Understanding the Barrier of Childhood Vaccination Uptake Among Internally Displaced Populations (IDPs) in Bosaso, Puntland, Somalia

Abstract

Background: Childhood vaccination is a critical public health intervention that prevents morbidity and mortality from vaccine-preventable diseases. However, in conflict-affected and resource-limited settings like Bosaso, Puntland, Somalia, particularly among internally displaced populations (IDPs), vaccination coverage remains alarmingly low. This study aimed to assess the barriers to childhood vaccination uptake within IDP communities in Bosaso, Puntland, Somalia. Methods: A cross-sectional, community-based survey was conducted among caregivers of children under five years residing in IDP camps. Structured questionnaires collected data on socio-demographic characteristics, cultural beliefs, healthcare access, and perceptions regarding vaccination. Descriptive statistics and thematic analysis were used to interpret the findings. Results: The study revealed that 49% of respondents had no formal education, and 49% earned less than $50 per month, limiting their health-seeking capacity. Time constraints and domestic responsibilities affected 59.8% of caregivers, while only 22.5% reported full immunization of their children. Cultural and religious beliefs were significant barriers, with 70.1% acknowledging cultural misconceptions against vaccines and 75% consulting religious or community leaders before vaccinating. Additionally, 55.9% believed traditional medicine was more effective than vaccines. Logistical barriers were prevalent, with 73.5% walking to health centers and 63.2% facing transportation challenges. Vaccine availability was poor, reported consistently by only 5.9% of respondents. Although 63.7% were satisfied with service quality, 92.6% indicated healthcare workers did not explain vaccine benefits. Trust in government efforts was low, with only 17.6% expressing confidence. Conclusion: Multiple, intersecting barriers hinder vaccination uptake among IDP populations in Bosaso, Puntland, Somalia, including low education levels, cultural beliefs, economic constraints, logistical issues, and limited health education. Addressing these challenges requires integrated interventions targeting healthcare accessibility, community awareness, healthcare provider communication, and consistent vaccine supply.