MUHIMBILI UNIVERSITY OF HEALTH AND ALLIED SCIENCE

SCHOOL OF PUBLIC HEALTH AND SOCIAL SCIENCES

DEPARTMENT OF COMMUNITY HEALTH

IMMUNIZATION, GROWH MONITORING AND INFECTION CONTROL REPORT

MSOLWA WARD, CHALINZE DISTRICT.

PREPARED BY
SUBGROUP 2, GROUP A.
SUPERVISED BY
MR. ANTONY ANATOLI

4TH Aug TO 7th Aug, 2025.

Name Of Students

S/N Names Registration Number

1 TARKI RABII ABDALLAH 2021-04-16005

2 TAUSI A. BEBE 2021-04-16008

3 WALTER ANDREW 2021-04-16039

4 HUSNA HAMIS DADIA 2021-04-15498

5 ENOCK PATRICK ALEXANDER 2021-04-15369

6 KELVIN KOUW AMEY 2021-04-15626

7 DAVID MUGANYIZI BAGUMA 2021-04-15284

8 YUSUPH M. ARABI 2021-04-16072

9 HENRY NGOSSO CHRISTOPHER 2021-04-15493

10 SALUM O. ABDALLAH 2021-04-15937

11 GIANFRANCO MUTAYOBA CYRIACUS 2021-04-15444

12 FRANSISKO KABU FELIX 2021-04-14322

Table of Contents
ACKNOWLEDGEMENT.................................................................................................................................... 4
LIST OF ABBREVIATIONS ................................................................................................................................ 5
ABSTRACT....................................................................................................................................................... 6
Background: ............................................................................................................................................... 7
Aim ............................................................................................................................................................. 7
Methodology: ............................................................................................................................................ 7
Results: ....................................................................................................................................................... 7
Conclusion:................................................................................................................................................. 8
1.0 INTRODUCTION ........................................................................................................................................ 7
1.1 Background .......................................................................................................................................... 7
1.2 OBJECTIVE ........................................................................................................................................... 8
1.2.1 Broad Objective ............................................................................................................................ 8
1.2.2 Specific Objectives ........................................................................................................................ 8
2.0 METHODOLOGY ....................................................................................................................................11
2.1 Study design ........................................................................................................................................ 9
2.2 Study area ............................................................................................................................................ 9
2.3 Study population.................................................................................................................................. 9
2.4 Sample size and sampling technique ................................................................................................... 9
2.5 Data collection tools and procedures ................................................................................................10
2.6 Data analysis ......................................................................................................................................10
2.7 Ethical considerations .......................................................................................................................10
2.8 Limitations and Mitigation ................................................................................................................11
3.0 RESULTS .................................................................................................................................................12
3.1 IMMUNIZATION .................................................................................................................................12
3.2 GROWTH MONITORING .....................................................................................................................13
3.3 INFECTIOUS DISEASE CONTROL .........................................................................................................13
4.0 DISCUSSION ...........................................................................................................................................15
CONCLUSION................................................................................................................................................17
RECOMENDATIONS ......................................................................................................................................18
REFERENCES .................................................................................................................................................19
ACKNOWLEDGEMENT
First and foremost, we would like to convey our greatest gratitude to the Almighty God, who gave
us health, strength and will to complete our field work training.

We would like to convey our sincerest gratitude to our supervisor Mr. ANTONY ANATOLI who
guided us through our study at Msolwa village, directing us through objectives to pursue in our
study and reminding us of what is important and where to put our focus and efforts while providing
us with
the necessary knowledge and skills along the way. We would also like to thank the course
coordinators for their support and wisdom throughout our study.

