (see Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e) have shown that age of parent/caretaker had a significant association to delayed completion of PCV, specifically age 20\u0026ndash;29 years [aOR\u0026thinsp;=\u0026thinsp;2.39 (1.14\u0026ndash;5.01); P\u0026thinsp;=\u0026thinsp;0.021] and 30\u0026ndash;39 years [aOR\u0026thinsp;=\u0026thinsp;2.51 (1.16\u0026ndash;5.45); P\u0026thinsp;=\u0026thinsp;0.020] have shown 2.39 times and 2.51 times increased chances of delayed completion respectively as compared to a caretaker aged 40 years and above. Similar observation had earlier been reported in Saudi Arabia where mother\u0026rsquo;s age\u0026thinsp;\u0026gt;\u0026thinsp;26 years was strongly associated with delayed vaccination [\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e] as well as in Malawi where maternal age\u0026thinsp;\u0026gt;\u0026thinsp;30 years was associated with increased risk of delayed vaccination [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]. This tendency may be explained by the fact that most of the caretakers were in this age bracket and were working (occupied); and so busy at work to spare time or even to remember taking their children for immunization in time or at all.\u003c/p\u003e \u003cp\u003eFurthermore, the study has discovered that caretakers who are married [aOR\u0026thinsp;=\u0026thinsp;0.20 (0.04\u0026ndash;0.96); P\u0026thinsp;=\u0026thinsp;0.044] are less likely to delay taking their children for PCV3 as compared to caretakers who are not married. Earlier findings had also seen similar associations including the one in Jerusalem where married caretakers (P\u0026thinsp;=\u0026thinsp;0.006) were more likely to take their children for the last dose of the vaccine in time as compared to non-married ones [\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e]. This protective phenomenon expressed by married caretakers could be sourced from the family support from the spouse but also most married couples have a stationed home which thus provide a stable location to both allow same site vaccination and also timeliness of the receipt of the doses as compared to the single or separated parents who are most likely to have changed locations.\u003c/p\u003e"},{"header":"Conclusions","content":"\u003cp\u003eThis survey has confirmed that among the few children who complete the last dose of PCV vaccination, a considerable proportion are actually receiving it late. This double burden if not addressed will eventually lead to failures to curb the bacterial respiratory tract infection especially among both the non-vaccinated and also those who delay to complete the doses. It has also been witnessed that tripled emphasis in terms of sensitization is un-doubtfully desired among caretakers who are aged 20\u0026ndash;39 years as well as those who are not married.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003eEthical Approval and Consent to Participate\u003c/p\u003e\n\u003cp\u003eEthical clearance was sought from Institutional Research Ethics Committee of Bishop Stuart University \u0026ndash; Uganda (BSU-REC). Ethical approval number: BSU-REC-2023-166. Voluntary informed consent and proxy consent to participate was both written and verbal. This was done with reference to the Helsinki guidelines were; respect for individuals (both caretakers and children), right to make informed decisions (caretakers) and recognition of vulnerable groups (children) were considered throughout the data collection process.\u003c/p\u003e\n\u003cp\u003eConsent for Publication\u003c/p\u003e\n\u003cp\u003eThis manuscript does not have personal identifying information; thus consent for publication was not applicable.\u003c/p\u003e\n\u003cp\u003eData Availability\u003c/p\u003e\n\u003cp\u003eThe dataset used to support the findings of this study are included within the related information files.\u003c/p\u003e\n\u003cp\u003eCompeting Interests\u003c/p\u003e\n\u003cp\u003eThe authors declare that there is no conflict of interest either financial or non-financial regarding the publication of this paper.\u003c/p\u003e\n\u003cp\u003eFunding\u003c/p\u003e\n\u003cp\u003eThe study was funded by Kampala International University under the Staff Development Scheme Scholarship (Ref No. KIU/HR/APPT/01.04.21-036).\u003c/p\u003e\n\u003cp\u003eAuthors\u0026rsquo; Contributions\u003c/p\u003e\n\u003cp\u003eH. M analysed the data and wrote the manuscript. I. A checked for grammar in the manuscript. A. T, P. K, M. C. I, M. G. A, S. A. M, I. A, and D. R. M reviewed the manuscript.\u003c/p\u003e\n\u003cp\u003eAcknowledgments\u003c/p\u003e\n\u003cp\u003eSpecial thanks are conveyed to the Dean School of Allied Health Sciences, Assistant District Health Officer \u0026ndash; Sheema District and the Head of Public Health Department \u0026ndash; School of Allied Health Science; for their technical, professional and parental guidance rendered during the entire research process.\u003c/p\u003e\n\u003cp\u003eSupplementary Materials\u003c/p\u003e\n\u003cp\u003eAll necessary analyses, figures and tables have been submitted within the manuscript. No supplementary materials are added.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eKarafillakis E, Dinca I, Apfel F, Cecconi S, W\u0026uuml;rz A, Takacs J, Suk J, Velentano LP, Kramarz P, Larson HJ. 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Vaccination rates and adherence in pneumococcal conjugate vaccination in mature born infants before and after vaccination schedule change \u0026ndash; A claims database analysis. Vaccine. 2021;39(24):3287\u0026ndash;95. