Immunisation decision-making and barriers to vaccine uptake among children under-5 in limited-resource settings

Immunisation coverage remains a fundamental challenge in sub-Saharan Africa, which still has the highest under-five mortality rate in the world, due to wide-ranging drivers that have complicated interventions. Unless the knowledge gaps affecting childhood vaccination decision-making are identified and effectively addressed, low immunisation coverage will persist in the region. This study aims to assess the factors influencing immunisation decision-making among caregivers of children Under-5 years old, and to understand the behaviours that shape these influences. The study employed qualitative methods, such as focus group discussions. Participants were caregivers of children Under-5 years old in Nigeria. A simplified cluster sampling approach was used to select caregivers from four geographical clusters. A minimum of seven caregivers from each cluster were purposively included. The data were analysed deductively using a meta-aggregation approach. The findings show that caregivers’ immunisation decision-making are mainly motivated by: inadequate knowledge about childhood immunisation, especially the conflict between vaccine-preventable and non-vaccine-preventable diseases; masculinity (attitudes of fathers or men can help or hinder immunisation); the child’s gender (the perception of stronger versus weaker sex); misinformation about immunisation (especially the perception that it is a form of family planning). Other influences include the exploitation of caregivers by healthcare workers; incessant stock-outs of vaccines leading to complacent behaviour associated with vaccine hesitancy; religious beliefs; poor attitudes of healthcare workers; among other factors. The factors influencing immunisation decision-making in limited-resource settings and the motivations shaping these behaviours are largely psychological, socio-cultural, behavioural, health system and structural. Interventions designed to address the root causes of gender inequity must start with men’s attitudes and the socio-cultural practices that enable them. Furthermore, the sandwich model for addressing vaccine misinformation seems promising in countering myths and conspiracies about vaccines.