Submitted by Ana Maria Fiscina Sampaio (fiscina@bahia.fiocruz.br) on 2014-05-22T16:45:28Z No. of bitstreams: 1 Rodrigo de Araujo Silva. Avaliação.. 2013.pdf: 704260 bytes, checksum: 65c652d8db75845b4afbf79b59d83a94 (MD5) / Made available in DSpace on 2014-05-22T16:45:28Z (GMT). No. of bitstreams: 1 Rodrigo de Araujo Silva. Avaliação.. 2013.pdf: 704260 bytes, checksum: 65c652d8db75845b4afbf79b59d83a94 (MD5) Previous issue date: 2013 / Fundação Oswaldo Cruz. Centro de Pesquisa Gonçalo Moniz. Salvador, BA, Brasil / A leishmaniose visceral (LV) é atualmente um grande problema de saúde pública, tendo o cão como seu principal reservatório em áreas urbanas. O controle da enfermidade é baseado no diagnóstico e eutanásia de cães infectados por Leishmania infantum que apresentam soropositividade para infecção. Como tentativa de conter o aumento do número de casos de LV canina (LVC), duas vacinas comerciais vêm sendo empregadas como medida de controle. Os testes diagnósticos preconizados pelo Ministério da Saúde no Brasil para identificação da infecção em cães é o teste sorológico rápido (DPPLVC ©) como triagem e ELISA (EIA-Biomanguinhos) como confirmatório. Estes métodos não foram desenvolvidos para diferenciar cães vacinados e infectados. Assim, animais que se tornam sorologicamente positivos em razão da vacinação podem vir a ser eutanasiados. Sete antígenos recombinantes foram previamente selecionados a partir de bibliotecas de cDNA e DNA utilizando soros de homens e cães infectados por L. infantum e foram empregados no presente estudo para terem sua reatividade testada contra soros de animais vacinados, utilizando o teste de triagem multi antigen print imunoassay (MAPIA). Primeiramente, esses antígenos recombinantes foram produzidos a partir da transformação de Escherichia coli (BL21(DE3)pLysS) com construções em plasmídeo pRSET, contendo cauda de histidina. Os sedimentos bacterianos contendo os sete antígenos recombinantes previamente selecionados foram purificados por cromatografia de afinidade. No presente estudo, foi utilizado um conjunto de soros de cães sem raça definida que foram vacinados com LEISHMUNE® (n = 28) ou Leish- Tec® (n = 30) e, cumpriram os critérios de inclusão (negativos para Leishmania em ELISA, cultura e qPCR). Assim, foi avaliada a reatividade desses soros frente ao antígeno bruto, utilizando ELISA, e aos sete antígenos recombinantes de L. infantum, utilizando o MAPIA. Em relação à reatividade ao antígeno bruto, 43,3% (13/30) dos soros de cães vacinados com Leish-Tec® e 96,4% (27/28) dos soros de cães vacinados com LEISHMUNE® testaram positivo no ELISA. Além disso, em relação à reatividade aos antígenos recombinantes, 54% dos soros de cães vacinados com LEISHMUNE® identificaram pelo menos uma das três proteínas rLci1A, rLci2B ou rLci12A-II, enquanto que 77% dos soros de cães vacinados com Leish-Tec® identificaram pelo menos uma das duas proteínas rLci6A-I ou rLci12A-II. Como em estudo anterior, identificamos que rLci1A, rLci2B e rLci12A-II foram altamente reconhecidas por soros de cães infectados com LVC, as análises de positividade contra os soros de animais vacinados foram também realizadas sem considerar essas proteínas. Assim, a reatividade dos soros de cães vacinados, sem considerar as proteínas rLci1A, rLci2B e rLci12A-II, identificadas como candidatas promissoras para comporem um teste para o diagnóstico de LVC, mostrou que o conjunto formado pelos antígenos rLci6A-I, rLci7A ou rLci10A-II foram reconhecidos por 70% dos soros de cães vacinados com Leish- Tec® e apenas 4% de cães vacinados com LEISHMUNE®. Em resumo, esse conjunto de antígenos recombinantes de L. infantum (rLci6A-I + rLci7A + rLci10A-II) não permitiu a diferenciação dos soros de cães vacinados com LEISHMUNE® de cães infectados, porém, permitiram a diferenciação dos soros de cães vacinados com Leish- Tec® de cães infectados, empregando a técnica do MAPIA / Visceral leishmaniasis is currently a major public health problem, and the dog the main reservoir in urban areas. The control of the disease is based on the diagnosis