P3.H158: Social Connections: A Critical Element to Overcome Structural Constraints of Routine Vaccination in urban and rural Haïti, 2022

Background: Vaccines are free to children under one-year-old in Haïti, still vaccine coverage remains suboptimal. In 2020, UNICEF reported a concerning 28-44% decline in the vaccination rate in Haïti during the COVID-19 pandemic and a period of political instability. This study aims to identify the factors associated with missing or delayed vaccines during this dual crisis period and determine the role of social connections in mitigating those outcomes in Port-au-Prince and Mirebalais, Haïti.

Methods: From April to June 2022, we performed a Convergent Parallel Mixed-Method study in Port-au-Prince, an urban city, and Mirebalais, a rural one. We surveyed 200 caregivers and interviewed 28 of them. Selected caregivers were older than 17 with at least one preschool child (2-35 months). We used a multivariable logistic regression analysis to identify the factors associated with missing and delayed vaccines. We coded the qualitative data through an iterative content analysis approach and defined the final themes. We integrated the quantitative and qualitative results through joint displays.

Results: Lack of time [OR= 5.826, CI 95% (2.323-14.606)] and living in the urban area [OR= 3.992, CI 95% (1.401-11.373)] were mainly associated with missing or delayed vaccines. A high sense of collective responsibility [0.188 (0.036 – 0.961)] was a protective factor. During the interviews, parents highlighted the beneficial role of the elders and healthcare providers in motivating them to continue vaccinating their children. They explained innovative ways in which schools and churches motivate them and provide logistic support for vaccination.

Conclusion: Living in an urban area torn by gun violence was a major associated factor of missing or delayed vaccines. However, respondents emphasize the support from their individual and collective social connections in successful vaccine completion. Moving from an institution-centered vaccine promotion and delivery system to a community-centered one must be the next step in increasing vaccination coverage in Haïti.