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Abstract Background With the onset of the COVID-19 pandemic, governments implemented social distancing regulations to limit the spread of the disease. Some health experts warned that these measures could negatively affect access to essential health services, such as routine childhood immunizations. Others noted that without these regulations, COVID-19 cases would increase, leading to overburdened health systems. Methods We analyze four years (2018–2021) of monthly administrative data on childhood immunizations in all administrative districts in Ghana and exploit variations in social distancing regulations across districts. Given variations in social distancing regulations across Ghanaian districts, we can further differentiate between the effect of public lockdowns and the effect of the pandemic. Results We find that child immunizations in Ghana declined by 6% during the public lockdown in April 2020, but the country compensated with higher vaccination rates starting in June, and immunization services recovered to pre-pandemic growth levels by 2021. Time-critical vaccines, such as polio, were not affected at all. We do find a substantially larger disruption in April 2020 (14%) and a slower recovery in 2020 in the 40 lockdown-affected districts. Interestingly, vaccination rates already decreased in February and March by about 5% before the public lockdown and before the pandemic had reached Ghana, but with the pandemic already spreading globally and in the news. Conclusion Our results indicate that the negative effect on child immunization was less severe and shorter than predicted by experts. Fear of COVID-19 and delayed vaccination campaigns had a substantial impact on childhood immunization while rising COVID-19 cases and moderate social distancing regulations did not seem to affect immunization rates.

Background: With the onset of the COVID-19 pandemic, governments implemented social distancing regulations to limit the spread of the disease. Some health experts warned that these measures could negatively affect access to essential health services, such as routine childhood immunizations. Others noted that without these regulations, COVID-19 cases would increase, leading to overburdened health systems. Methods: We analyze four years (2018–2021) of monthly administrative data on childhood immunizations in all administrative districts in Ghana and exploit variations in social distancing regulations across districts. Given variations in social distancing regulations across Ghanaian districts, we can further differentiate between the effect of public lockdowns and the effect of the pandemic. Results: We find that child immunizations in Ghana declined by 6% during the public lockdown in April 2020, but the country compensated with higher vaccination rates starting in June, and immunization services recovered to pre-pandemic growth levels by 2021. Time-critical vaccines, such as polio, were not affected at all. We do find a substantially larger disruption in April 2020 (14%) and a slower recovery in 2020 in the 40 lockdown-affected districts. Interestingly, vaccination rates already decreased in February and March by about 5% before the public lockdown and before the pandemic had reached Ghana, but with the pandemic already spreading globally and in the news. Conclusion: Our results indicate that the negative effect on child immunization was less severe and shorter than predicted by experts. Fear of COVID-19 and delayed vaccination campaigns had a substantial impact on childhood immunization while rising COVID-19 cases and moderate social distancing regulations did not seem to affect immunization rates. [ABSTRACT FROM AUTHOR]

Introduction: World Health Organization (WHO) recommends postpartum family planning (PPFP) as a critical component of health care that has the potential to save millions of maternal and infant lives in low- and middle-income countries. Methods: participants in our randomized, controlled trial were mothers coming for vaccination of their child in three selected health centers in Addis Ababa during the first 10 weeks postpartum. Eligible mothers were randomly assigned to intervention (pamphlet-supported counseling about the benefits of family planning) and non-intervention (routine care) arms. Data were collected when mothers came with their infants for a routine measles vaccination at nine months of life. Family planning (FP) use was compared between the groups using logistic regression, and bivariate and multivariate analyses. The study also used Kaplan Meier and Cox regressions to compare the median time of PPFP use and its correlation using SPSS version 26. The research was undertaken from December 2019 to June 2021. Results: a total of 347 women (177 control, 170 intervention) enrolled in the study. Fifty-eight percent were 24-30 years old. Young age, knowledge about FP, previous use of an FP method, and being married were found to be independent predictors for PPFP use. When comparing intervention and non-intervention groups, there was no significant effect on contraceptive use (adjusted OR 0.633 [95% CI 0.385-1.040]). Conclusion: pamphlet-supported counseling of mothers in the first 10 weeks postpartum did not increase PPFP at nine months postpartum. Successful interventions will likely require holistic strategies, especially in resourcelimited settings. The trial had been registered with clinicaltrials.gov (NCT04521517) on September 24, 2019. [ABSTRACT FROM AUTHOR]