We would also like to thank the village government of Msolwa for their support and cooperation
and the community health worker for introducing us to the community and guiding us through the
households which helped us to conduct our study.
LIST OF ABBREVIATIONS
BCG Bacillus Calmette-Guérin

EPI Expanded Program of Immunization

IDI In-Depth Interview

ITN’s Insecticide Treated Nets

IVD Immunization and Vaccination Development

MR Measles-Rubella vaccine

RCH Reproductive and Child Health

TDHS Tanzania Demographic Health Survey

UTI Urinary Tract Infection

VEO Village Executive Officer

WEO Ward Executive Officer

ABSTRACT
Background:
Childhood immunization is a highly effective strategy to reduce mortality and morbidity in
children under five. Despite international and national efforts, many developing countries face low
immunization coverage due to logistical and systemic challenges. Complementary to routine
vaccines, children are recommended to receive BCG and OPV0 at birth; three doses of
pneumococcal, OPV, and Pentavalent vaccines; and two doses of the rotavirus vaccine before their
first birthday. Nutritional status—measured through age, weight, and height—helps identify
stunting, underweight, and wasting. Malaria and helminth infections remain major causes of child
mortality in Africa, with preventive strategies hindered by poor sanitation, limited access to clean
water, and inadequate health education.

Aim: To explore the vaccination status, nutritional health, and behavioral risk factors for infectious
diseases among children under five in Msolwa village.

Methodology: A cross-sectional qualitative study was conducted with 48 participants in Msolwa

village. Data were gathered through in-depth interviews (IDIs) with mothers of children under five
who possessed RCH-1 cards. Thematic content analysis was employed to analyze the data.

Results: Most children received required vaccinations; however, vaccine shortages, travel barriers,
and caregiving responsibilities caused delays for some. Growth monitoring revealed caregivers’
limited understanding of growth charts, though some recognized color coding. Weight issues
stemmed from poor appetite, chronic illness, and financial hardship. While caregivers received
nutritional guidance, gaps remained in practical implementation. Most children received
deworming treatment and used insecticide-treated nets (ITNs), but some caregivers lacked access
or awareness. Risk awareness was generally strong, though a few misconceptions persisted
regarding disease transmission.

Conclusion: Caregiver education gaps, logistical barriers, and economic limitations challenge
optimal child health outcomes. Targeted interventions are needed to improve vaccine coverage,
nutrition monitoring, and infectious disease prevention efforts in low-resource settings.
 CHAPTER ONE

1.0 INTRODUCTION
1.1 Background
Immunization, growth monitoring, and infection control are vital for maintaining public health and
preventing numerous diseases. Regular assessment of community knowledge and practices in
these areas is essential for improving child health outcomes (1,2). This study examines awareness
and practices related to vaccination, growth monitoring, and infection control among children
under five at the household level in Msolwa village, Pwani Region.

Immunization refers to the process of making an individual immune to specific diseases through
vaccine administration (3). Vaccinations are widely recognized as a key strategy for reducing the
burden of infectious diseases, lowering associated morbidity and mortality, and decreasing
healthcare costs. Children who are not fully vaccinated or miss certain doses are at a higher risk of
contracting vaccine-preventable diseases, which claim millions of lives annually. Estimates
indicate that 10 million children under five die each year, with one-third of these deaths linked to
infectious diseases that could have been prevented through vaccination. A child is considered to
have underutilized a vaccine if they miss one or more recommended doses. In Pwani, only 12.6%
of children have received all vaccines according to the immunization schedule.

Additionally, child growth monitoring and infection control are crucial for ensuring optimal health
and development. Growth monitoring involves regularly tracking a child’s weight, height, and
overall development to detect malnutrition, stunted growth, or other health concerns at an early
stage. Infection control focuses on preventing and managing common childhood illnesses such as
malaria and parasitic infections, which significantly contribute to child morbidity and mortality
(4,5). Globally, these issues align with the Sustainable Development Goals (SDGs), particularly
Goal 3, which aims to promote health and well-being for all.

