# Complementary Vaccination in Morocco’s Pediatric Population: A Cross-Sectional Study at Mohamed VI University Hospital, Oujda

## TL;DR

This study in Morocco found that only 19% of children received optional complementary vaccines, with low awareness and cost being major barriers.

## Contribution

The study identifies specific factors influencing complementary vaccine acceptance in Morocco’s pediatric population.

## Key findings

- Only 19% of children received complementary vaccines, with hepatitis A being the most common.
- Lack of knowledge and safety concerns were the main reasons for vaccine reluctance among mothers.
- Higher maternal education and socioeconomic status were significantly associated with vaccine acceptance.

## Abstract

Introduction: Complementary vaccination (CV) in Morocco refers to vaccines administered in addition to those in the National Immunization Program (NIP). Although optional, CV plays a crucial role in preventing certain childhood diseases. This study aimed to determine the CV rate and identify factors associated with reluctance to receive CV.

Material/methods: A cross-sectional study employing descriptive and analytical methods was conducted among a sample of 450 mothers of children aged one to 16 years at the University Hospital Mohammed VI in Oujda, Morocco, over four months.

Results: All children were vaccinated according to the NIP. Most children (414; 92%) had received their obligatory vaccinations at health centers, while only 36 (8%) had received them at a private pediatrician. Only 85 children (19%) had received complementary vaccines (CVs). The hepatitis A vaccine was the most noted (89%). Mothers' knowledge of CVs is limited. Information on the names of CVs, the age of vaccine administration, the number of doses, and the benefit of the vaccine was limited among 369 mothers (82%). Mothers are often reluctant to accept CV because of a lack of knowledge about the vaccine among 351 mothers (78%), fears about vaccine safety among 279 mothers (62%), the unimportance of the vaccine among 256 mothers (57%), the non-obligatory nature of the vaccine among 234 mothers (52%), the sufficiency of compulsory NIP vaccines among 225 mothers (50%), the non-availability of the vaccine at the health center among 220 mothers (49%) and the high cost of the vaccine among 202 mothers (45%). Statistical analysis showed that multiparity (OR = 1.02; 95% CI: 1.21-2.26) and university-level education (OR = 1.52; 95% CI: 1.23-3.23) were significantly associated with CV acceptance. Having an only child (OR = 1.56; 95% CI: 1.11-2.07), low socioeconomic status (OR = 1.54; 95% CI: 1.12-2.17), and lack of medical coverage (OR = 1.20; 95% CI: 0.99-2.01) were significantly associated with reluctance to undergo CV. The results of the chi-square test revealed that the proportion of acceptability of supplementary vaccination increased with younger maternal age (χ2 = 19.74, p < 0.001*), higher maternal education (χ2 = 24.05, p < 0.001*), availability of health coverage (χ2 = 16.66, p < 0.001*) and higher family socioeconomic level (χ2 = 19.75, p < 0.001*). In the case of mothers whose children had received CV, all mothers rated their experience of vaccination with CVs as good.

Conclusion: The results of our study highlighted a low rate of CV, as well as the various factors influencing this type of vaccination. In Morocco, CVs are available in the private sector, but the demand for and acceptability of these vaccines seem to depend on informing parents and raising the awareness of healthcare personnel. Government efforts are needed to tackle the challenges identified in our study.