and euthanasia of all Leishmania infantum-infected dogs showing seropositivity to infection. In attempt to contain the increase in the number of cases of canine visceral leishmaniasis (CVL), two commercial vaccines have been employed as a measure of prophylaxis. The diagnostic tests recommended by the Brazilian Ministry of Health to identify the infection in dogs are the rapid test DPP-LVC© for screening and EIABiomanguinhos to confirm. Serological methods currently used are not able to differentiate infected from vaccinated dogs, resulting in the euthanasia of animals that become serologically positive due to vaccination. Seven recombinant antigens were previously screened from a cDNA and DNA library using sera from Leishmania infantum-infected human and dogs and employed in this study to have their reactivity tested against sera from vaccinated dogs using the screening test multi antigen print imunoassay MAPIA. Selected fragments were produced using Escherichia coli (BL21 (DE3) pLysS), which were transformed with plasmid constructions in pRSET with a histidine tag. The recombinant antigens were purified by affinity chromatography. Dogs tested negative for Leishmania in ELISA, culture and qPCR were vaccinated with LEISHMUNE® (n= 28) or Leish-Tec® (n= 30). Reactivity of serum from 58 vaccinated dogs was assessed against a set of seven recombinant antigens of L. infantum, using MAPIA. The results using in house ELISA diagnostic test containing crude L. infantum as antigen showed that 43.3% (13/30) of sera from Leish-Tec® vaccinated dogs and 96.4% (27/28) of sera from Leishmune® vaccinated dogs tested positive. In addition, it was observed that 54% of sera from Leishmune® vaccinated dogs identified at least one of the three proteins, rLci1A, rLci2B or rLci12A-II, whereas 77% of the sera from Leish-Tec® vaccinated dogs identify at least one of the two proteins, rLci6A-I or rLci12A-II. Since in a previous study we found that rLci1A, rLci2B, and rLci12A-II shown to be highly recognized by sera from dogs with CVL, analysis of positivite reactivity against serum of vaccinated dogs were also performed without considering these proteins. Therefore, 70% of sera from Leish-Tec® vaccinated dogs recognized at least one of the recombinant proteins rLci6A-I, rLci7A or rLci10A-II. However, the percentage of sera from Leishmune® vaccinated dogs that recognized other recombinant proteins than rLci1A, rLci2B, and rLci12A-II did not exceed 4%. In summary, a set of recombinant antigens from L. infantum used in this study did not allow the differentiation of sera from LEISHMUNE® vaccinated dogs and those from infected dogs, however, together the recombinant antigens, rLci6A-I, rLci7A and rLci10A-II of L. infan,tum allowed the differentiation of sera from Leish-Tec® vaccinated dogs from those of infected dogs, employing the technique of MAPIA.

The area of self-esteem in people with learning disabilities has been largely neglected, and previous researchers have employed a variety of approaches. It is important to further our understanding in the context of providing appropriate clinical interventions and in monitoring the effect of social policy developments on the individuals at the receiving end of service provision. The study aimed to assess the reliability and validity of a set of measures devised specifically for use with learning disabled people, by Szivos-Bach (1993). The measures assess social comparisons, perception of stigma and aspirations and expectations. The study was carried out with 30 adults with mild and moderate learning disabilities between the ages of 18 and 65. The results provide initial support for the social comparisons test as a measure of self-esteem. Less evidence was found for the stigma questionnaire and the aspirations-expectations test. The results are discussed in the light of comparable research into self-esteem measures with non-learning disabled populations. Further research is required, and the most profitable way forward seems to be development of multi-dimensional measures of self-esteem.

