When coverage is high: rethinking the role of caregiver perceptions in childhood vaccination uptake in Uganda

BACKGROUND: Beliefs of a child's primary caregiver are known to influence immunization uptake. As coverage increases, the characteristics of households with undervaccinated children may be shifting. METHODS: We conducted a cross-sectional survey of households with a child 12-23 months of age. Vaccine status was verified by inspection of immunization cards or caregiver report. Composite scores captured caregiver beliefs and experiences with vaccination. Associations between these measures and vaccination status were evaluated using weighted logistic regression. RESULTS: Caregivers of 1689 children were surveyed. The odds of full vaccination were not associated with composite beliefs (adjusted odds ratio [aOR] 1.04 [95% confidence interval {CI} 0.95 to 1.14]) or experiences scores (aOR 1.04 [95% CI 0.96 to 1.13]). Specific beliefs that vaccines prevent severe disease (aOR 2.68 [95% CI 1.64 to 4.37]) and protect the community (aOR 1.67 [95% CI 1.10 to 2.53]) were positively associated, whereas beliefs that children receive too many vaccines (aOR 0.60 [95% CI 0.44 to 0.83]) were negatively associated with full vaccination. Positive experiences, including knowing someone affected by a vaccine-preventable disease (aOR 2.10 [95% CI 1.47 to 3.00]) were also linked to full vaccination. CONCLUSIONS: Although composite scores were not associated with immunization status, individual beliefs and experiences may still factor into caregiver decisions to vaccinate their children.