In Africa, child health remains a pressing issue, with factors such as malnutrition, poverty, and
inadequate healthcare access exacerbating growth and infection challenges. Nearly one in three
children under five in sub-Saharan Africa experience stunted growth, while preventable diseases
like malaria and intestinal worm infections continue to strain families and healthcare systems. In
Tanzania, the government has implemented initiatives such as the National Multi-sectoral
Nutrition Action Plan and the National Malaria Strategic Plan to prioritize child health (6–9).
However, challenges persist, including inadequate nutrition, limited healthcare access, and cultural
barriers that affect child growth and infection prevention (10). Programs aimed at educating
caregivers on growth monitoring and infection control such as using growth charts, administering
deworming medication, and promoting insecticide-treated nets seek to address these challenges
and improve child health outcomes.

1.2 OBJECTIVE
1.2.1 Broad Objective
To understand the vaccination status, nutrition status, and risk behaviors of acquiring infections
among under-fives in Msolwa village.

1.2.2 Specific Objectives

1. To understand the immunization status of under-five at Msolwa village
2. To explore the awareness of mothers/caregivers of under-five children regarding growth
monitoring at Msolwa village.
3. To explore infection control practices among mothers/caregivers of under-five at Msolwa
village.
 CHAPTER TWO

2.0 METHODOLOGY
2.1 Study Design
Cross-sectional study design using qualitative methods was carried out to understand
immunization status of children, growth monitoring, knowledge, and practices on infection control
among mothers/caregivers of under-fives.

2.2 Study Area

The research was conducted in Msolwa village in the Chalinze district. The area is located in the
coast region, 111 km from Dar-es-Salaam city. The area has a total population of 6,404 people.
Msolwa village has a total of seven streets with one dispensary known as Msolwa dispensary and
one private medical laboratory which provides the required health services for the whole area (as
per the most recent population and housing census,2022). Common diseases affecting residents
include malaria, helminthic infections, urinary tract infections (UTIs), upper respiratory tract
infections (URTIs), skin infections and Sexually Transmitted infections (STIs).

2.3 Study population

The study population consisted of mothers and primary caregivers of children aged 0-59 months
(under five years old) who possessed a Reproductive and Child Health (RCH-1) card. These
individuals were identified as key informants due to their direct involvement in the daily care and
health management of young children, making them ideal sources for rich, contextualized data
regarding the study's objectives.

2.4 Sample size and sampling technique

This study included a total of 48 participants. Purposive sampling was used to select the
participants based on the age of their children and their possession of the RCH-1 card.
2.5 Data Collection Tools and Procedures
Data were primarily collected through in-depth interviews (IDIs) conducted with each participant.
A semi-structured interview guide was used to ensure consistency across interviews while
allowing for flexibility to explore emerging themes. All interviews were conducted in Swahili, the
local language, by trained researchers and lasted approximately 15 minutes. To ensure accuracy
and capture rich detail, verbal consent was obtained from all participants before the interviews,
which were audio-recorded. Complementary field notes were meticulously taken during and
immediately after each interview to capture non-verbal cues and contextual information. A total
of 48 IDIs were conducted over one days,

2.6 Data Analysis

Detailed notes and voice records of conversations were taken during in-depth interviews with
caregivers/mothers on their child’s health. They were then transcribed and translated. Coding was
done, then categories were formulated from the identified codes and finally, themes were generated
and then discussed among team members to identify common themes, and conclusions on
discrepancies were reached through discussions.

2.7 Ethical Considerations

Prior to commencing data collection, comprehensive ethical approval was obtained from
Muhimbili University of Health and Allied Sciences (MUHAS) Institutional Review Board, or
relevant regional health authority. Additionally, formal permission and cooperation were sought
from the local administrative authorities, specifically the Ward Executive Officer (WEO) and
Village Executive Officer (VEO), within whose jurisdiction the study was carried out. Both
officers provided their consent and offered maximum cooperation, including facilitating access to
households and introducing researchers to the residents.

