ArticleBMJ open2025
Identifying context-specific drivers of routine childhood immunisation dropout in Mozambique and Malawi: a secondary thematic analysis of qualitative community-based participatory research data.
Article in BMJ open, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper.
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1 citing paper in PubMed.
- Factors Associated with Childhood Vaccination in Sub-Saharan African Countries Experiencing Armed Conflicts: A Scoping Review.Journal of epidemiology and global health · 2026Article
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Abstract
objectiveRoutine childhood immunisation is vital to preventing life-threatening illness; however, global coverage of routine childhood immunisations has fallen in recent years, leaving over 14 million children globally without protection. This study aimed to identify shared and context-specific drivers of routine childhood immunisation dropout in select sites in Mozambique and Malawi through a secondary analysis of qualitative data.
designWe conducted a secondary inductive thematic analysis on qualitative data from a community-based participatory research study. Co-creation workshops, guided by a human-centred design approach, were held to develop context-specific solutions in each study site. Data for this analysis were collected between February 2020 and March 2021 in Mozambique and between July 2022 and February 2023 in Malawi.
settingZambezia, Mozambique and Lilongwe and Mzimba North Districts, Malawi.
participantsParticipants included caregivers of partially (n=60) and fully vaccinated (n=22) children aged 25-34 months, healthcare workers (n=12), community healthcare workers (n=30), Expanded Programme on Immunisation staff (n=11) and community representatives (n=14). Caregivers were identified through vaccination registers and with support from health workers, community leaders and health volunteers.
resultsWe identified four key contextual and health system differences between Malawi and Mozambique affecting dropout: the composition of the immunisation workforce, the state of the vaccine ecosystem, vaccination card policies and vaccination outreach models. Common challenges across both countries included gender roles that burdened mothers, limited vaccine information, negative health worker interactions, pandemic-related disruptions and stockouts. Common solutions generated through co-creation workshops included improving health worker-caregiver communication, vaccine education and immunisation outreach resources. Solutions in Mozambique emphasised strengthening the community health worker (CHW) role in immunisation, while in Malawi, whose CHW workforce already administers vaccines, solution ideas focused on improving CHW data management.
conclusionsOur analysis highlights the opportunity for scalable solutions to identified common immunisation barriers, including tailored vaccine education that addresses caregiver knowledge gaps, improved caregiver-health worker communication, improved outreach models and addressing gender dynamics and vaccine stockouts.
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