RotaTeq coverage and perceived barriers to vaccination in a rural health district in RAAN, Nicaragua

The politically and geographically isolated Tasba Pri region of RAAN, an impoverished rural area in northeastern Nicaragua, has a weak health care system in place; children in this area face multiple barriers to receiving immunizations. This study investigated the prevalence of rotavirus vaccination in the region and perceived barriers to vaccination as reported by mothers of children less than four years. A population-based, cross-sectional survey of women of reproductive age (n=189) was conducted in the catchment area served by the Sahsa health clinic in RAAN, Nicaragua in July, 2009. Households were selected by two stage cluster sampling methodology. Vaccination data from MINSA-issued cards were collected and analyzed for children under four eligible for rotavirus vaccination. 41% of eligible children received any dose of rotavirus vaccine; 23% received the full three dose series. Despite low vaccination rates, 68% of women were aware of the vaccine. Clinic stock outs of vaccine and distance were the most frequently reported barriers to vaccination. The low rotavirus vaccination rates and high dropout rates in Tasba Pri are of great concern. The Ministry of Health must explore additional vaccine delivery routes for this area in order to increase rotavirus vaccination coverage to match vaccination rates in other areas of Nicaragua, where almost 80% of infants receive the full three dose series. Considering the perceived barriers to vaccination reported in the study, increased frequency of vaccination brigades in outlying areas and better staffing and supply of satellite clinics could increase rotavirus vaccination coverage in this area.