Informed consent and confidentiality were paramount ethical principles strictly adhered to
throughout the study. Before each interview, participants were provided with comprehensive
information regarding the study's aim, the methodology, the voluntary nature of their participation,
and their right to withdraw at any time without penalty. Verbal consent was formally obtained
from each participant confirming their willingness to participate.
Confidentiality and privacy of all information shared were rigorously assured. No personal
identifying details, including participants' names, were collected. Audio recordings were handled
with utmost discretion, used solely for data interpretation and analysis by authorized research
personnel, and were not accessible to unauthorized individuals. This ensured that participants
could speak freely and openly without fear of their identity or responses being compromised

2.8 Limitations and Mitigation

1. Response Bias: Some participants may have provided responses they perceived as socially
desirable rather than reflecting their true household situation.
o Mitigation: This was partially mitigated by cross-referencing verbal responses with
objective information available in the child's RCH-1 card, where applicable (e.g.,
immunization dates, growth chart entries), adding a layer of verification.
2. Interview Duration: Some participants provided extensive, sometimes irrelevant,
information, potentially extending interview duration beyond the anticipated 15-minute
timeframe.
o Mitigation: Interviewers were trained in effective communication and guided
participants gently back to relevant topics through focused questioning and
redirection, ensuring efficient use of interview time without curtailing valuable
input.
3. Limited Detail in Responses: Conversely, some participants gave very brief answers,
potentially limiting the depth of information gathered.
o Mitigation: This was addressed through skilled deep probing by the interviewers,
using follow-up questions to encourage more elaborate explanations and elicit
richer details pertinent to the study's objectives.
 CHAPTER THREE

3.0 RESULTS
3.1 IMMUNIZATION
The study involved children under five years old and their caregivers, primarily mothers. Most of
the children were between 1 and 50 months old and had received all the required vaccines.
However, a few with delayed vaccinations due to various reasons, including traveling to areas
without immunization services, hospital rescheduling due to vaccine shortage, due to sickness,
forgetting clinic dates, and being unable to attend due to household responsibilities.

One participant explained the reason for a delayed vaccine, stating, "The vaccine was out of stock,
so the nurse asked us to return the following week to get it." Vaccine shortages can arise from
supply chain challenges such as delayed deliveries, inadequate coordination, and poor demand
forecasting at health facilities. Additionally, financial constraints and limited cold-chain storage
capacity contribute to these issues, especially in resource-limited settings.

Most participants adhered to the immunization schedule, following the dates recorded by nurses
on their children's immunization cards. However, some reported delays in receiving certain
vaccines. One mother attributed her delay to household responsibilities, explaining, "I was
overwhelmed by responsibilities here at home." While she did not specify the exact tasks, they
likely included caregiving, household chores, and other family obligations such as cooking,
farming, and caring for other children, which made timely clinic visits challenging.

Most participants reported that their children did not contract communicable diseases before or
after receiving vaccinations according to Tanzania’s national immunization schedule. However, a
few noted that their children experienced illnesses such as malaria, fever, skin infections, diarrhea,
and respiratory conditions like severe coughs and pneumonia during colder periods. One
respondent shared, "As for my child, he doesn’t normally get sick. He just gets some fever and
malaria, which get treated at the hospital and he gets better."
3.2 GROWTH MONITORING
Most study participants had children weighing between 4.8kg and 14kg. However, the majority
lacked knowledge about child growth based on the growth chart and color coding on the RCH
card. One participant admitted, "I don’t know how to interpret this, and I have never been told how
to read it." Among those who understood it, one explained, "The top one (red) means overweight,
the middle one (green) means good growth, and the line below means the child’s growth is
stunted."

Participants provided several reasons for discrepancies between their children's age and weight,
including poor appetite, chronic illnesses, and, in some cases, inadequate nutrition due to financial
constraints. Many respondents mentioned receiving advice on ensuring proper child growth, such
as attending clinic appointments on schedule, providing a balanced diet with nutritious porridge,
practicing proper breastfeeding, and ensuring children receive adequate and timely meals. One
participant shared, "Yes, they encourage and advise me to add some nutrients to the child, for
instance, the use of pumpkin seeds for proper maintenance and growth of the child, but also not to
miss any clinic visits."

