Quality of health worker and caregiver interaction during child vaccination sessions: A qualitative study from Benishangul-Gumuz region of Ethiopia

Abstract

Introduction: Benishangul-Gumuz is one of nine regions in Ethiopia, located in the north-west of the country. The region has low immunization coverage, and a corresponding high risk to children from vaccine-preventable diseases. Adequate and clear communication during immunization sessions is a key factor that influences caregivers to adhere to the vaccination schedule and continue to bring children for vaccination. This study aims to explore the quality of interaction between health workers and caregivers during vaccination sessions, and to identify communication gaps that impact on the continued use of the vaccination service.

Methods: This cross-sectional qualitative study was carried out using in-depth interviews with health workers who provide vaccination at health facilities, observation of the interactions between vaccinators and caregivers during vaccination sessions, and exit interviews of caregivers. Health workers who provided vaccinations in 12 health facilities based in central and remote parts of the region were interviewed. A total of 79 vaccination sessions in the 12 health facilities were observed and caregivers were interviewed on exit.

Results: Health workers at the health facilities expressed that they enjoy the work they do to get children vaccinated, while caregivers who brought their children for vaccination described the vaccinators as friendly and supportive. Not all health workers explain the purpose of the immunization card to caregivers, hence caregivers do not give due attention to the importance of the card. Some caregivers forget to bring the immunization card with them to vaccination session. In some institutions, those who did not bring the immunization card were refused the service. Health workers write the date of the next vaccination on immunization cards. The majority of caregivers, however, cannot read, so do not understand the return date, type of vaccine, or the purpose of the vaccine given. Caregivers agree that their children should get all vaccines recommended by health workers. Vaccination is scheduled twice weekly at health centers and once weekly at health posts. The BCG and measles vaccination is scheduled monthly. However, when there are uncertainties regarding the availability and/or transportation of vaccines for the scheduled day, health workers do not tell caregivers when the next vaccination date will be. Health workers work with community volunteers to pass on immunization messages house to house.

Conclusions: Health workers do not communicate all key immunization messages to caregivers during vaccination sessions. Training health workers in health facilities on the essentials of immunization and interpersonal communication is important to ensure the continued use of the vaccination service by caregivers. [Ethiop. J. Health Dev. 2020; 34(2):122-128]

Key words: Immunization, vaccine, communication, health workers, caregivers, Ethiopia