Factors Influencing Childhood Immunization Status among 18 to 24 month-old Children in Hlaing Thar Yar Township, Yangon Region, Myanmar

Abstract

Background: Immunization is one of the most cost-effective and efficient strategies in reducing morbidity and mortality of neonates and under-five children from vaccine preventable diseases. In Myanmar, there are still inequalities and gaps in immunization service provision for children especially in geographically and socially hard to reach and conflict affected areas, among peri-urban, slum and migratory population, and self-administered regions. Population migration becomes one of the social determinants of health, and the number of internal migrants has been gradually increasing in Myanmar. Since Yangon Region is primarily urban and the most socio-economic developed area of Myanmar, rural-urban migration mostly takes place in that region especially in the peri-urban area, Hlaing Thar Yar Township.

Objective: The study aims to explore the influencing factors on immunization status among 18 to 24 month-old children in Hlaing Thar Yar Township, Yangon Region of Myanmar in order to provide evidence for further strategic implementation of expanded programme of immunization in peri-urban areas by policy makers.

Methodology: A cross-sectional analytical study was conducted in the study area, and cluster sampling method was applied to recruit the participants. A total of 298 mothers having 18-24 month-old children were interviewed with semi-structured questionnaires. The collected data were entered by using EpiData 3.1 and analyzed by using SPSS version 23. Ethical approval was obtained from the Institutional Review Board from the Defence Services Medical Research Centre, and the Institute for Health Research Ethics Committee from the University of Bedfordshire.

Result: Only 40.3% of children had completed immunization for all basic vaccines, and the immunization coverages of the township were below the national immunization targets. The mothers with high knowledge score regarding childhood immunization were reported as a small proportion (16.4%), and mothers with positive perception were revealed as a higher proportion. The main reasons of mothers for incomplete immunization are tight with work schedule (36.5%), migrate to another area (21.3%) and minor illness of child (13.5%). Statistically significant associations were present between the urban/ rural residence and the immunization status of children (P = 0.034), the number of siblings and the immunization status of children (P = 0.047), the knowledge of mothers and the immunization status of children (P < 0.001), and the educational status and the knowledge of mothers (P = 0.031).

Conclusions and recommendations: The findings of the study reported that there are still gaps and challenges in immunization coverages of children, and knowledge of mothers regarding childhood immunization is extremely low, and it is important to strengthen health literacy promotion on childhood immunization in the community by using innovative approaches. Appropriate strategies should be developed targeting mobile and migrant population in order to ensure providing equitable access to immunization services that can lead to achieve Sustainable Development Goal targets of ending preventable deaths of newborns and under-five children and reducing the neonatal and under-five mortality rates in Myanmar.

Key Words: Immunization, Coverage, Knowledge, Peri-urban, Myanmar