Factors associated with non-uptake of measles-rubella vaccine second dose among children under five years in Mtwara district council, Tanzania, 2017

Abstract

Introduction: in 2014, Tanzania introduced the combined measles-rubella vaccine in the routine immunization schedule. Two doses of measlesrubella vaccine (MR1 and MR2) are recommended at 9 and 18 months, respectively. In 2015, MR2 coverage among eligible 18-month-old children
in Tanzania was only 57%, lower than the WHO-recommended coverage (95%). During the same period Mtwara District Council (MDC) reported a
coverage of 52% which is lower than the nation average. We determined factors associated with non-uptake of MR2 among children in MDC Tanzania.
Methods: we conducted a community-based cross-sectional survey using cluster sampling during January - April 2017 in MDC. Caretakers of children
born during January 2014 - January 2015 and residing in MDC for the past three years were recruited. We interviewed participants and reviewed
vaccination cards. Logistic regression modeling was employed to identify independent factors associated with uptake of MR2. Results: of 1,000
children assessed, 558 (55.8%) were unvaccinated with MR2. Factors independently associated with non-uptake of MR2 included the caretaker being
unaware of the ages for MR1 and MR2 administration [aOR=3.50; 95%CI 1.98-6.21; p=0.001], having MR2 vaccination services offered at the local
vaccination station fewer than three days per week [aOR=1.50; 95%CI 1.42-5.59; p=0.001], not having the vaccine available during vaccination
days [aOR=3.38; 95%CI 1.08-10.61; p=0.01], unwillingness of health workers to open multi-dose vaccine vials for a single child [aOR=3.80; 95%
CI 2.12-6.79; p=0.001], and long waiting times for vaccination services [aOR=1.80; 95% CI 1.08-3.00; p=0.01]. Conclusion: more than half the
children under five years in MDC were not vaccinated with MR2. Lack of caretaker knowledge about appropriate vaccination age, unavailability of
vaccine, having insufficient numbers of children waiting to warrant multidose vial use, and long clinic waiting times were associated with MR2 nonuptake. The community should receive education about MR vaccine; we recommend thorough screening of children?s vaccination status at each
clinic visit and provision of vaccine whenever possible. Vaccine distribution should be improved in MDC.