3.3 INFECTIOUS DISEASE CONTROL

Most participants reported that their children received anti-helminthic medication during clinic
visits, although they were unfamiliar with the drug’s name. A few did not administer the
medication due to their child’s age.

Many participants received insecticide-treated nets (ITNs) for their children, particularly during
antenatal clinic visits, and continued to use them. However, a few mentioned that they did not
receive ITNs, with one participant stating, "Mmh, I have never received the mosquito net either
during pregnancy or after delivery, because I used to attend private hospital for clinic."

Most participants were aware of behaviors that could lead to worm infestations, such as playing
with dirty materials, ingesting soil, consuming raw or undercooked foods like rice, not washing
hands, eating spoiled food, and walking barefoot. However, a few had limited knowledge of these
risks, as one participant remarked, "I think, overfeeding."
Similarly, most participants understood the habits that contribute to malaria transmission,
including not using treated mosquito nets, staying outside late at night, failing to dressing their
child protective clothing that covers most of the body, exposure to dirty environments, and the
presence of stagnant water. One participant noted, "To my side, dirty environment and tall grasses
act as breeding site for mosquitoes which can result into spread of malaria."
 CHAPTER FOUR

4.0 DISCUSSION

4.1 IMMUNIZATION

In sub-Saharan Africa (SSA), routine childhood vaccination coverage has plateaued at 72%,
raising concerns about the potential resurgence of vaccine-preventable diseases and setbacks in
immunization efforts. A significant factor affecting vaccination rates is parental vaccine hesitancy,
which refers to the reluctance or delay in vaccinating children despite vaccine availability (3). To
address this issue, the World Health Organization (WHO) has made reducing vaccine hesitancy a
global health priority. Timely vaccination is crucial for ensuring sufficient protective immunity
and lowering child mortality caused by preventable illnesses.

Tanzania faces challenges in achieving comprehensive vaccine coverage. Nationally, only 68% of
children receive all basic vaccinations within their first year of life (1). However, this study found
that 95.2% of children were immunized according to the recommendations of the Immunization
and Vaccine Development (IVD) program. This higher rate may be due to various factors,
including caregivers' awareness of vaccination benefits, effective outreach programs aimed at
unvaccinated children, and the study's relatively small sample size of 48 participants.

This study also highlighted the relationship between vaccination timing and health outcomes. Prior
to vaccination, 29% of children experienced diarrhea, fever, flue and cough. 16% after vaccination,
and another 4.76% were uncertain about when symptoms developed. These results align with
national health data, which indicate that 1.5% of children under five showed symptoms of acute
respiratory infections (ARI), 11% experienced fever, and 9% had diarrhea in the two weeks before
the survey (1,2). Despite these illness rates, the majority of affected children received medical
care, reflecting caregivers’ strong health-seeking behaviors, which may be attributed to increased
awareness and improved healthcare access within the study population.
4.2 GROWTH MONITORING

The study found a strong awareness among caregivers regarding the existence and purpose of the
RCH-1 card for growth monitoring. This indicates successful dissemination of information about
growth monitoring programs at the health facility level. However, a critical gap emerged: while
caregivers acknowledged the importance of the card, only a small minority (four out of 48) could
accurately interpret the growth chart's color coding and weight trends. This suggests that the
current method of communicating growth information, while leading to card possession, may not
be effectively translating into caregivers' ability to proactively identify early signs of malnutrition
or growth faltering at home. This knowledge gap is particularly concerning given that early
detection is crucial for timely nutritional interventions. This aligns with challenges observed in
other low-resource settings, where the availability of health tools often outpaces the community's
capacity for their effective utilization without sustained, simplified education.

