Abstract
Introduction
Low vaccination coverage rates can lead to disease emergence, outbreaks, and epidemics, potentially resulting in disabilities or fatalities. Globally, in 2023, approximately 14.5 million children had not received any vaccines, whereas 83% of children had received the first dose of the measles vaccine. In Cambodia, vaccines currently in use include BCG, diphtheria, pertussis, tetanus, polio, hepatitis B, Haemophilus influenzae, measles, DTP-Hib-HepB, pneumonia, Japanese encephalitis, and cervical cancer. At the Chroy Changvar health center (HC), the vaccine coverage rate is notably low, standing at 36.6% for key indicators of the National Immunization Program (NIP). Therefore, it is imperative to investigate the factors influencing vaccination coverage at this HC to identify challenges and improve vaccine delivery to target children, achieving higher coverage rates in the Chroy Changvar HC and meeting the NIP indicators.
Methods
This study used qualitative approaches to collect data in December 2024. They included document review, direct observation, and in-depth interviews (IDIs) with key informants; focus group discussions (FGDs) with parents or child care givers; and semi-structured questionnaires with caregivers. The participants were selected from five villages with the lowest vaccination coverage rates. The interviews were audio recorded, transcribed, and transcribed verbatim. The transcribed data were verified for accuracy. In cases of missing or insufficient data, extra data were gathered. We used thematic analysis methods by coding themes via Microsoft Excel.
Results
In total, 37 participants were included: 14 IDIs and 23 FGDs. The challenges for the vaccine providers consisted of inaccuracies and reliability in document filling (no recording of the vaccination results, incorrect report filling), no visual charts for vaccine coverage monitoring, and a high vaccine refusal rate (11.5%), especially for DPT-HepB-Hib 3 and MR-18. Moreover, challenges for vaccine recipients included unclear communication between health workers and village heads and non-full involvement from local authorities and stakeholders. Limited knowledge from parents and guardians about the importance of vaccinations was also common. Moreover, enabling factors included HC motivation to further increase vaccination coverage, the availability of proper vaccine storage systems, and regular monitoring and support of the vaccination team at higher levels.
Conclusion
This study revealed multiple barriers to vaccination coverage from both service providers and recipients while recognizing enablers that could improve immunization rates. To address these challenges, strategic interventions are recommended at both the Operational District and HCs, including strengthening governance and clear operational plans, improving monitoring systems, and ensuring equitable vaccine access. Implementing these measures would increase vaccination effectiveness and ensure that children receive adequate protection against vaccine-preventable diseases.