Sequencing B and T cell receptor genes allows for detailed characterisation of the genetic diversity underlying adaptive immune responses in health and disease. In the context of infectious diseases this can act as a powerful tool for identification of pathogen-specific immune signatures and genetic determinants of immune memory, protection and response to re-exposure. As part of my PhD I developed and optimised a method for high-resolution profiling of B cell receptor (BCR) immune repertoires based on the barcoded sequencing of the human immunoglobulin genes. The use of molecular barcodes allowed for reduction of technical noise, which can lead to erroneous assignment of lymphocyte function. I applied this methodology to the study of natural infection with measles virus in unvaccinated children. Childhood measles causes a profound immune suppression, which can last for weeks to months post infection, with large reductions in numbers of circulating B cells. Interestingly, long-term consequences of measles immune suppression result in increased incidence of secondary infections up to 3 years after resolution of measles. Vaccination against measles virus with the MMR vaccine has been a major factor in reducing direct and secondary childhood morbidity and mortality. The maintenance of sufficient global vaccine coverage, however, has been challenging due to the refusal of vaccination, mainly in religious communities, resulting in increasing number of outbreaks worldwide. In addition to the overall drop in measles virus herd immunity, measles-induced immune suppression can compromise immunity to other infectious pathogens, thus complicating global vaccination and surveillance efforts. The exact mechanisms underlying the prolonged immune-suppression associated with measles remain elusive and have not been investigated in humans. I applied BCR sequencing to characterise the long-term immunological effects of natural measles virus infection in a cohort of unvaccinated children. Specifically, I addressed the restructuring of immune memory and the possible loss of immunity to non-measles pathogens. My work provided evidence for previously hypothesised depletion of B cell memory pools, referred to as ‘immunological amnesia’. Loss of clonally expanded B memory populations lead to immune re-setting and convergence in repertoire diversity between measles-infected and control groups. In addition to the loss of individual-specific variation in immune memory, a subset of measles-infected individuals exhibited dramatic collapse in the diversity of their naïve B cell compartment, despite the recovery of normal B naïve cell counts. An effect of measles on serological immunity was also demonstrated in a ferret model of measles, where lymphotropic challenge lead to significant loss of vaccine-acquired immunity to influenza virus. The work presented in this dissertation demonstrates the utility of BCR sequencing for understanding adaptive immune responses in the context of infectious diseases and highlights the potential of this approach to uncover novel mechanisms of immune (dys)function.

Submitted by PAULA FERNANDES CHADI null (pchadi@hotmail.com.br) on 2018-03-19T19:39:18Z No. of bitstreams: 1 Vacina dTpa em gestantes na redução da coqueluche na criança_ Paula Fernandes Chadi.pdf: 5748928 bytes, checksum: 303a79e29b44a02e7c23e3f872799555 (MD5) / Approved for entry into archive by Luciana Pizzani null (luciana@btu.unesp.br) on 2018-03-20T12:38:55Z (GMT) No. of bitstreams: 1 chadi_pf_dr_bot.pdf: 5748928 bytes, checksum: 303a79e29b44a02e7c23e3f872799555 (MD5) / Made available in DSpace on 2018-03-20T12:38:55Z (GMT). No. of bitstreams: 1 chadi_pf_dr_bot.pdf: 5748928 bytes, checksum: 303a79e29b44a02e7c23e3f872799555 (MD5) Previous issue date: 2018-03-02 / Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES) / Introdução: A epidemiologia é uma ciência que estuda os processos de saúde e doença na população, sejam eles individuais ou coletivos. A lista Nacional de Notificação compulsória teve sua última atualização em 17 de fevereiro de 2016 por meio da portaria nº 204, que define novas doenças, agravos e eventos de saúde nos serviços públicos e privados em todo o território nacional, sendo a comunicação destes acontecimentos obrigatória. A coqueluche, que se encontra na lista das doenças de notificação compulsória, define-se por uma doença infecciosa aguda do trato respiratório inferior sendo seu agente etiológico a bactéria Bordetella pertussis. Apesar dos esforços dispendidos pelo Programa Nacional de Imunizações, da Vigilância Epidemiológica e outros Centros de Vigilância internacionais, no mundo, ainda, estima-se que a cada ano ocorram de 20 a 50 milhões de casos de coqueluche, com aproximadamente 200 a 400 mil mortes, sendo a maior parte em lactentes que não foram vacinados ou com a vacinação incompleta. Mesmo com a