This is the first national, study that has shown the predictors of childhood rotavirus and pneumococcal uptake in Malawi. We have demonstrated that the uptake of these two vaccines was high, however, the coverage of pneumococcal vaccine is falling short the benchmark set by the WHO 15. In the multivariate analysis, maternal education, ANC visits, vaccination card, maternal employment status, and geographical region were statistically significantly associated with uptake of rotavirus and pneumococcal vaccines among the children aged 12-35 in Malawi. Having none ANC visits was significantly associated with low uptake of rotavirus and pneumococcal vaccines. A possible explanation might be that, unlike women with none ANC visits, women who have frequent ANC visits might be more satisfied with the health care system and become aware of the need for vaccination which in turn may make them more likely to return for child vaccination 1617. Their interactions with the healthcare providers may foster trust and strengthen the women–provider relationship and in turn, may positively affect women’s health care-seeking behavior. Evidence has shown that utilization of antenatal care encourages the use of subsequent maternal and child health services including vaccination.

Mothers’ possession of a child health card was previously found to correlate with child’s complete immunization 1819. Prior research has demonstrated that being in possession of a child’s immunization card allows the mother to easily follow the immunization schedule and thus may be able to return in time for the immunization their child. Moreover, having a well-kept immunization card with a clearly-labeled schedule can prevent mothers from missing out on vaccinations appointments 18. On the other hand, mothers who did not have immunization cards might avoid seeking immunization services for fear of ill-treatment from some health care providers as a result of misplaced, lost or spoiled child health card 20. As with previous studies 182122, infants born to mothers with no formal education had reduced odds of vaccination uptake. Previous research attributed this ?nding to maternal education and associated women’s increased autonomy, changes in traditional beliefs, and women’s control over household resources 23. These can, in turn, enhance women’s healthcare-seeking behavior and their ability to comprehend new health knowledge more quickly either because of their social circumstances or cognitive priming that education affords 1821.

 Furthermore, mothers with white collar jobs had high uptake of pneumococcal vaccines. Previously, it was reported that children whose mothers had white-collar jobs were more advantaged compared to those in agriculture and blue-collar jobs in Uganda 18. It was argued that mothers had white-collar jobs may find it easy to access to information due to their economic ability.

In addition, the majority of white-collar workers are located in urban areas hence they may also find it easy to access to health facilities 18.Children from the northern region were more likely to achieve the uptake of pneumococcal vaccination compared to those from the southern region. In this context, vaccination may reveal intra-regional and intra-ethnic differences because of economic, political, and climatic factors and diverse sociocultural norms that might affect childcare practices 24. In Malawi, the northern region has the most favorable health characteristics (e.

g., a large percentage of men and women had completed primary and secondary education, exposure to mass media, and a better wealth status) 525. This study was prone to recall bias as the respondents who did not have the child health cards, were asked to recall the vaccines. The cross-sectional nature of the study design limits our ability to draw causal inferences. The use of secondary data limited us to include other variables that could explain complete childhood immunization.CONCLUSIONSPublic health programmes aimed at increasing the uptake of rotavirus and pneumococcal vaccines in Malawi should be designed interventions based on the factors addressed in this study.

Specifically, the focus should be emphasized more on the maternal education so that they should have the health knowledge related to the ANC and immunization card.  Efforts should be increased in order to achieve the high uptake of pneumococcal vaccination. 

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