IntroductionDespite the advances in vaccination, there are still several challenges in reaching millions of children in low- and middle-income countries (LMICs). In this review, we present an extensive summary of the various strategies used for improving routine immunization in LMICs to aid program implementers in designing vaccination interventions.MethodsExperimental and quasi-experimental impact evaluations conducted in LMICs evaluating the effectiveness of interventions in improving routine immunization of children aged 0–5 years or the intermediate outcomes were included from 3ie’s review of systematic reviews. Some additional impact evaluation studies published in recent years in select LMICs with large number of unvaccinated children were also included. Studies were coded to identify interventions and the barriers in the study context using the intervention framework developed in 3ie’s Evidence Gap Map and the WHO’s Behavioral and Social Drivers (BeSD) of vaccination framework, respectively. Qualitative analysis of the content was conducted to analyze the intervention strategies and the vaccination barriers that they addressed.Results and conclusionOne hundred and forty-two impact evaluations were included to summarize the interventions. To address attitudinal and knowledge related barriers to vaccination and to motivate caregivers, sensitization and educational programs, media campaigns, and monetary or non-monetary incentives to caregivers, that may or may not be conditional upon certain health behaviors, have been used across contexts. To improve knowledge of vaccination, its place, time, and schedule, automated voice messages and written or pictorial messages have been used as standalone or multicomponent strategies. Interventions used to improve service quality included training and education of health workers and providing monetary or non-monetary perks to them or sending reminders to them on different aspects of provision of vaccination services. Interventions like effective planning or outreach activities, follow-up of children, tracking of children that have missed vaccinations, pay-for-performance schemes and health system strengthening have also been used to improve service access and quality. Interventions aimed at mobilizing and collaborating with the community to impact social norms, attitudes, and empower communities to make health decisions have also been widely implemented.

BackgroundChild immunization is crucial to protect children from vaccine-preventable diseases. However, if a child defaults from completing immunization, they are at a greater risk of contracting such diseases. Previous studies have evaluated various factors that contribute to defaulting from immunization, but they did not consider the fear of COVID-19 as a variable. Additionally, there is inconsistency in the factors identified across different areas. This study aimed to examine the determinants of defaulting from child immunization among children aged 15–23 months in Kacha Bira district, Kembata Tembaro zone, South Ethiopia.MethodsA study was conducted using a community-based unmatched case–control design to identify the determinants of child immunization completion. The study included 255 children aged 15–23 months in the Kacha Bira district from 3 May 2022 to 1 June 2022, using a multi-stage sampling technique. Face-to-face interviews of mothers or immediate caretakers of the child were conducted using a mobile device, and the questionnaire was developed using the Kobo Toolbox. The data collected were analyzed using SPSS version 25. Multivariable logistic regression was used to identify the determinants, and the adjusted odds ratio with 95% CI and a p < 0.05 were considered statistical significant.ResultsThe multivariable logistic regression analysis identified four independent predictors of immunization defaulting. Antenatal care (ANC) follow-up [AOR = 5.40, 95% CI (2.24–13.52)], postponing vaccination schedule [AOR = 2.28, 95% CI: (1.05–4.93)], parity of the mother [AOR = 3.25, 95% CI: (1.45–7.27)], and knowledge of the mother about vaccination [AOR = 6.77, 95% CI: (2.33–19.64)] were determinants of immunization defaulting.ConclusionIn this study, lack of ANC follow-up, postponement of the vaccination schedule, mothers with parity of greater than four, and poor knowledge of the mothers about immunization were identified as determinants of immunization defaulting.

