Vaccination Gaps in Burundi's Children: A Call to Action

Vaccination plays a vital role in keeping children healthy and reducing the number of deaths caused by infectious diseases worldwide. It is particularly important in low- and middle-income countries, where vaccination rates can indicate how well a country is developing. The World Health Organization (WHO) states that vaccination prevents nearly 3 million deaths annually, and many more lives could be saved with better vaccination coverage. Currently, 19.5 million infants around the world do not receive the Vaccinations they need. In developed countries, some children still miss vaccinations. For example, in the United States, about one in eight children under two years old is not fully vaccinated. In Italy, vaccination coverage rates have dropped from 95.7% in 2013 to 93.3% in 2016. Meanwhile, in Africa, many children miss vaccination opportunities due to various challenges.

#The Situation in Burundi

In Burundi, vaccination rates for children aged 12-23 months are concerning. Data shows that only 85% of children have received all basic vaccines, and 72% have received all appropriate vaccines for their age. While a small number of children (0.3%) have not been vaccinated at all, there are significant gaps in vaccination coverage. For instance, the percentage of children receiving the first, second, and third doses of certain vaccines drops significantly, with losses of up to 99% for some doses. Even though Burundi has maintained over 80% coverage for vaccinations since 1980, there has been a recent decline in the performance of its vaccination program.

#Research Questions

This study aims to identify the reasons why some children hospitalized in national hospitals in Burundi are not vaccinated correctly.

#General Objective

The main goal of this research is to help reduce illness and death among infants from diseases that can be prevented by vaccines. This will be achieved by finding out what factors affect vaccination status for children aged 24 to 48 months in hospitals in Bujumbura.

#Specific Objectives

1. To look at how mothers’ education, age, marital status, and religion relate to vaccination status.
2. To examine how a child's gender and birth order affect vaccination status.
3. To investigate whether access to healthcare facilities influences vaccination rates.
4. To identify household characteristics, like living standards and family size, related to vaccination status.
5. The findings will provide recommendations to improve vaccination efforts in Bujumbura.

#Research Hypotheses

1. A child's gender and birth order can impact the likelihood of being fully vaccinated.
2. Household characteristics, such as living standards and family size, may affect vaccination status.
3. Mothers’ education levels are linked to how fully their children are vaccinated.
4. The distance to vaccination facilities could influence how many vaccinations children receive.

#Study Population

The research focused on children aged 24 to 48 months who were admitted to four national hospitals in Bujumbura, including Prince Régent Charles Hospital, Prince Louis Rwagasore Clinic, Kamenge Military Hospital, and Kamenge University Hospital Center.

#Study Type

This was a cross-sectional study, meaning it looked at a specific group of children in hospitals at one time. Data was collected from their mothers or caregivers.

#Study Period

The data collection took place over one month, from December 2019 to January 2020, in the four hospitals mentioned above.

#Sampling Technique

All children aged 24 to 48 months who were in the hospitals during the study period were included.

#Sample Size

The minimum number of participants needed for the study was calculated based on vaccination rates, ensuring a valid representation of the population.

#Data Collection Tools

Data was gathered through a questionnaire, which included:

• Information from vaccination cards to check vaccination status.
• Responses from mothers about their sociodemographic information, child characteristics, and access to vaccination centers. Consent was obtained from parents before starting the data collection.

#Inclusion Criteria

Children aged 24 to 48 months who were hospitalized and whose parents consented to take part in the study were included.

#Exclusion Criteria

Children were excluded from the study if their mothers were not available, if caregivers could not provide vaccination information, or if vaccination cards were missing.

#Data Analysis

• Descriptive Analysis: Basic statistics were calculated, such as averages and percentages.
• Bivariate Analysis: Relationships between vaccination status and various factors were tested using statistical methods.
• Multivariate Analysis: A logistic regression model was used to identify the factors that affect vaccination status while considering other variables.

#Study Validity

To ensure the study's reliability, trained medical personnel collected the data, and a pilot test of the questionnaire was conducted beforehand. The findings were generalized to the broader population of children in similar situations.

#Ethical Aspects

The research followed ethical guidelines, obtaining approval from relevant committees and ensuring participant confidentiality. Parents were informed that participation was voluntary and they could withdraw at any time without consequences.

#Results

#Sample Description

Among the children in the study, 64.81% were correctly vaccinated. The average age of mothers was around 29 years, with a majority between the ages of 25 and 35. Most mothers had at least a primary or secondary education, and most were married. The research showed that children from families with a medium standard of living were the most common in the study.

#Child Characteristics

The vaccination status revealed that 64.81% of children were correctly vaccinated, with a higher percentage of boys than girls.

#Knowledge about Vaccination

The study also examined mothers’ understanding of vaccination schedules and diseases that vaccines can prevent. Many mothers had a poor grasp of this knowledge, which can affect vaccination rates.

#Bivariate Analysis

The analysis showed several factors influencing vaccination rates. For instance, the Educational Level of mothers and fathers, along with socioeconomic status, played significant roles in determining whether children received the necessary vaccinations.

#Multivariate Analysis

When controlling for other variables, factors such as the father’s education and Household Wealth remained strong predictors of vaccination status. Also, the distance to health facilities influenced whether children were vaccinated correctly, as did mothers’ knowledge about vaccines.

#Factors Affecting Vaccination

1. Parental Education: A higher education level among parents, especially fathers, significantly increased the likelihood of children being vaccinated.
2. Household Wealth: Families with better living standards were more likely to have their children vaccinated.
3. Distance to Clinics: Children whose mothers found it difficult to access clinics were less likely to be vaccinated.
4. Mothers’ Knowledge: The more informed mothers were about vaccines, the higher the chances of their children getting vaccinated.

#Study Limitations

The study had some limitations. It focused only on children hospitalized in specific hospitals, which may not represent the entire population. Also, lacking vaccination cards for some children might have affected the results.

#Conclusion

The study highlighted that many children in Burundi are not fully vaccinated according to the recommended schedule. Several factors contribute to this issue, including the education levels of both parents, socioeconomic status, access to healthcare, and mothers’ knowledge regarding vaccination. For improving vaccination rates, initiatives to enhance education and awareness among families and to increase access to healthcare facilities are necessary. This approach will help reduce infant morbidity and mortality rates from vaccine-preventable diseases.