# Factors contributing to compliance with Expanded Programme on Immunization and RTS, S/AS01 schedules among children aged 24–40 months in Central Tongu District of Ghana

## TL;DR

The study explores why some caregivers in Ghana follow or don't follow recommended vaccination schedules for children, including a malaria vaccine.

## Contribution

The study identifies socio-economic and informational factors influencing compliance with EPI and RTS,S/AS01 vaccination schedules in Ghana.

## Key findings

- Caregivers with better knowledge and access to immunization services were more likely to comply with vaccination schedules.
- Socio-economic factors and lack of information significantly contributed to non-compliance with recommended vaccinations.
- Education and improved access to services could enhance immunization coverage in the region.

## Abstract

The Expanded Programme on Immunization (EPI) is the most successful global childhood programme in reducing mortality and morbidity from vaccine-preventable diseases. Introducing the RTS, S/AS01 malaria vaccine into the routine health system added additional vaccination visits at 24 months. This study determined the factors contributing to compliance with EPI, including RTS, S/AS01 malaria vaccine schedules in the Central Tongu District of Ghana.

A matched case–control study (1:1) was undertaken between December 2021 and February 2022 among caregivers of children aged 24 to 40 months. Mantel-Haenzel odds ratio and conditional logistic regression analysis were used to determine the strength of association between the level of compliance and independent variables.

Of the 220 caregivers,110 were cases, and 110 were controls. Good knowledge about vaccines and vaccination schedules among caregivers was 62% (n = 139). Caregivers who earned income 46% (ORMH 0.54, 95% CI 0.29–1.00, p = 0.047); had immunization information 98% (ORMH 0.02, 95% CI 0.00–0.12, p = 0.001); with no obstacles accessing immunization services 98% (ORMH 0.02, 95% CI 0.00–0.12, p < 0.001) and had good knowledge about immunization schedules 70% (ORMH 0.30, 95% CI 0.15–0.61, p < 0.001) were more likely to comply with childhood vaccination. Knowledge of (EPI) services, including RTS, S/AS01 malaria vaccine, was associated with high compliance to overall immunization services and schedules 78% (AOR 0.22, 95% CI 0.06–0.78, p = 0.019).

Non-compliance with recommended EPI vaccinations, including RTS,S/AS01, was largely due to socio-economic factors, having information and knowledge about vaccines, immunization schedules, and access to immunization services. Healthcare providers can improve immunization coverage by emphasizing education on vaccines and vaccine schedules, using technologies and making services accessible in Ghana.