{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,3]],"date-time":"2026-11-03T08:32:46Z","timestamp":1793694766195,"version":"4.5.1"},"reference-count":13,"publisher":"BMJ","issue":"12","license":[{"start":{"date-parts":[[2025,12,5]],"date-time":"2025-12-05T00:00:00Z","timestamp":1764892800000},"content-version":"unspecified","delay-in-days":4,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"DOI":"10.13039\/100006641","name":"UNICEF","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100006641","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2025,11,6]]},"published-print":{"date-parts":[[2025,12]]},"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Immunisation is one of the most valuable, impactful and cost-effective public health interventions which delivers positive health, social and economic benefits. Globally, 4\u2009million deaths worldwide are prevented by childhood vaccination every year. In Ethiopia, despite huge progress being made, the routine immunisation coverage has never reached the targeted figures and planned goals. Pastoralist communities are often disproportionately under-vaccinated, and there is often a confluence of interrelated factors that drive this outcome. This study enables us to identify factors affecting immunisation service utilisation in the pastoralist communities of Ethiopia, which helps to design effective and context-specific interventions.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>This study aims to explore the behavioural and social drivers (BeSDs) of routine immunisation among the communities with high numbers of zero-dose and under-immunised children in Afar, Somali and Gambella regions of Ethiopia.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A qualitative exploratory study was conducted in three selected regions of Ethiopia (Gambella, Somali and Afar) from 9 November 2023 to 30 December 2023. Purposive sampling was used. A total of 33 interviews were conducted in the three regions. Sample size was determined based on idea saturation. Data was collected using interview guides. The interview guide was developed after reviewing relevant literature, desk review and using the journey to health and immunisation framework. A separate interview guide was developed for the journey mapping exercise, in-depth interview, healthcare workers discussion guide, focus group discussion and observation. Data was analysed thematically.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Behavioural (lack of awareness, lack of reminder\/forgetting, misperception about vaccines, negative previous experience, lost card and fear of post-vaccination adverse events).<\/jats:p>\n                    <jats:p>Structural (language barrier, long distance from home to facility, high cost of transportation, long waiting time, limited training of healthcare professionals and incentives, inconvenient service hours, shortage of health professionals, disrespect by the healthcare provider), Socio-cultural (competing priorities, low community engagement, lack of decision-making autonomy, limited husband involvement, workload, rural residence and larger family size were the commonly mentioned barriers to routine immunisation uptake. On the other hand, structural (house to house visit by health extension workers, counselling about adverse events, presence of outreach service, affordability (free of charge)), behavioural and socio-cultural (knowledge of adverse event management, and respect from community) were enablers to routine immunisation service uptake in pastoralist communities.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>The study found several individual and contextual factors affecting routine immunisation uptake in pastoralist communities. Context-specific and tailored interventions which address zero dose drivers should be designed so as to enhance vaccine uptake. The findings suggested the need to design context-specific interventions to address the aforementioned barriers to immunisation.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjopen-2025-105253","type":"journal-article","created":{"date-parts":[[2025,12,5]],"date-time":"2025-12-05T09:50:27Z","timestamp":1764928227000},"page":"e105253","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":2,"title":["Behavioural and social drivers of immunisation among zero dose children in pastoralist communities of Ethiopia: a qualitative study"],"prefix":"10.1136","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-2226-1669","authenticated-orcid":false,"given":"Menen Tsegaw","family":"Biadiglgn","sequence":"first","affiliation":[{"name":"School of Rural Health, Monash University, Warragul, Victoria, Australia"},{"name":"Department of Public Health, Ambo University, Ambo, Ethiopia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nardos","family":"Gelana","sequence":"additional","affiliation":[{"name":"Ethiopian Health Education and Promotion Professionals Association, Addis Ababa, Ethiopia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eshetu","family":"Girma","sequence":"additional","affiliation":[{"name":"African Population and Health Research Centre, Nairobi, Kenya"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0465-1831","authenticated-orcid":false,"given":"Finina","family":"Abebe","sequence":"additional","affiliation":[{"name":"Clinton Health Access Initiative (CHAI), Addis Ababa, Ethiopia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hnin Su","family":"Mon","sequence":"additional","affiliation":[{"name":"United Nations Children\u2019s Fund (UNICEF), Addis Ababa, Ethiopia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4541-7654","authenticated-orcid":false,"given":"Yordanos","family":"Tadesse","sequence":"additional","affiliation":[{"name":"School of Public Health, Addis Ababa University, Addis Ababa, Ethiopia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Melkamu","family":"Ayalew Kokebie","sequence":"additional","affiliation":[{"name":"Ethiopia Ministry of Health, Addis Ababa, Ethiopia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tseganesh","family":"Gedlu","sequence":"additional","affiliation":[{"name":"Ethiopia Ministry of Health, Addis