{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,30]],"date-time":"2026-07-30T16:01:15Z","timestamp":1785427275269,"version":"3.56.0"},"reference-count":31,"publisher":"AOSIS","issue":"0","license":[{"start":{"date-parts":[[2026,7,21]],"date-time":"2026-07-21T00:00:00Z","timestamp":1784592000000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"abstract":"<jats:p>Background:\u00a0Vaccination is a crucial public health intervention for reducing child mortality and morbidity, but Ethiopia and Africa have not met the Global Vaccine Action Plan\u2019s target.\nAim:\u00a0The study aimed at exploring barriers to the expanded programme on immunisation service utilisation in pastoralist communities of Afar Regional State, Ethiopia.\nSetting:\u00a0The research study was conducted in the Afar region of Ethiopia.\nMethods:\u00a0A qualitative research approach was utilised, combining exploratory and descriptive designs with an appreciative inquiry method. The study focused on parents or guardians of children aged 12 months \u2013 23 months who missed vaccines, along with Expanded Program on Immunisation (EPI) health workers, totalling 77 participants (60 parents and 17 healthcare providers). Data were collected through one-on-one interviews and focus group discussions, with the sample size determined by data saturation, employing non-probability purposive sampling.\nResults:\u00a0Four main themes from the interview data include barriers to community immunization programs, such as geographical challenges, family mobility, vaccine hesitancy due to concerns about side effects, and general reluctance or ignorance regarding vaccination.\nConclusion:\u00a0The study identified barriers to community immunisation programmes, including geographical challenges, family mobility, vaccine hesitancy due to concerns about side effects and general reluctance or ignorance regarding vaccination.\nContribution:\u00a0This study provides context-specific insights into nursing care supervision, informing practice and policy for primary health care professionals in patient management and serving as a foundation for future research.<\/jats:p>","DOI":"10.4102\/hsag.v31i0.3230","type":"journal-article","created":{"date-parts":[[2026,7,17]],"date-time":"2026-07-17T11:08:10Z","timestamp":1784286490000},"update-policy":"https:\/\/doi.org\/10.4102\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Exploring barriers to the expanded programme on immunisation service utilisation in pastoralist communities of Afar, Afar Regional State, Ethiopia"],"prefix":"10.4102","volume":"31","author":[{"ORCID":"https:\/\/orcid.org\/0009-0006-3875-6059","authenticated-orcid":false,"given":"Mohammed A.","family":"Bilal","sequence":"first","affiliation":[{"id":[{"id":"https:\/\/ror.org\/048cwvf49","id-type":"ROR","asserted-by":"publisher"}],"name":"University of South Africa"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1038-0740","authenticated-orcid":false,"given":"Robert T.","family":"Netangaheni","sequence":"additional","affiliation":[{"id":[{"id":"https:\/\/ror.org\/048cwvf49","id-type":"ROR","asserted-by":"publisher"}],"name":"University of South Africa"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"2580","published-online":{"date-parts":[[2026,7,21]]},"reference":[{"key":"ref0","doi-asserted-by":"crossref","unstructured":"Akwataghibe, N.N., Ogunsola, E.A., Broerse, J.E.W., Popoola, O.A., Agbo, A.I. & Dieleman, M.A., 2019, \u2018Exploring factors influencing immunization utilization in Nigeria: A mixed methods study\u2019, Frontiers in Public Health 7, 