Determinants of Low Diphtheria–Tetanus Immunization Coverage Among School-Age Children

Abstract

ABSTRACT

Background: Diphtheria–Tetanus immunization is an essential booster vaccine for school-age children, yet coverage remains suboptimal in many settings. Communication gaps, parental uncertainty, and programmatic challenges often contribute to low uptake. This study aimed to identify the determinants associated with low Diphtheria–Tetanus immunization coverage among school-age children.

Methods: An analytical cross-sectional study was conducted involving 98 parents or guardians whose children did not receive the Diphtheria–Tetanus immunization. Data were collected using a structured, pre-tested questionnaire assessing sociodemographic characteristics, knowledge, schedule awareness, clarity of information, perceptions, and concerns regarding immunization. Additional qualitative insights were obtained through interviews with immunization officers. Quantitative data were analyzed descriptively and through bivariate analysis using the chi-square test, while qualitative data were examined thematically.

Results: Bivariate analysis showed significant associations between Diphtheria–Tetanus immunization uptake and parental knowledge (p = 0.021), awareness of the immunization schedule (p = 0.008), clarity of information received (p = 0.003), and concerns about side effects (p = 0.015). In contrast, sociodemographic factors such as education level showed no significant relationship (p = 0.062). Qualitative findings revealed complementary insights, highlighting misinformation, limited communication through schools, and logistical constraints within the immunization program.

Conclusion: ommunication-related determinants are the primary factors influencing Diphtheria–Tetanus immunization uptake among school-age children. Strengthening information delivery, improving collaboration between health centers and schools, and addressing parental concerns through clearer and more consistent communication strategies are essential to increasing immunization coverage.

Keywords: Diphtheria–Tetanus immunization, immunization coverage, parental knowledge, communication barriers, school-age children.