Ababa, Ethiopia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hanna","family":"Alemayehu","sequence":"additional","affiliation":[{"name":"Ethiopia Ministry of Health, Addis Ababa, Ethiopia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tesfaye","family":"Bikes","sequence":"additional","affiliation":[{"name":"Ethiopia Ministry of Health, Addis Ababa, Ethiopia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yeshiwork","family":"Eshetu","sequence":"additional","affiliation":[{"name":"Ethiopia Ministry of Health, Addis Ababa, Ethiopia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mesfin","family":"Kasaye","sequence":"additional","affiliation":[{"name":"Ethiopia Ministry of Health, Addis Ababa, Ethiopia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Adugna","family":"Endale","sequence":"additional","affiliation":[{"name":"United Nations Children\u2019s Fund (UNICEF), Addis Ababa, Ethiopia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rachana","family":"Sharma","sequence":"additional","affiliation":[{"name":"United Nations Children\u2019s Fund (UNICEF), Addis Ababa, Ethiopia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hiwot","family":"Getachew","sequence":"additional","affiliation":[{"name":"United Nations Children\u2019s Fund (UNICEF), Addis Ababa, Ethiopia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2025,12,5]]},"reference":[{"key":"2026010703455734000_15.12.e105253.1","doi-asserted-by":"crossref","first-page":"27041","DOI":"10.3402\/jmahp.v3.27041","article-title":"Vaccination: the cornerstone of an efficient healthcare system","volume":"3","author":"R\u00e9my","year":"2015","journal-title":"Journal of Market Access & Health Policy"},{"key":"2026010703455734000_15.12.e105253.2","unstructured":"Prevention . Prevention, c. for d. c. and. fast facts on global immunization. 2022."},{"key":"2026010703455734000_15.12.e105253.3","unstructured":"ICF . Ethiopia Mini Demographic and Health Survey 2019, 2021. Available: https:\/\/www.dhsprogram.com\/pubs\/pdf\/FR363\/FR363.pdf"},{"key":"2026010703455734000_15.12.e105253.4","doi-asserted-by":"crossref","DOI":"10.1186\/s12889-024-18077-w","article-title":"High prevalence of zero-dose children in underserved and special setting populations in Ethiopia using a generalize estimating equation and concentration index analysis","volume":"24","author":"Biks","year":"2024","journal-title":"BMC Public Health"},{"key":"2026010703455734000_15.12.e105253.5","doi-asserted-by":"crossref","DOI":"10.3390\/vaccines10071052","article-title":"Correlates of Zero-Dose Vaccination Status among Children Aged 12-59 Months in Sub-Saharan Africa: A Multilevel Analysis of Individual and Contextual Factors","volume":"10","author":"Ozigbu","year":"2022","journal-title":"Vaccines (Basel)"},{"key":"2026010703455734000_15.12.e105253.6","doi-asserted-by":"crossref","DOI":"10.1186\/s12889-021-11466-5","article-title":"Factors influencing childhood immunisation uptake in Africa: a systematic review","volume":"21","author":"Galadima","year":"2021","journal-title":"BMC Public Health"},{"key":"2026010703455734000_15.12.e105253.7","doi-asserted-by":"crossref","first-page":"e14","DOI":"10.1016\/j.puhe.2021.01.008","article-title":"Ensuring access to COVID-19 vaccines among marginalised populations in Africa","volume":"197","author":"Lucero-Prisno","year":"2021","journal-title":"Public Health (Fairfax)"},{"key":"2026010703455734000_15.12.e105253.8","first-page":"100454","article-title":"In-depth reasons for the high proportion of zero-dose children in underserved populations of Ethiopia: Results from a qualitative study","volume":"16","author":"Biks","year":"2024","journal-title":"Vaccine: X"},{"key":"2026010703455734000_15.12.e105253.9","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0312171","article-title":"Identifying the zero-dose and under-immunized children in Bangladesh: Approaches and experiences","volume":"19","author":"Jannat","year":"2024","journal-title":"PLoS One"},{"key":"2026010703455734000_15.12.e105253.10","doi-asserted-by":"crossref","first-page":"5433","DOI":"10.1016\/j.vaccine.2022.07.058","article-title":"Zero- or missed-dose children in Nigeria: Contributing factors and interventions to overcome immunization service delivery challenges","volume":"40","author":"Mahachi","year":"2022","journal-title":"Vaccine (Auckl)"},{"key":"2026010703455734000_15.12.e105253.11","doi-asserted-by":"crossref","unstructured":"Saidu Y , Mattei PD , Sangwe Clovis N , et al . In-depth reasons for the high proportion of zero-dose children in a remote rural district in cameroon: a qualitative study. Public Health and Healthcare [Preprint] 2023. doi:10.20944\/preprints202304.1047.v1","DOI":"10.20944\/preprints202304.1047.v1"},{"key":"2026010703455734000_15.12.e105253.12","doi-asserted-by":"crossref","first-page":"814","DOI":"10.1093\/trstmh\/trac011","article-title":"Enablers and barriers towards ensuring routine immunization services during the COVID-19 pandemic: findings from a qualitative study across five different states in India","volume":"116","author":"Patel","year":"2022","journal-title":"Trans R Soc Trop Med Hyg"},{"key":"2026010703455734000_15.12.e105253.13","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0303215","article-title":"\u201cI\u2019ll take them another day\u201d: A qualitative study exploring the socio-behavioral complexities of childhood vaccination in urban poor settlements","volume":"19","author":"Gichuki","year":"2024","journal-title":"PLoS One"}],"container-title":["BMJ Open"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bmjopen-2025-105253","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,1,7]],"date-time":"2026-01-07T11:46:37Z","timestamp":1767786397000},"score":1,"resource":{"primary":{"URL":"https:\/\/bmjopen.bmj.com\/lookup\/doi\/10.1136\/bmjopen-2025-105253"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,12]]},"references-count":13,"journal-issue":{"issue":"12","published-online":{"date-parts":[[2025,12,5]]},"published-print":{"date-parts":[[2025,12]]}},"alternative-id":["10.1136\/bmjopen-2025-105253"],"URL":"https:\/\/doi.org\/10.1136\/bmjopen-2025-105253","relation":{},"ISSN":["2044-6055","2044-6055"],"issn-type":[{"value":"2044-6055","type":"print"},{"value":"2044-6055","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,12]]}}}