392. https:\/\/doi.org\/10.3389\/fpubh.2019.00392","DOI":"10.3389\/fpubh.2019.00392"},{"key":"ref1","doi-asserted-by":"crossref","unstructured":"Anand, A., Vardhan, A., Sinha, A., Baibhav, S., Komal, Anupriya et al., 2025, \u2018Knowledge, attitude and practice of the caregivers regarding immunization in under-5 children in rural Bihar, India\u2019, Journal of Family Medicine and Primary Care 14(7), 2752\u20132758. https:\/\/doi.org\/10.4103\/jfmpc.jfmpc_1850_24","DOI":"10.4103\/jfmpc.jfmpc_1850_24"},{"key":"ref2","doi-asserted-by":"crossref","unstructured":"Besnier, E., Thomson, K., Stonkute, D., Mohammad, T., Akhter, N., Todd, A. et al., 2019, \u2018Which public health interventions are effective in reducing morbidity, mortality and health inequalities from infectious diseases amongst children in low-income and middle-income countries (LMICs): Protocol for an umbrella review\u2019, BMJ Open 9(12), e032981. https:\/\/doi.org\/10.1136\/bmjopen-2019-032981","DOI":"10.1136\/bmjopen-2019-032981"},{"key":"ref3","doi-asserted-by":"crossref","unstructured":"Braun, V. & Clarke, V., 2021, Thematic analysis: A practical guide, Sage, London.","DOI":"10.4135\/9781036232078.n9"},{"key":"ref4","doi-asserted-by":"crossref","unstructured":"Dawadi, S., Shrestha, S. & Giri, R.A., 2021, \u2018Mixed-methods research: A discussion on its types, challenges, and criticisms\u2019, Journal of Practical Studies in Education 2(2), 25\u201336. https:\/\/doi.org\/10.46809\/jpse.v2i2.20","DOI":"10.46809\/jpse.v2i2.20"},{"key":"ref5","doi-asserted-by":"crossref","unstructured":"De Figueiredo, A., Simas, C., Karafillakis, E., Paterson, P. & Larson, H.J., 2020, \u2018Mapping global trends in vaccine confidence and investigating barriers to vaccine uptake: A large-scale retrospective temporal modelling study\u2019, The Lancet 396(10255), 898\u2013908. https:\/\/doi.org\/10.1016\/S0140-6736(20)31558-0","DOI":"10.1016\/S0140-6736(20)31558-0"},{"key":"ref6","doi-asserted-by":"crossref","unstructured":"Eshete, A., Shewasinad, S. & Hailemeskel, S., 2020, \u2018Immunization coverage and its determinants in Ethiopia\u2019, BMC Pediatrics 20, 1\u201313. https:\/\/doi.org\/10.1186\/s12887-020-02163-0","DOI":"10.1186\/s12887-020-02163-0"},{"key":"ref7","doi-asserted-by":"crossref","unstructured":"Fahmida, A., Zaheer-Ud-Din, B., Asadullah, M., Muhammad, A. & Yang, Y., 2022, \u2018Unveiling and addressing implementation barriers of vaccination communication strategy: Perspectives from government officials at national and provincial levels\u2019, Human Vaccines & Immunotherapeutics 18(7), 2153513. https:\/\/doi.org\/10.1080\/21645515.2022.2153513","DOI":"10.1080\/21645515.2022.2153513"},{"key":"ref8","doi-asserted-by":"crossref","unstructured":"Fite, R.O. & Hailu, L.D., 2019, \u2018Immunization coverage of 12 to 23 months old children in Ethiopia\u2019, Journal of Public Health and Epidemiology 11(1), 31\u201337. https:\/\/doi.org\/10.5897\/JPHE2018.1071","DOI":"10.5897\/JPHE2018.1071"},{"key":"ref9","unstructured":"FMoH, 2019, Fact sheets, Ministry of Health \u2013 Ethiopia, Expanded Program on Immunization (EPI) [3], viewed from, https:\/\/www.moh.gov.et\/en\/fact-sheets?language_content_entity=en [1] Ministry of Health - Ethiopia."