Factors related to immunization uptake among the hill tribe and stateless children in northern Thailand: A mixed methods study

Abstract

Immunization is a significant health care tool to protect against crisis-related threats to human health, particularly in underserved populations such as hill tribes and stateless people in Thailand. A mixed method aimed to identify the barriers to and facilitators of the use of vaccines among five-year-old hill tribe and stateless children living in the border areas of northern Thailand and Myanmar. Logistic regression was used to detect associations in the quantitative data, and content analysis was used for qualitative data analysis. A total of 188 cases and 188 controls were analyzed; 54.0 % were boys, and 54.3 % were from the Akha tribe. Children without a birth certificate (AOR = 8.57), children who received a vaccine at a provincial/district hospital (AOR = 14.76), private hospital or clinic (AOR = 7.29), children living with ≥3 other children aged 6–12 years (AOR = 3.61), children living with mothers who were non-Thai citizens (AOR = 4.40), children living with mothers who had not attended school (AOR = 4.08), children living with a primary caregiver who was Yao (AOR = 4.58) or Lisu (AOR = 2.94), children living with a Christian or Muslim primary caregiver (AOR = 2.76), and children living with elderly individuals who brought them for vaccinations (AOR = 2.30) had greater odds of having incomplete vaccination than children with the opposite characteristics. Communication challenges, different perspectives on vaccines among different generations, stages of citizenship, mobility, disasters, and a lack of effective health policies were detected as barriers to vaccination. While seeking a new life for younger generations was a facilitator for vaccination. A public health policy for vaccine services without a Thai citizenship requirement should be implemented to increase coverage for hill tribe and stateless children living in the border areas of Thailand and Myanmar.