Access to vaccination services for children in Kampala is high; however, vaccination uptake and timeliness decrease over time, as indicated by the high percentage of partially vaccinated children (58.6%).

Parents of partially vaccinated children stated that receiving inadequate information about immunization from health workers was a barrier to vaccination. This highlights the need for tailored health education and social mobilization efforts in Kampala taking into consideration the transient and diverse populations.

Vaccine stock-outs and long waiting times prevented parents from vaccinating their children. Stronger public-private partnerships in urban areas could help address these barriers.

A primary health care model that harnesses the strengths of the private sector can help address the barrier of hidden immunization costs that deter people from seeking immunization services.

Innovative survey methods that capture data from the highly mobile nonresidents in urban settings need to be developed as this population contributes to the pool of children that need to be immunized but also to the risk of disease outbreaks.

Limited evidence exists regarding the drivers of vaccination coverage and equity in Kampala city, despite frequent measles outbreaks, inequities in vaccination coverage, and the decline in vaccination coverage rates. This study was designed to determine vaccine coverage among children aged 12–36 months and to understand its demand-side drivers.

We utilized a mixed-methods parallel convergent study design. A household survey was conducted to quantify the drivers of vaccine coverage among households with children aged 12–36 months. We employed a multistage sampling approach to select households, using a primary sampling unit of an enumeration area. We conducted 30 key informant interviews, 7 focus group discussions, and 6 in-depth interviews with representatives from the immunization program, health workers, and parents residing in areas with low vaccine coverage.

Of the 590 enrolled children, 340 (57.6%) were partially vaccinated, 244 (41.4%) were fully vaccinated and had received all the recommended vaccinations, and 6 (1.0%) had never received any vaccine. Of the 244 with all recommended vaccinations, only 65 (26.6%) received their vaccines on time. Access to vaccination services was high (first dose of diphtheria, pertussis, and tetanus [DPT1] coverage of 96%), but utilization decreased over time, as shown by a dropout rate of 17.3% from the first to third dose of DPT. The main driver of complete vaccination was the parents’ appreciation of the benefits of vaccination. Among partially vaccinated children, the barriers to vaccination were inadequate information about vaccination (its benefits and schedule), vaccine stock-outs, long waiting times to receive vaccination services, and hidden vaccination costs.

Vaccination needs to be targeted to all children irrespective of whether they reside in slum areas or nonslum areas, as most are under-vaccinated. Social mobilization and communication efforts should be tailored to the complexities of urban settings characterized by transient and diverse populations with different cultures.

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