Knowledge and reporting of adverse events following childhood immunization (AEFI) among health workers and caregivers at Mengo Hospital (2021), Kampala, Uganda: A mixed-methods study

Abstract

Vaccines used in National Immunization Programmes (NIPs) are known to be safe and effective if used correctly, however, no vaccine is completely risk-free as adverse events occasionally occur after immunization. The World Health Organization (WHO) recommends adverse event following immunization (AEFI) surveillance for all vaccines as a critical tool to monitor safety and address potential concerns. However, the factors contributing to Uganda's inability to meet global vaccine safety indicators remain unclear. This study assessed the level of knowledge and reporting of AEFI of children among healthcare workers and caregivers at Mengo Hospital, Kampala. A cross-sectional mixed-methods study involving three focus group discussions, each consisting of five caregivers, eight key informant interviews with healthcare workers (HCWs) and 388 face-to-face interviews with caregivers was carried out. Caregivers accompanying their children for their routine vaccination visits were invited to participate in the study. We descriptively summarized data using measures of central tendency, dispersion, and frequencies. Crude and adjusted measures of association between predictors and AEFI reporting were assessed using Pearson's Chi-square test, and binary logistic regression analysis respectively. Thematic analysis was used to identify behavioral, personal, and social patterns influencing knowledge and reporting of adverse events following immunization among caregivers and HCWs. Approximately one-third of caregivers (130, 33.5%) reported that their children experienced an AEFI and reported it to a healthcare facility. Significant predictors of AEFI reporting included having a secondary education (aOR = 3.56, 95% CI: 1.12-11.30), tertiary education or higher (aOR = 8.52, 95% CI: 2.09-34.81), being older than 35 years (aOR= 18.77; 95% CI: 2.34-150.60) and unmarried (aOR = 3.27, 95% CI: 1.51-7.12). While most HCWs had good AEFI knowledge, they lacked awareness of the national reporting system. Strengthening training for HCWs and raising awareness among caregivers is essential to improve AEFI surveillance.

Fig 1. Summary of vaccination status, knowledge and reporting of AEFI among caregivers as per the last visit.