• Vaccine refusal and hesitancy toward childhood and COVID-19 vaccines hinder the achievement of adequate immunization coverage worldwide. • The prevalence of parents who previously rejected childhood vaccines due to personal beliefs accounted for 7.8%, and parental COVID-19 hesitancy was 85.6%. • Parental attitudes and beliefs toward vaccines were significantly associated with their behavior regarding the vaccination of their children. • Many parents who did not refuse childhood vaccines were found to have negative attitudes toward vaccines and distrust health authorities. • Significant changes in parental attitudes toward childhood vaccines after the onset of the COVID-19 pandemic are possible. Vaccination rates worldwide have declined in recent years. This decrease is primarily driven by vaccine hesitancy, which remains understudied in Central Asia, including Kazakhstan. Furthermore, there is great concern about parental hesitancy toward COVID-19 vaccines, as previous studies have focused on adult vaccine hesitancy. The current study was conducted by UNICEF and funded by USAID to explore the drivers of routine and COVID-19 immunization behaviors among parents and caregivers in Kazakhstan. Using a cross-sectional methodology, researchers conducted 3081 face-to-face interviews with parents and caregivers of children aged 0–17 years across cities and villages in Kazakhstan. A tablet-based questionnaire (CAPI) was utilized, collecting participants' data on sociodemographic characteristics, childhood and COVID-19 vaccination behaviors, and potential drivers. Total of 239 participants (7.8%) were found to previously refuse vaccination due to their own beliefs. Stronger belief that vaccines are efficacious (AdjOR = 0.47), stronger belief that childhood vaccines are safe and danger of vaccine-preventable diseases is high (AdjOR = 0.73), firmer trust in societal factors (AdjOR = 0.77) and positive attitudes of family members toward immunization (AdjOR = 0.6) were significantly associated with parental refusal of childhood vaccines. The large proportion of respondents (N = 2,634, 85.6%) missed the COVID-19 vaccination of their child or were unwilling to get vaccinated. Stronger belief that COVID-19 vaccines are safe and efficacious (AdjsOR = 0.18), lacking important information about COVID-19 vaccines (AdjOR = 1.25) and parents being unvaccinated against COVID-19 (AdjOR = 2.3) were significant predictors of vaccine hesitancy. This study revealed numerous socio-demographic and behavioral factors significantly associated with parental refusal of childhood vaccines and hesitancy toward COVID-19 vaccines. Many parents not refusing vaccination possessed negative attitudes towards vaccines. Potential changes in their attitudes and beliefs of parents were observed compared to findings from pre-COVID era. Continuous monitoring of parental hesitancy, proper interventions and education of healthcare workers are suggested to reduce parental vaccine hesitancy. [ABSTRACT FROM AUTHOR]

Abstract Routine childhood vaccinations are among the most cost-effective child health interventions. In recent years, the broader benefits of vaccines, which include improved cognitive and schooling outcomes, have also been established. This paper evaluates the long-term economic benefits of India's national program of childhood vaccinations, known as the Universal Immunization Programme (UIP). We combine individual-level data from the 68th round of the National Sample Survey of India (2011–12) with district-wise data on the rollout of UIP from 1985 to 1990. We employ age-district fixed-effects regression models to compare the earnings and per capita household consumer spending of 21- to 26-year-old adults who were born in UIP-covered districts vis-à-vis non-UIP districts between 1985 and 1990. We find that exposure to UIP in infancy increases weekly wages by 13.8 percent (95 percent CI: 7.6–20.3 percent, p < 0.01) and monthly per capita household consumption expenditure by 2.9 percent (95 percent CI: 0.7–5.0 percent, p < 0.01). Program exposure also reduces the probability that an individual's household relies on agriculture as the main source of income by 1.9 percent (95 percent CI: 0.0–3.5 percent, p < 0.01). The findings are robust to several specifications including varying study duration and accounting for potential migration. The effects vary by sex, location, and caste group. [ABSTRACT FROM AUTHOR]

Lan Thanh Thi Truong,1,&ast; Truc Thanh Thai,2,&ast; Tap Van Nguyen,3 Tran Que Nguyen,4 Tuyet Anh Thi Le,1 Nga Hong Le,1 Phuong Thu Thi Pham,2 Quynh Ngoc Ho Huynh2 1Department of Prevention of Infectious Diseases, Ho Chi Minh Provincial Center for Disease Control, Ho Chi Minh City, Vietnam; 2Faculty of Public Health, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, Vietnam; 3Faculty of Medical Management, Nguyen Tat Thanh University, Ho Chi Minh City, Vietnam; 4Department of Nursing, University Medical Center Ho Chi Minh City, Ho Chi Minh City, Vietnam&ast;These authors contributed equally to this workCorrespondence: Truc Thanh Thai, Faculty of Public Health, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, Vietnam, Tel +84 908 381 266, Email thaithanhtruc@ump.edu.vn Tap Van Nguyen, Faculty of Medical Management, Nguyen Tat Thanh University, Ho Chi Minh City, Vietnam, Tel +84 914064340, Email tapnv@ntt.edu.vnPurpose: Immunization is the most cost-effective health strategy, contributing significantly to public health interventions for all ages, particularly for children. However, caregivers’ satisfaction with immunization systems affects their decisions on immunization for their children. This study evaluated the levels of clients’ satisfaction toward child immunization and to identify its associated factors.Methods: A cross-sectional study was conducted at 40 commune health centers (CHCs) in 24 districts in Ho Chi Minh City, Vietnam among 1200 caregivers of children aged under 5 years. Clients who took their children to CHCs for immunization were recruited based on convenience sampling technique and were asked to complete a self-report questionnaire. Satisfaction was measured using the Satisfaction with Immunization Service Questionnaire (SWISQ). Ordinal logistic regression models were fitted to identify factors associated with satisfaction levels.Results: The majority of participants were female (85.5%) with a mean age of 33.3 (standard deviation = 9.0). Approximately 60% of participants reported a moderate (40.2%) or high (17.1%) level of satisfaction. Participants with older children and those who waited for a longer duration had a lower satisfaction level. In contrast, high satisfaction level was found to be positive associated with being reminded by healthcare workers and the condition of follow-up areas, vaccine storage and the immunization process met participant’s need.Conclusion: The level of clients’ satisfaction toward child immunization at grassroot healthcare centers in Ho Chi Minh City is relatively low, with 40.2% having moderate satisfaction and 17.1% having high satisfaction. Strategies to improve vaccination programs at CHCs are needed, focusing on clients’ experiences at CHCs during vaccination sessions. Further studies are also needed to have an in-depth understanding of more factors affecting satisfaction in this population.Keywords: service satisfaction, child immunization, community healthcare center, Vietnam

