_____________________________________________________________________________________________________ *Corresponding author: E-mail: ezenelson24@gmail.com; Asian Journal of Immunology 1(1): 30-35, 2018; Article no.AJI.44949 Reasons for Childhood Immunisation Drop-out in Rural Health Facilities in Abakaliki, Nigeria N. C. Eze1* 1 Department of Community Medicine, Federal Teaching Hospital Abakaliki, Nigeria. Author’s contribution The sole author designed, analysed, interpreted and prepared the manuscript. Article Information DOI: 10.9734/AJI/2018/44949 Editor(s): (1) Dr. Tania Mara Pinto Dabes Guimaraes, Associate Professor, Faculty of Pharmacy, Federal University of Minas Gerais, Belo Horizonte, Minas Gerais, Brazil. (2) Dr. Juandy Jo, Science Analytical Team Leader, Danone Nutricia Research, Singapore. (3) Dr. Darko Nozic, Professor, Higher Medical School in Belgrade, University of Belgrade, Serbia. Reviewers: (1) Giuseppe Gregori, Italy. (2) Pooja Sarmah, Sapthagiri Institute of Medical Sciences, Rajiv Gandhi University of Health Sciences, India. (3) Amanda Mcrae, University of the West Indies, Trinidad and Tobago. (4) Franco Mantovan, University of Verona, Italy. Complete Peer review History: http://www.sciencedomain.org/review-history/27672 Received 18 th September 2018 Accepted 26 th November 2018 Published 8 th December 2018 ABSTRACT Background: High rate of childhood vaccination drop-outs is a significant public health problem in rural areas of developing countries especially in Nigeria. The reasons for immunisation drop-out are poorly understood and little or no data is available to explain the phenomenon that could support the decision making. This study, therefore, determined the reasons for immunisation drop-out in the rural areas of Abakaliki, Nigeria. Materials and Methods: Descriptive analytical cross- sectional study design was used for the survey. Data were collected using pretested, semi-structured interviewer administered questionnaire from 290 mothers/caregivers accessing childhood immunisation services in Mile Four and St. Vincent hospitals selected using systematic random sampling technique. Reasons for immunisation drop-out were gotten from caregivers when they brought their children for immunisation in subsequent immunisation dates after the drop-out interval. Analysis was done using SPSS version 22 and level of statistical significance set at p< 0.05 and confidence level at 95%. Ethical approval was obtained from the Research and Ethics Committee (REC) of the Federal Teaching Hospital Abakaliki (FETHA), Ebonyi State, Nigeria. Results: The mean age of respondents in Mile Four hospital was 26.6 ±4.9 years while 27.1±4.2 years in the St.Vincent hospital. The reasons for immunisation drop-out in Mile Four were no Original Research Article Eze; AJI, 1(1): 30-35, 2018; Article no.AJI.44949 31 money for transport (2.1%), caregiver travelled (1.4%), baby was sick (1.4%), far distance to health facility (0.7%). In St.Vincent reasons cited were- Far distance to health facility (6.2%), no money for transport (4.8%), Mother was sick (2.8%), caregiver travelled (2.1%) and baby was sick (2.1%).Far distance to health facility was a predictor of immunisation drop-out in St. Vincent group. It is 2.8 times more likely to cause immunisation drop-out than near distance to health facility. Conclusion: High rate of immunisation drop-outs need to be addressed collectively both by individuals and government in order to achieve the targeted 95% immunisation coverage necessary for the sustained control of vaccine preventable diseases. Keywords: Immunisation drop-out; reasons; rural infants; Abakaliki; Nigeria. 1. INTRODUCTION Immunisation drop-out and coverage rates at primary health care (PHC) level indicate the level at which communities utilise the preventive services and thus serve as a measure of the strength of public health system. They also measure the effectiveness of the immunisation programme [1]. Immunisation drop-outs refer to infants who have used or missed immunisation services and do not return for subsequent vaccinations. When drop-outs exceed 10 percent, it indicates a problem of utilisation of services. In most settings where full immunisation coverage is low, most infants receive at least one dose of pentavalent vaccines, but the proportion that receive the needed second and third doses drops significantly [1]. However differences in the indicators of access and utilisation of immunisation services exist [2,3]. Indicators of access to health services among other factors include level of education, sex, patriarchal social arrangement, rural residence, poverty, religious and cultural beliefs about certain diseases and location of health facilities etc. Indicators of utilisation of immunisation services include quality of staff skills, protocols of treatment, availability of supplies and environment of health facilities, physical and financial accessibility of services, knowledge of what services exist, education about how to best utilise self and practitioner-provided services and cultural norms of treatment [2,3]. In previous studies most important reason given for immunisation dropout was distance to health facility [4]. However, reasons for childhood immunisation drop out are unknown in the study area, hence this study determined the reasons for dropout in rural areas of Abakaliki, Ebonyi State Nigeria. 