Factors contributing to children missing doses of Expanded Program on Immunization in Vhembe District, Thulamela Municipality

Abstract

Missed doses of childhood immunisation remain a significant public health concern in South Africa, particularly in rural settings, where vaccine-preventable diseases continue to contribute to avoidable childhood morbidity and mortality. There is free immunisation services available through the Expanded Programme on Immunisation (EPI), despite this, many children fail to complete the recommended vaccination schedule. This study aimed to explore caregiver-related factors contributing to children missing EPI doses in Thulamela Municipality, Vhembe District, Limpopo Province. A qualitative, exploratory, descriptive, and contextual research design was employed to gain an in-depth understanding of caregivers’ experiences. Non-probability purposive sampling was used to select mothers or primary caregivers of children aged 6 weeks to 12 months, who had missed at least one scheduled EPI dose. Data were collected through in-depth individual interviews guided by a central open-ended question. Interviews were audio-recorded, transcribed verbatim, and analysed using thematic content analysis to identify recurring patterns and themes. The findings revealed that missed immunisation doses were influenced by a complex interplay of caregiver-related challenges, socio-economic constraints, and health system barriers. Key factors include – caregivers’ burden and cognitive strain, competing work and educational responsibilities, personal beliefs and behaviours, financial and transport difficulties, long waiting times at clinics, vaccine stock-outs, and negative attitudes of healthcare staff. These barriers collectively hinder timely access to immunisation services. The study concludes that improving childhood immunisation coverage in Thulamela Municipality requires multifaceted, context-specific interventions. Strengthening caregiver support; improving health service efficiency; enhancing healthcare-worker and caregivers’ interactions, and implementing flexible and community-based immunisation strategies, are essential to reducing the missing of EPI doses and improving child health outcomes in rural communities.