Vaccine-preventable diseases pose a significant threat to children under five globally, creating disparities in immunization coverage. Despite its cost-effectiveness and life-saving potential, immunization faces challenges in achieving equitable coverage. Gender inequalities deeply influence access to healthcare, affecting immunization rates. This study examines the action plans submitted by participants of the World Health Organization's (WHO) IA2030 Scholar Level 1 certification course in 2021. A qualitative analysis was conducted on a subset of 111 action plans that scored above 75%, employing narrative thematic analysis to categorize and explore gender incorporation and identified barriers based on the IA2030 Gender Guide. Among the 111 analyzed action plans, gender considerations were present in almost all plans, underscoring the effectiveness of integrating gender perspectives in the course curriculum. The most frequently cited barriers included low education and health literacy, issues related to accessing quality immunization services, gendered dynamics in decision-making within households, and limited access to resources and mobility, predominantly impacting women. The findings confirm that gender inequalities significantly contribute to suboptimal immunization coverage. An intersectional approach, recognizing diverse social markers impacting immunization, is vital to address disparities effectively. Moreover, the need for gender-sensitive data and deeper understanding of intersectional dynamics was emphasized. The study highlights the importance of gender-transformative interventions, including community engagement and efforts targeting both men and women to enhance immunization coverage. While acknowledging limitations, such as potential biases in peer evaluations and the need for wider inclusivity in gender perspectives, this analysis underscores the significance of mainstreaming gender in immunization capacity-building programs. The integration of gender considerations not only raises awareness but also equips professionals to create more gender-responsive immunization programs. Continuous efforts to incorporate gender perspectives can lead to more effective, equitable, and gender-transformative immunization initiatives at various levels.

BackgroundImmunization remains one of the most cost-effective health interventions. However, there are still issues of vaccine hesitancy especially in caregivers who are required to protect their children from vaccine-preventable diseases. This thwarts the overall vaccine coverage in disease-endemic areas such as sub-Saharan Africa. Therefore, to determine the factors that promote vaccine hesitancy in caregivers, this study sought to assess the knowledge, attitude, and practices of caregivers on childhood immunization in Okaikoi, a sub-metro of Accra in Ghana.MethodsA cross-sectional study on childhood immunization was conducted to determine the knowledge, attitudes, and practices of caregivers. A total of 120 caregivers with infants aged 12 months to 23 months were interviewed with a structured questionnaire containing open-ended and closed-ended queries.ResultsFrom the community, infants whose caregivers had adhered completely to immunization constituted 53.3% while the rest were partially immunized. The two main deterrents to complete immunization were time constraints (25.8%) and forgetfulness (17.5%). It was observed that vaccination uptake and maternal level of education, as well as vaccination adverse reaction, did not impact the completion of the EPI program by these caregivers. Unfortunately, it was noted that caregivers with higher education levels were unable to complete their vaccination schedules due to their busy work schedules. Nonetheless, the main deterrent to adhering to complete childhood immunization was poor maternal knowledge (58%).ConclusionThe study revealed that, the caregivers in the community had poor knowledge on vaccination and its benefits, and therefore, with no strict adherence to vaccination schedules. This promoted the incomplete immunization of children in the community by their caregivers. Also, since the main source of information with regard to immunization in the sub-metro was through the antenatal and postnatal child welfare clinics and the media, we recommend that the health workers collaborate with media personnel to ensure that standardized information is disseminated.