2. MATERIALS AND METHODS Descriptive analytical cross- sectional study design was used for the survey. Vaccines such as BCG, OPV0 and HBV0 are given at birth, OPV1, PCV1, Penta1 are given at 6 th week of life, OPV2, PCV2, Penta2 are given at 10 th week of life, OPV3, PCV3, Penta3 are given at 14 th week of life while Measles, Yellow fever, Meningitis vaccines are given at 9 th month of life. These vaccines are given free. This minimum sample size for the study was determined using the formula for comparing two proportions [5,6]. They were selected using systematic random sampling technique. Data were collected using semi-structured interviewer administered questionnaire on the mothers/caregivers and immunisation registers of 290 infants who were brought for immunisation in Mile Four and St.Vincent hospitals in Ebonyi and Izzi local Government Areas of Ebonyi State after the drop-out interval. Reasons for immunisation drop-out were gotten from caregivers when they brought their children for immunisation in subsequent immunisation dates after the drop- out interval. The interval considered as drop-out period was 4 weeks after due date for the uptake of that vaccine. Analysis was done using SPSS version 22.0. Chi-squared test was used to determine association or differences between proportion of the variables and the level of statistical significance set at p< 0.05 and confidence level at 95%. Logistic regression model was used to determine predictors of immunisation drop-out. Ethical approval was obtained from the Research and Ethics Committee (REC) of the Federal Teaching Hospital Abakaliki (FETHA), Ebonyi State, Nigeria. 3. RESULTS The mean age of respondents in Mile Four hospital was 26.6 ±4.9 years while 27.1±4.2 years in the St. Vincent hospital. Fig. 1 showed the proportion of infants who dropped-out of immunisation in both groups. It also shows between group comparisons of Eze; AJI, 1(1): 30-35, 2018; Article no.AJI.44949 32 immunisation drop-outs which was found to be statistically significant (p<0.01). Table 2 showed the reasons for immunisation drop-out among respondents in both groups. More caregivers (6.2%) in St. Vincent cited distance to the health facility as the major reason for immunisation drop-out compared to those in Mile Four (0.7%), a difference that was significant (p=0.01). Other reasons were not significant (p>0.05). In Table 3, far distance to health facility was a predictor of immunisation drop-out in St.Vincent hospital. It was 2.8 times more likely to cause immunisation drop-out than near distance to health facility. Immunisation drop-outs refer to infants who have used or missed immunisation services and do not return for subsequent vaccinations. Missed immunisation is when infants scheduled for immunisation did not come at that given date but returned later for uptake of the given vaccination. Table 1. Socio-demographic characteristics of respondents in both health facilities Variables Mile four (n=145) Freq. (%) St. Vincent (n=145) Freq. (%) χ 2 p-value Sex Male 5 (3.4) 4 (2.8) FT 0.73 Female 140 (96.6) 141 (97.2) Age group (years) 15-19 11 (7.6) 9 (6.2) 6.38 0.16 20-24 50 (34.5) 37 (25.5) 25-29 48 (33.1) 68 (46.9) 30-39 36 (24.8) 31 (21.4) Marital status Married 137 (94.5) 134 (92.4) 2.44 0.69 Single 8 (5.5) 11 (7.5 ) Education Primary 10 (6.8) 17 (11.7) 3.67 0.15 Secondary 88 (60.7) 93 (64.1) Tertiary 47 (32.4) 35 (24.1) Employment Paid employment 25 (17.2) 21 (14.5) 2.75 0.25 Self employment 56 (38.6) 70 (48.3) Unemployed 64 (44.1) 54 (37.2) Religion Christianity 142 (97.9) 143 (98.6) FT 1.00 Others 3 (2.1) 2 (1.4) FT= Fisher’s exact test Table 2. Respondents’ reasons for immunisation drop-out in each study group Variables Mile four group (n=145) Freq. (%) St. Vincent group (n=145) Freq. (%) χ 2 p-value Reasons for dropping-out Yes Yes Distance to facility 1 (0.7) 9 (6.2) 6.6 0.01٭ No money for transport 3 (2.1) 7 (4.8) 1.6 0.33 Caregiver travelled 2 (1.4) 3 (2.1) 0.2 1.00 Baby was sick 2 (1.4) 3 (2.1) 0.2 1.00 Mother was sick 0 (0.0) 4 (2.8) FT 0.12 FT= Fisher’s exact test; ٭statistically significant Eze; AJI, 1(1): 30-35, 2018; Article no.AJI.44949 33 Table 3. Predictors of immunisation drop-out at St. Vincent hospital Variables Immunisation drop-out AOR 95% CI of AOR P-value Marital status Not married 1 Married 4.31 -0.89-10.51 0.09 Educational status