disponibilidade da vacina contra difteria, tétano e pertussis incluída no calendário vacinal da criança através da pentavalente, a imunidade não é permanente, surgindo então a pergunta deste estudo: Apenas a vacinação na gestante com dTpa elimina a coqueluche em crianças até dois anos? Objetivo: Analisar em dois municípios do interior do Estado de São Paulo, se as crianças menores de dois anos, filhos de mulheres vacinas pela dTpa tiveram coqueluche. Método: Trata-se de um estudo epidemiológico, observacional descritivo antes e depois de delineamento transversal, sobre avaliação das crianças que desenvolveram a coqueluche, notificadas nos municípios de Botucatu e Marília, interior do estado de São Paulo, no período retrospectivo (2008 a 2014) e prospectivo à vacina da dTpa na gestante (2014 a 2016). Resultados: Percebe-se que há uma carência de publicação sobre a abordagem da coqueluche na criança, sua prevenção, tratamento e controle. Todas as fichas de notificação avaliadas no estudo estavam parcialmente preenchidas, comprometendo a qualidade das informações. Em relação à avaliação comparativa entre os dois municípios em estudo, percebe-se que, no período retrospectivo o número de casos confirmados de coqueluche nos dois municípios totalizou-se em 56 casos, dos quais 25% (14) em Botucatu e 75% (42) em Marília. Já no período prospectivo, após a implantação da vacina ainda houve casos confirmados nos dois municípios, perfazendo 21 casos – 71,42% (15) em Botucatu e 28,58% (6) em Marília – e mesmo havendo redução, os casos ainda persistem apresentando exposição do público vulnerável, crianças menores de um ano a coqueluche. Conclusão: A introdução da dTpa no calendário vacinal da gestante não foi suficiente para impedir a transmissão do microorganismo Bordetella pertussis às crianças com idade inferior a dois anos, conforme a proposta do Ministério da Saúde. / Introduction: Epidemiology is an area of public health aimed at understanding health-disease processes within the population, an aspect that differentiates it from the clinic, since its objective is the study of these processes, individual or collective. The National Compulsory Notification list was last updated on February 17th, 2016 through ordinance No. 204, which defines new diseases, injuries and health events in public and private services throughout the national territory, and the communication is mandatory. Pertussis on the list of compulsorily notifiable diseases is defined as an acute infectious disease of the lower respiratory tract, its etiological agent being Bordetella pertussis. Despite the efforts made by the National Immunization Program (PNI), Epidemiological Surveillance and other International Surveillance Centers, it is still estimated that 20 to 50 million cases of pertussis occur every year, with approximately 200 to 400,000 deaths, most of them in infants who were not vaccinated or had incomplete vaccination. Even though the DTP vaccine is in the child's immunization schedule, immunity is not permanent, so the question arises in this study, only vaccination in the pregnant woman reduces the infection of the Bordetella pertussis bacterium in children up to 4 (four) years? Objective: To analyze in two municipalities of the interior of the State of São Paulo, if children under two years of age, children of dTpa vaccine women had pertussis. Method: This is a descriptive and observational epidemiological study before and after a cross-sectional study on the evaluation of children who developed the disease by the Bordetella pertussis microorganism reported in the municipalities of Botucatu and Marília, in the state of São Paulo, in the period retrospective and prospective study of the dTpa vaccine in the pregnant woman from 2008 to 2016. Results: It is noticed that there is a lack of publication about the pertussis approach in the child its prevention, treatment and control. All of the notification sheets evaluated in the study were partially completed. Regarding the comparative evaluation between the two municipalities under study, it can be seen that in the retrospective period from January 2008 to October 31th, 2014, the number of confirmed cases in the two municipalities was analyzed, in a total of 56 cases, of which 14 (25%) in Botucatu and 42 (75%) in Marília. Since the prospective period analyzed after the implementation of the vaccine from November 1th, 2014 to December 31th, 2016, there are still positive cases in the two municipalities, 21 cases, of which 15 (71.42%) were in Botucatu and six (28.58 %) in Marília, that even reducing still persist presenting risk to the vulnerable public. Conclusion: The introduction of dTpa into the pregnant woman's immunization schedule was not sufficient to prevent transmission of the Bordetella pertussis microorganism to children under two years of age, as proposed by the Ministry of Health.