Chinese caregivers’ intentions to allow their children to be vaccinated against coronavirus disease 2019 (COVID-19) is unknown. We explored the intention rate of Chinese caregivers to allow their children to be vaccinated and examined potential influencing factors and underlying reasons for their unwillingness or hesitation. From November 30, 2020, to January 31, 2021, we conducted a cross-sectional survey of 3703 caregivers in six representative provinces in China. We assessed intention rates and correlates of caregivers’ intentions to vaccinate children against COVID-19, using descriptive analyses and a multiple logistic regression analysis, respectively. In the study sample, about 84.0% of caregivers intended to get their children vaccinated for COVID-19 if the vaccine was available. In particular, 92.2% of caregivers who were willing to be vaccinated themselves for COVID-19 intended to have their children vaccinated, yet among caregivers who were unwilling (or uncertain) whether to be vaccinated, only 41.1% intended to have their children vaccinated. Older age, lower education level, and perceived safety and effectiveness of the COVID-19 vaccine were associated with increased odds of caregivers intending to have their children vaccinated. Of the six provinces included in the study, residence in a province other than Hubei increased the likelihood that caregivers would choose not to have their children vaccinated. We found a relatively high vaccination rate (84.0%) among caregivers by using a cross-sectional sample in China. Concerted efforts are needed to address caregivers’ concerns about vaccine safety, especially among caregivers who do not intend to be vaccinated themselves.

Although COVID-19 vaccines have been available in Jordan for more than a year, Jordan suffers from a low vaccination rate. The aim of this study was to explore attitudes towards recent issues in vaccination among university students in Jordan. We adopted a cross sectional study design using an online questionnaire distributed in a Jordanian university with a medical school chosen at random. The survey asked about COVID-19 vaccine preferences, factors affecting COVID-19 vaccine preferences, child vaccination, and booster vaccines. A total of 417 students completed the survey. Most respondents (54.7%) preferred the Pfizer vaccine, and 6.2% refused to take any vaccine. Pfizer's efficacy against new strains is a main factor in preferring Pfizer over other vaccines (p < 0.01). Most respondents (71%) believed that vaccination is crucial to prevent COVID-19 surges from new COVID-19 strains, while 44.6% of respondents believed that children should be included in vaccination campaigns, and 70% believed that booster vaccines required more studies to prove their efficacy. Students had mixed attitudes towards many recent issues concerning COVID-19 vaccination. Studying these factors and attitudes in more depth and in different populations can pave the way towards improving vaccination rates worldwide. [ABSTRACT FROM AUTHOR]

This article aimed to assess the relationships within the continuum of care for maternal, neonatal, and child health (MNCH) at four service levels, the utilization distribution, and its contributing factors in six lower-middle-income countries in Southeast Asia. It was based on data from the Demographic and Health Survey, a nationally representative and repeated cross-sectional survey, on 50 619 ever-married women aged 15-49 years. Only 21.9% of women (n = 10 252) obtained all four levels of continuing MNCH services. Women and husbands' education and employment, parity, mass media consumption, and wealth quintiles were the strongest determinants for the continuation of care, apart from access to health care, decision-making autonomy in health care, and women's age. Identifying populations that experience health inequalities, prominent policy intervention, and better health promotion and advocacy systems regarding pregnancy, delivery, and postnatal and immunization care might help to enhance maternal and child health and equity outcomes. [ABSTRACT FROM AUTHOR]