},{"key":"ref10","doi-asserted-by":"crossref","unstructured":"Hailemeskel, S., Eshete, A. & Shewasinad, S., 2020, \u2018Immunization coverage and its determinant factors among children aged 12\u201323 months in Ethiopia: A systematic review, and Meta- analysis of cross-sectional studies\u2019, BMC Pediatrics 20, 283. https:\/\/doi.org\/10.1186\/s12887-020-02163-0","DOI":"10.1186\/s12887-020-02163-0"},{"key":"ref11","doi-asserted-by":"crossref","unstructured":"Ketema, D.B., Assemie, M.A., Alamneh, A.A., Alene, M., Chane, K.Y., Alamneh, Y.M. et al., 2020, \u2018Full vaccination coverage among children aged 12\u201323 months in Ethiopia: A systematic review and meta-analysis\u2019, BMC Public Health 20(1), a777. https:\/\/doi.org\/10.1186\/s12889-020-08940-x","DOI":"10.1186\/s12889-020-08940-x"},{"key":"ref12","doi-asserted-by":"crossref","unstructured":"Malande, O.O., Munube, D., Afaayo, R.N., Annet, K., Bodo, B., Bakainaga, A. et al., 2019, \u2018Barriers to effective uptake and provision of immunization in a rural district in Uganda\u2019, PLoS One 14(2), e0212270. https:\/\/doi.org\/10.1371\/journal.pone.0212270","DOI":"10.1371\/journal.pone.0212270"},{"key":"ref13","doi-asserted-by":"crossref","unstructured":"Malas, O. & Tols\u00e1, M.D., 2022, \u2018Needle-related fear versus vaccination fear, vaccination intention, and declared reasons for avoiding vaccination\u2019, Cl\u00ednica y Salud 33(3), 101\u2013107. https:\/\/doi.org\/10.5093\/clysa2022a11","DOI":"10.5093\/clysa2022a11"},{"key":"ref14","doi-asserted-by":"crossref","unstructured":"Melkamu, H.T., Beyene, A.M. & Zegeye, D.T., 2020a, \u2018Knowledge, attitude and practices of the resident community about visceral leishmaniasis in West Armachiho district, Northwest Ethiopia\u2019, Heliyon 6(1), e03152. https:\/\/doi.org\/10.1016\/j.heliyon.2019.e03152","DOI":"10.1016\/j.heliyon.2019.e03152"},{"key":"ref15","unstructured":"Moh.gov.et., 2016, Expanded Program on Immunization (EPI), Ministry of Health Ethiopia, viewed 24 February 2026, from https:\/\/www.moh.gov.et\/Expanded_Program_on_Immunization_%28EPI%29."},{"key":"ref16","doi-asserted-by":"crossref","unstructured":"Mohamud, M.H.T., Magan, M.A., Mohamed, L.M., Mohamud, M.A. & Muse, A.A., 2020, \u2018Barriers for full immunization coverage among under 5 years children in Mogadishu, Somalia\u2019, Journal of Family Medicine and Primary Care 9(6), 2664\u20132669. https:\/\/doi.org\/10.4103\/jfmpc.jfmpc_119_20","DOI":"10.4103\/jfmpc.jfmpc_119_20"},{"key":"ref17","doi-asserted-by":"crossref","unstructured":"Mohamoud, S.A., Ali-Salad, M.A., Bile, A.S., Singh, N.S., Mahmud, A.J. & Nor, B., 2024, \u2018Determinants and prevalence of zero-dose children in Somalia: Analysis of the 2020 Health Demographic Survey data\u2019, PLoS Global Public Health 4(7), e0002612. https:\/\/doi.org\/10.1371\/journal.pgph.0002612","DOI":"10.1371\/journal.pgph.0002612"},{"key":"ref18","doi-asserted-by":"crossref","unstructured":"Nigatu, T., Abraham, L., Willems, H., Tilaye, M., Tiruneh, F., Gebru, F. et al., 2024, \u2018The status of immunization program and challenges in Ethiopia: A mixed method study\u2019, SAGE Open Medicine 12(11), 1\u201311. https:\/\/doi.org\/10.1177\/20503121241237115","DOI":"10.1177\/20503121241237115"},{"key":"ref19","unstructured":"Njeru, M.W., 2019, \u2018Tinea capitis in children aged under five in Kirinyaga County, Kenya\u2019, Maternal and Child Health Journal 109(69), 75\u201384."},{"key":"ref20","doi-asserted-by":"crossref","unstructured":"Olawuyi, D.A., Esanju, D.O., Olowolayemo, S.A., Asogwa, C.S., Salako, O.O., Kolajo, A.E. et al., 2023, \u2018Immunization of children in Africa: Strides and challenges\u2019, Nigerian Journal of Medicine 32(3), 229\u2013234. https:\/\/doi.org\/10.4103\/NJM.NJM_42_23","DOI":"10.4103\/NJM.NJM_42_23"},{"key":"ref21","unstructured":"Polit, D.F. & Beck, C.T., 2021, Nursing research: Generating and assessing evidence for nursing practice, pp. 166\u2013300, Wolters Kluwer Health, Philadelphia, PA."