Assessment of factors responsible for high dropout rate in the expanded programme on immunization (EPI): a case study of the Tema Municipal Area, Ghana

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This study was done in the Tema municipal area in the Greater Accra Region of Ghana. The aim of this study was to assess the factors that are responsible for the high dropout rate in the EPI of the municipality. The objective of the study was to promote the completion of full immunization series by providing information necessary for micro planning at the health facility and district levels to solve dropout problems. To address the objectives of the research, data were collected by administering questionnaires to mothers who have resided in the municipality for more than two years and have defaulted in immunizing their children preceding the study. To assess the level of the EP1-related knowledge and skills among health personnel with respect to the study, a focus group discussion was employed to collect data to this regard. The research work took place between July and October, 2004. Two main sampling strategies were employed for the purpose of data collection. They include probability and non-probability sampling. The immunization registers were collected from the clinics of the four sub-districts and a list of all defaulters drawn to obtain a sample frame. The listed defaulters were then numbered/coded and then drawn from a basket randomly to obtain the study sample. Twelve (12) of the MCI-i nurses; three each from the four sub-districts responsible for immunization were purposively sampled for a FGD. The study identified the factors responsible for the high dropout rates in the EPI as: poor understanding of the immunization schedule, missed opportunities, unawareness of the next immunization date and lack of information on the use of immunization card by mothers. Traders were the most defaulters and constituted forty percent of the 9th month vaccination schedule dropouts. Cross sections of health personnel have poor knowledge of details of the Multi-dose vial policy and its applicability. With respect to contraindications, health workers are in a dilemma when they are faced with conditions like Fever, Boils and Skin infections during immunization. All the four (4) sub-districts had no immunization defaulter register. Dropout targets are not set as periodic activity target and more of the FGD participants were not aware of the ten percent WHO acceptable dropout rates for routine immunization. It is recommended inter alia that information in the immunization card is translated from English language to local dialects. Managers of the EPI and the MHMT must intensify their supervisory role to make sure that the ten percent WHO dropout rate is adhered to achieve programme objectives. Donors and stakeholders in immunization must he impressed upon to procure single dose vaccine or 10 dose vial for countries facing high EPI dropout rates. The health education units must design the appropriate IEC tools and techniques towards improving mothers understanding of immunization activities and the schedule to promote full immunization status of the children. Finally, health workers must be re-oriented on new strategies and developments in the EPI to achieve the programme objective.
A thesis submitted to the Department of Community Health, School of Medical Sciences in partial fulfilment of the requirements for the degree of Master of Science in Health Services Planning and Management, 2004