Beyond the clinic gate: barriers to childhood immunization access and strategies for improvement at a rural Zimbabwean clinic.

backgroundChildhood immunization through the Expanded Programme on Immunization (EPI) remains central to reducing vaccine-preventable disease morbidity and mortality in sub-Saharan Africa. Zimbabwe's national EPI coverage for pentavalent 3 stood at 83% in 2023, below the 90% global target. Nyaure Clinic in Goromonzi District, Mashonaland East Province, recorded coverage of 65%, 62%, and 67% for pentavalent 3 in 2021, 2022, and 2023 respectively. This study investigated factors affecting access to EPI services at Nyaure Clinic and identified strategies to improve coverage.

methodsA quantitative cross-sectional survey design was used. The study population comprised 261 caregivers, 10 community health workers (CHWs), and 3 nurses in the Nyaure catchment area. A stratified random sample of 61 participants was selected using the Raosoft sample size calculator at a 90% confidence level. Data were collected in October 2024 using structured, self-administered questionnaires. Descriptive analysis was performed using Microsoft Excel and results are presented in tables and figures.

resultsOf 61 respondents, 93.4% were female. Among caregivers (n = 55), 96.4% reported receiving information about EPI, with 70.9% citing health facility workers as the primary source. Vaccines were reported as unavailable 14.5% of the time. Distance was reported as a barrier by 29.1% of caregivers and all 6 health workers. Religious and cultural beliefs, particularly among Apostolic sects, were reported as contributing to vaccine hesitancy. Poverty and political interference were not perceived as barriers. The leading strategies proposed by caregivers were outreach programmes (92.7%), health education (70.9%), and door-to-door vaccination (58.2%). The six health workers also endorsed building more clinics and recruiting more CHWs; support for legislation against vaccine hesitancy was expressed only by this small subgroup.

conclusionsDistance, religious and cultural beliefs, and intermittent vaccine shortages were the barriers most commonly reported by caregivers and health workers at Nyaure Clinic. Intensified outreach programmes, health education, and door-to-door vaccination were the strategies most frequently proposed by respondents. These reported barriers and preferred strategies may inform the work of EPI programme managers and district health teams in rural Zimbabwe, though the descriptive, single-site design means findings should be interpreted with caution.