},{"key":"ref22","doi-asserted-by":"crossref","unstructured":"Pollard, A.J. & Bijker, E.M., 2020, \u2018A guide to vaccinology: From basic principles to new developments\u2019, Nature Reviews Immunology 21(2), 83\u2013100. https:\/\/doi.org\/10.1038\/s41577-020-00479-7","DOI":"10.1038\/s41577-020-00479-7"},{"key":"ref23","doi-asserted-by":"crossref","unstructured":"Saleh, A. & Saleh, A., 2022, \u2018Parental knowledge levels, attitudes, and practices regarding childhood vaccination: A cross-sectional study in Riyadh City, Saudi Arabia\u2019, International Journal of Science and Research. https:\/\/doi.org\/10.21275\/SR221022021436","DOI":"10.21275\/SR221022021436"},{"key":"ref24","doi-asserted-by":"crossref","unstructured":"Sharma, S. & Singh, P., 2021, \u2018Knowledge and awareness of childhood immunization among caregivers in rural India: A cross-sectional study\u2019, Journal of Family Medicine and Primary Care 10(7), 2541\u20132547. https:\/\/doi.org\/10.4103\/jfmpc.jfmpc_2345_20","DOI":"10.4103\/jfmpc.jfmpc_2345_20"},{"key":"ref25","doi-asserted-by":"crossref","unstructured":"Tagbo, B., Okafor, V. & Okolie, S., 2020, \u2018Acceptability of the use of reminder\/recall in vaccination services among clients and service providers in Enugu, Nigeria\u2019, Vaccines & Vaccination Open Access 5(2), 1\u20136. https:\/\/doi.org\/10.23880\/vvoa-16000141","DOI":"10.23880\/vvoa-16000141"},{"key":"ref26","doi-asserted-by":"crossref","unstructured":"Tight, M., 2019, Documentary research in the social sciences, p. 54, Sage, London.","DOI":"10.4135\/9781529716559"},{"key":"ref27","doi-asserted-by":"crossref","unstructured":"Vaghela, G., Narain, K., Isa, M.A., Kanisetti, V., Ahmadi, A. & Lucero-Prisno, D.E., 2021, \u2018World\u2019s largest vaccination drive in India: Challenges and recommendations\u2019, Health Science Reports 4(3), e355. https:\/\/doi.org\/10.1002\/hsr2.355","DOI":"10.1002\/hsr2.355"},{"key":"ref28","unstructured":"World Health Organization (WHO), 2018, Progress and challenges with achieving universal immunization coverage: 2018 estimates of immunization coverage, viewed n.d., from https:\/\/www.unicef.org\/supply\/media\/3186\/file\/_VIC-2018-Session-2-Tania-Cernuschi-IVB-WHO.pdf."},{"key":"ref29","unstructured":"WHO, 2020, Progress and challenges with achieving universal immunization coverage: 2020 Estimates of immunization coverage, viewed 28 June 2021, from https:\/\/www.unicef.org\/supply\/media\/3186\/file\/_VIC-2019-Session-2-Tania-Cernuschi-IVB-WHO.pdf."},{"key":"ref30","doi-asserted-by":"crossref","unstructured":"Zemariam, A.B., Abebe, G.K., Kassa, M.A., Alamaw, A.W., Molla, R.W., Abate, B.B. et al., 2024, \u2018Immunization coverage and its associated factors among children aged 12\u201323 months in Ethiopia: An umbrella review of systematic review and meta-analysis studies\u2019, PLoS One 19(3), e0299384. https:\/\/doi.org\/10.1371\/journal.pone.0299384","DOI":"10.1371\/journal.pone.0299384"}],"container-title":["Health SA Gesondheid"],"original-title":[],"deposited":{"date-parts":[[2026,7,22]],"date-time":"2026-07-22T12:21:10Z","timestamp":1784722870000},"score":1,"resource":{"primary":{"URL":"https:\/\/hsag.co.za\/index.php\/hsag\/article\/view\/3230"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,7,21]]},"references-count":31,"journal-issue":{"issue":"0","published-online":{"date-parts":[[2026,1,1]]}},"URL":"https:\/\/doi.org\/10.4102\/hsag.v31i0.3230","relation":{},"ISSN":["1025-9848","2071-9736"],"issn-type":[{"value":"1025-9848","type":"print"},{"value":"2071-9736","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,7,21]]},"article-number":"a3230"}}