Furthermore, the reported challenges in ensuring good child growth, particularly financial
constraints and inadequate time for supervision, directly impact caregivers' ability to provide
adequate and balanced nutrition. The poignant example of a caregiver struggling to afford formula
milk after a maternal death vividly illustrates the severe socio-economic determinants of child
nutrition. While caregivers largely received advice on crucial practices like exclusive
breastfeeding, proper diet, and hygiene from health facilities, these efforts are often undermined
by prevailing economic hardships. This underscores that public health interventions must not only
focus on knowledge transfer but also address the underlying socio-economic barriers that limit a
family's capacity to implement recommended practices.

4.3 INFECTIOUS DISEASES CONTROL

The study revealed commendable efforts in infection control, with universal reception and reported
use of Insecticide-Treated Mosquito Nets (ITNs) among the studied children, and high uptake of
anti-helminthic drugs as per national guidelines. These findings reflect the success of national
distribution programs and deworming campaigns in reaching the Msolwa community. However,
nuances emerged; while most caregivers recognized risk factors for malaria (e.g., not using ITNs,
prolonged outdoor stay) and worm infestations (e.g., poor hygiene, eating soil), a significant
portion were unaware of the specific names of deworming drugs, and some held misconceptions
about disease transmission. This suggests a need for more detailed health education that goes
beyond general awareness to build deeper understanding and empower caregivers with specific
knowledge about medications and disease mechanisms.
The identified behaviors contributing to worm infestation, such as poor hygiene during food
preparation, children playing in dirty water, and pica (eating soil), highlight the persistent
challenge of environmental sanitation and hygiene. Despite high ITN use, the continued
prevalence of malaria underscores the multifaceted nature of disease transmission, requiring
integrated approaches that include environmental management and improved sanitation alongside
vector control. These findings resonate with the broader African context where, despite
interventions, preventable diseases like malaria and intestinal worms continue to exert a heavy
burden due to complex interplay of environmental, behavioral, and socio-economic factors.

CONCLUSION
This qualitative study in Msolwa ward provided valuable insights into the status of child
immunization, growth monitoring, and infectious disease control among under-fives and their
caregivers. The findings demonstrate remarkable success in immunization uptake, with all studied
children reportedly fully vaccinated according to national schedules, suggesting robust primary
healthcare service delivery and high community adherence in this specific ward. Similarly, there
is widespread provision and utilization of essential tools like Insecticide-Treated Nets (ITNs) and
anti-helminthic drugs.
However, the study also unveiled critical areas requiring targeted intervention. Despite widespread
awareness of child growth monitoring cards and receipt of nutritional advice, a significant gap
exists in caregivers' ability to interpret growth charts, limiting their capacity for proactive health
management at home. Furthermore, while caregivers possess general knowledge of infectious
disease risk factors, some specific knowledge gaps and misconceptions persist. Overarching socio-
economic challenges, particularly financial constraints and limited time, emerged as significant
barriers consistently impacting caregivers' efforts to ensure optimal child nutrition and health-
seeking behaviors. In essence, while Msolwa shows strong adherence to basic health interventions,
there's a clear need to deepen health literacy and address underlying socio-economic determinants
to enhance overall child health outcomes.

RECOMENDATIONS
Strengthen Vaccine Supply Chains

The government and health facilities should improve vaccine stock management to prevent
shortages. This can be achieved by enhancing supply forecasting, ensuring timely deliveries, and
increasing funding for immunization programs.

Improve Caregiver Education on Growth Monitoring

Health workers should educate caregivers on how to interpret growth charts and recognize signs
of malnutrition. This can be incorporated into routine clinic visits to ensure early intervention for
at-risk children.

Increase Access to Anti-Helminthic Medication

The Ministry of Health should ensure the widespread availability of deworming medication by
integrating it into regular child health visits and community outreach programs.

Promote Nutritional Support Programs

Strengthen initiatives that provide food assistance or nutritional supplements to families facing
economic constraints.

Encourage Exclusive Breastfeeding and Dietary Diversity

Reinforce messaging on breastfeeding and balanced diets to ensure optimal child growth. Address
Socioeconomic Barriers Advocate for policies that improve household income and food security
to mitigate malnutrition risks.
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