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1016/j.vaccine.2021.04.029\u003c/span\u003e\u003cspan address=\"10.1016/j.vaccine.2021.04.029\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"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":"PCV-3, Delayed Completion, Socio-demographic Factors, Young Children, Western Uganda","lastPublishedDoi":"10.21203/rs.3.rs-5306351/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-5306351/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003eIn spite of the commendable global Pneumococcal Conjugate Vaccine (PCV) coverage in the last two decades, full completion is still below target; and in Uganda, the 3\u0026thinsp;+\u0026thinsp;0 PCV regimen has been reported to have a steady decline in the completion rate. However, reasons for the delayed completion are unknown. Study aimed at assessing the influence of socio-demographic factors on delayed PCV completion among young children. A cross-sectional study design among 362 child/caretakers pairs in Bugongi Town Council was employed and using stratified sampling \u0026ndash; Allocation Proportional to Size, data was collected using pretested questionnaires; entered and analysed using STATA v14 and significant statistical association was considered at P\u0026thinsp;\u0026le;\u0026thinsp;0.05. Of the 362 children, majority (53.87%) were boys. Child mean age was 25.1\u0026thinsp;\u0026plusmn;\u0026thinsp;14.3 months. 87.57% caretakers were females and majorities of them were aged 20\u0026ndash;29yrs (47.8%), peasant farmers (79.8%), married (90.6%), attained primary education (63.5%) and earned average monthly income of UGX 10,000 \u0026ndash; UGX 50,000 (41.4%). Of the 362 children, 92 (25.41%) had delayed to receive their PCV-3 doses. Only boy child [cOR\u0026thinsp;=\u0026thinsp;1.65, (95%CI: 1.03\u0026ndash;2.66); P\u0026thinsp;=\u0026thinsp;0.039) and caretaker\u0026rsquo;s age 30\u0026ndash;39 [cOR\u0026thinsp;=\u0026thinsp;2.12 (95%CI: 1.06\u0026ndash;4.24); P\u0026thinsp;=\u0026thinsp;0.033) showed statistical significance at bivariate analysis. The multivariate model found parent\u0026rsquo;s age 20\u0026ndash;29 years [aOR\u0026thinsp;=\u0026thinsp;2.39 (1.14\u0026ndash;5.01); P\u0026thinsp;=\u0026thinsp;0.021] and 30\u0026ndash;39 years [aOR\u0026thinsp;=\u0026thinsp;2.51 (1.16\u0026ndash;5.45); P\u0026thinsp;=\u0026thinsp;0.020] as positively associated factors whereas being married [aOR\u0026thinsp;=\u0026thinsp;0.20 (0.04\u0026ndash;0.96); P\u0026thinsp;=\u0026thinsp;0.044] was the only negatively associated factors to delayed completion of PCV vaccination among young children. Among children who complete the last dose of PCV vaccination, a considerable proportion are actually receiving it late resulting into eventual failure to curb the intended bacterial respiratory tract infections. Thus, concerted efforts in terms of sensitization is un-doubtfully desired especially among caretakers aged 20\u0026ndash;39 years as well as those who are not married.\u003c/p\u003e","manuscriptTitle":"Delayed Completion of Pneumococcal Conjugate Vaccination among Children 0 – 4 years in Rural Uganda: A Socio-Demographic Inquiry","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-11-15 11:30:31","doi":"10.21203/rs.3.rs-5306351/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2024-11-26T07:55:13+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2024-11-22T12:15:13+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2024-11-21T10:08:01+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2024-11-19T08:00:51+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"121440345415447918500307543484679195156","date":"2024-11-18T19:59:48+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"214130483736974157122825330580980538219","date":"2024-11-14T13:03:43+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"150420233875917061078808148181532376027","date":"2024-11-14T09:30:27+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"138567896434999149061478371248862188030","date":"2024-11-14T06:47:47+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2024-11-09T18:00:36+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"270008815030837749243994027337013166258","date":"2024-10-31T10:31:07+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"299538593004023254901001577150890946304","date":"2024-10-30T14:44:24+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"78208673004973801694745943165300795617","date":"2024-10-26T18:33:40+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"288689846857953890879301041692646417205","date":"2024-10-26T15:17:48+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2024-10-26T15:14:02+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2024-10-23T16:19:35+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2024-10-23T07:34:12+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2024-10-23T07:30:29+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Pediatrics","date":"2024-10-21T17:36:03+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":"52a72c0e-31e8-4cf2-b595-b5da0f0a342b","owner":[],"postedDate":"November 15th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2025-01-20T16:06:59+00:00","versionOfRecord":{"articleIdentity":"rs-5306351","link":"https://doi.org/10.1186/s12887-025-05388-z","journal":{"identity":"bmc-pediatrics","isVorOnly":false,"title":"BMC Pediatrics"},"publishedOn":"2025-01-14 15:57:52","publishedOnDateReadable":"January 14th, 2025"},"versionCreatedAt":"2024-11-15 11:30:31","video":"","vorDoi":"10.1186/s12887-025-05388-z","vorDoiUrl":"https://doi.org/10.1186/s12887-025-05388-z","workflowStages":[]},"version":"v1","identity":"rs-5306351","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-5306351","identity":"rs-5306351","version":["v1"]},"buildId":"qtupq5eGEP_6zYnWcrvyt","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}