article · BMC Public Health
A cross-sectional investigation at Kisoro General Hospital in Uganda examined rates and drivers of incomplete childhood immunisation among children aged 12 to 23 months. Verified clinic records and caregiver interviews showed that 34.2 percent of children missed at least one scheduled vaccine dose. Several caregiver and facility-level factors strongly influenced non-completion. Starting vaccinations more than three weeks after birth increased the risk of non-completion more than sevenfold. Facility-level barriers, specifically vaccine stock-outs and perceived negative attitudes from healthcare staff, were associated with roughly sixfold increases in the odds of incomplete coverage. Lack of formal caregiver education also heightened the risk, while caregivers aged between 25 and 34 years were significantly more likely to have fully immunised children compared to older caregivers. Addressing these dropouts requires improvements in early infant tracking, staff communication training, and supply chain reliability.
Immunisation prevents severe childhood illnesses, yet coverage in rural settings remains well below international targets. Pinpointing specific local bottlenecks, such as drug stock-outs and delayed initial clinic visits, allows public health authorities to design targeted interventions. Ensuring children complete their full course of basic vaccines reduces preventable disease outbreaks and protects community health across vulnerable populations.
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Immunization non-completion, defined here as a child missing at least one age-appropriate vaccine dose under Uganda’s national immunization schedule (UNEPI), remains a critical public health problem in sub-Saharan Africa, exposing children to preventable diseases. In Uganda, coverage falls substantially below the WHO target of 90%, particularly in rural districts. This study determined the prevalence of immunization non-completion among children aged 12–23 months at Kisoro General Hospital and identified associated socio-economic and healthcare-related factors. A cross-sectional study was conducted from October to December 2024 at Kisoro General Hospital among 275 caregivers of children aged 12–23 months attending the immunization clinic, selected by systematic random sampling. Immunization non-completion was defined as failure to receive at least one age-appropriate dose per the UNEPI schedule (BCG, OPV, pentavalent, PCV, rotavirus, measles, and yellow fever vaccines) by 12–23 months of age. Data were collected via structured, pre-tested questionnaires and verified immunization card records. Descriptive statistics, bivariate chi-square tests, and multivariable logistic regression were performed using Stata version 15.1 (StataCorp, College Station, TX, USA). The participation rate was 90.5% (275/304). Caregivers who declined participation ( n = 10), were excluded after consent due to absent immunization records ( n = 12), or whose children fell outside the 12–23-month age range ( n = 7) are reported in full in the Results section. The prevalence of immunization non-completion was 34.2% (94/275; 95% CI: 28.5–39.8%). In multivariable analysis, significant predictors included lack of formal caregiver education (aOR = 3.3, 95% CI: 0.93–11.49; p = 0.044), delayed initiation of immunization beyond three weeks of birth (aOR = 7.3, 95% CI: 3.66–14.72; p < 0.001), unfriendly health worker attitude (aOR = 5.8, 95% CI: 1.29–11.46; p = 0.022), and vaccine stock-outs (aOR = 6.1, 95% CI: 1.71–14.67; p = 0.005). Children of caregivers aged 25–34 years were less likely to have incomplete immunization than those of caregivers aged over 34 years (aOR = 0.3, 95% CI: 0.16–0.76; p = 0.008). One in three children attending Kisoro General Hospital had incomplete immunization, far below national and global targets. Modifiable determinants at both caregiver and health system levels were identified. Targeted interventions including caregiver education, timely postnatal vaccination, health worker training, and vaccine supply strengthening are urgently needed.
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DOI: 10.1186/s12889-026-29002-8
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