Abstract
OBJECTIVES: The significant morbidity and mortalities from, and the recurrent outbreaks of, the vaccine-preventable infectious diseases (VPDs) of childhood could be due not only to non-receipt of recommended vaccinations but also to untimely receipt, which impairs the validity of immunisation coverage and protection against VPDs. This study explored the determinants of untimely receipt and non-receipt of routine childhood immunisation and made recommendations for policy and practice. DESIGN: This qualitative study was based on the Adapted Omale INDEPT FORCIS Framework - Determinants of Routine Childhood Vaccination Receipt Conceptual Framework. STUDY SETTING AND PARTICIPANTS: From 22 August 2022 to 9 September 2022, 15 semi-structured, face-to-face focus group discussions were conducted in English, pidgin English and the local language with 127 purposively selected consenting parents of infants aged 0-2 months (with other key community members) and primary healthcare workers involved in the provision of routine childhood immunisation in Ebonyi state, Nigeria. ANALYSIS: Data analysis involved deductive (and some inductive) thematic analysis. RESULTS: There were many underlying determinants of untimely receipt and non-receipt of routine childhood immunisation, which included individual-related factors (mothers' unfavourable experiences and perceptions and lack of knowledge about childhood diseases, vaccines/vaccinations and the vaccination system, relocation/travel from place of residence, children and/or mothers being ill); childhood disease-related, vaccination-related and the vaccination system-related factors (diseases not always severe/fatal, vaccinations causing side-effects, vaccination system constraints in availability, accessibility, affordability and acceptability); family and other individual-related factors; and broader context-related sociopolitical, cultural, economic, infrastructural, historic and health system factors. CONCLUSION: The evidence demonstrates many specific and fundamental complex and interrelated determinants of untimely receipt and non-receipt of routine childhood immunisation and emphasises the need for multifaceted and innovative actions in dealing with the determinants in the drive to address the high morbidity and mortalities and recurring outbreaks of VPDs in Ebonyi state, Nigeria, and similar settings.