Abstract Background Unmet need for postpartum contraception is high. Integration of family planning with routine child immunization services may help to satisfy unmet need. However, evidence about the determinants and effects of integration has been inconsistent, and more evidence is required to ascertain whether and how to invest in integration. In this study, facility-level family planning and immunization integration index scores are used to: (1) determine whether integration changes over time and (2) identify whether facility-level characteristics, including exposure to the Nigerian Urban Reproductive Health Initiative (NURHI), are associated with integration across facilities in six urban areas of Nigeria. Methods This study utilizes health facility data collected at baseline (n = 400) and endline (n = 385) for the NURHI impact evaluation. Difference-in-differences models estimate the associations between facility-level characteristics, including exposure to NURHI, and Provider and Facility Integration Index scores. The two outcome measures, Provider and Facility Integration Index scores, reflect attributes that support integrated service delivery. These indexes, which range from 0 (low) to 10 (high), were constructed using principal component analysis. Scores were calculated for each facility. Independent variables are (1) time period, (2) whether the facility received the NURHI intervention, and (3) additional facility-level characteristics. Results Within intervention facilities, mean Provider Integration Index scores were 6.46 at baseline and 6.79 at endline; mean Facility Integration Index scores were 7.16 (baseline) and 7.36 (endline). Within non-intervention facilities, mean Provider Integration Index scores were 5.01 at baseline and 6.25 at endline; mean Facility Integration Index scores were 5.83 (baseline) and 6.12 (endline). Provider Integration Index scores increased significantly (p = 0.00) among non-intervention facilities. Facility Integration Index scores did not increase significantly in either group. Results identify facility-level characteristics associated with higher levels of integration, including smaller family planning client load, family planning training among providers, and public facility ownership. Exposure to NURHI was not associated with integration index scores. Conclusion Programs aiming to increase integration of family planning and immunization services should monitor and provide targeted support for the implementation of a well-defined integration strategy that considers the influence of facility characteristics and concurrent initiatives.

Reproductive autonomy necessitates that women have access to high quality family planning information and services. Additionally, closely spaced pregnancies increase maternal and infant morbidity and mortality. Although integrating family planning into child immunization services may increase access to information and services and postpartum contraceptive use, evidence on how integration affects service delivery and health outcomes is scarce. One limitation of previous studies is the use of binary integration measures. To address this limitation, this study applied Provider and Facility Integration Index scores to estimate associations between integration and contraceptive use, receipt of family planning information, and knowledge of family planning services availability. This study leveraged pooled cross-sectional health facility client exit interview data collected from 2,535 women in Nigeria. Provider and Facility Integration Index scores were calculated (0–10, 0 = low, 10 = high) for each facility (N = 94). The Provider Integration Index score measures provider skills and practices that support integrated service delivery; the Facility Integration Index score measures facility norms that support integrated service delivery. Logistic regression models identified associations between Provider and Facility Integration Index scores and (a) contraceptive use among postpartum women, (b) receipt of family planning information during immunization visits, and (c) correct identification of family planning service availability. Overall, 46% of women were using any method of contraception, 51% received family planning information during the immunization appointment, and 83% correctly identified family planning service availability at the facility. Mean Provider and Facility Integration Index scores were 6.46 (SD = 0.21) and 7.27 (SD = 0.18), respectively. Provider and Facility Integration Index scores were not significantly associated with postpartum contraceptive use. Facility Integration Index scores were negatively associated with receipt of family planning information. Provider Integration Index scores were positively associated with correct identification of family planning service availability. Our results challenge the position that integration provides a clear path to improved outcomes. The presence of facility and provider attributes that support integration may not result in the delivery of integrated care.

Background: Immunization is one of the most successful public health initiatives. The World Health Organization in 2017 estimated that immunization averts about 2 to 3 million deaths every year. About 29,000 children worldwide under the age of five die every day, mainly from vaccine-preventable diseases. Uptake of vaccines with multiple doses up to the last dose has been a problem. Incomplete immunization against diseases leads to the reappearance of childhood vaccine-preventable diseases (VPD) and consequently high infant mortality. The paper explored the reasons for incomplete of child immunization schedule in Lusaka district, Zambia. Methods: The study employed a concurrent mixed method design where both quantitative and qualitative methods were used. This particular paper focuses on the results from the qualitative component where Focus Group Discussions (FGDs) and Key Informant Interviews (KIIs) were conducted with mothers and community health workers. Thematic analysis was used to analyse the data. Results: The study found that mothers were generally aware of vaccines and knew the benefits of the vaccines. The reasons for incomplete child immunisation include the mothers' negative perceptions such as the fear of side effects of the vaccines, mothers' unwillingness to bring the child for immunisation. Bad treatment of mothers by health workers and various social factors such as the mother having to attend to social engagements like funerals and weddings also contributed to incomplete child immunisation. Economic factors included a lack of transport money and mothers having to attend work are additional reasons for incomplete child immunization. Conclusion: The reasons for incomplete child immunisation revealed by this study reflect complex individual, interpersonal, health systems, and social cultural contexts within which mothers live in their daily lives. There is need for more comprehensive and multi sectoral approach to improve the completion of immunisation schedules in children. [ABSTRACT FROM AUTHOR]