The purpose of this project is to develop a clinical practice guideline with recommendations for vaccination and vaccine hesitancy in the pediatric setting. Routine vaccinations are given to children at recommended ages to decrease the incidence of, and prevent infectious disease. These vaccinations prevent diseases such as rotavirus, diphtheria, pertussis, tetanus, hepatitis B, haemophilus influenza type B, pneumococcal disease, polio, influenza, measles, mumps, rubella, varicella and hepatitis A. There are currently no guidelines that combine evidence-based interventions to increase vaccination rates, the recommended vaccine schedule, specific information on each vaccination, its side effects, and ingredients of each vaccination. By developing this guideline, it is hoped that pediatric providers will be able to effectively approach the caregivers of vaccine-aged children with evidence based information about vaccination, and be able to address specific concerns regarding vaccines. The available literature was formally evaluated using GRADEpro software. These results were put into the BRIDGE-Wiz (Building Recommendations in a Developer ’s Guideline Editor) software to create clear, concise, key action statements for the guideline. There were five recommendations that were created based on the literature review which include assessing parental concerns regarding vaccination at each visit, educating parents on vaccination, each vaccine, at each visit and when concerns arise, recommending vaccinations during each visit and when the opportunity arises, recommending pre-scheduling vaccination appointments, and implementing a reminder/recall system when vaccinations are due or past due. There were also informational tables created for provider reference that include important information regarding vaccines. The first table includes each vaccination, the disease it prevents, and the risk of the disease vs the risk of the vaccination. The second table includes the vaccine ingredients that commonly cause concern, and information to address those concerns. The guideline can be used in pediatric primary care to guide interventions to increase the uptake of vaccinations, and as a tool for providers to use while educating parents on specific vaccinations. The guideline was formally evaluated using the AGREE II tool by three experts in the field of pediatric primary care. All three of the reviewers stated that they would recommend the guideline for use in the pediatric setting.

Background: The HPV vaccine is a primary prevention method available to reduce the burden of HPV-related cancers and genital warts. The vaccine is currently approved for catch-up vaccination among women 18 to 26 years of age. Despite this recommendation, the rate of vaccine uptake among this group is considerably low (~34% uptake). One demographic characteristic that is consistently reported as a risk factor for non-vaccination is relationship status, specifically married or monogamous relationships. While the epidemiological data confirm this association, there is a lack of understanding how this risk factor operates. By elucidating the mechanism for this risk factor, HPV vaccine uptake among this consistently unvaccinated group could be improved. Purpose: The purpose of this study was to understand how young adult women’s relationship status influence informational needs, motivations, and behavioral skills related to HPV vaccination. This objective was achieved through the following specific aims: (1) assess how relationship status affects primary reasons for non-vaccination among 18 to 26 year old women; and (2) understand how relationship status frames HPV vaccine decision-making among 18 to 26 year old women. Methods: To effectively achieve these specific aims, a concurrent mixed-methods study design was conducted. In Phase I, a secondary data analysis using the 2010 National Health Interview Survey was employed to determine if women in relationships are less likely to be interested in vaccination and identify the primary reasons (e.g., misinformation, motivations, behavioral skills) for non-vaccination among different relationship status categories. In Phase II, in-depth interviews were conducted with a sample (N=50) of 18 to 26 year old women at the University of South Florida, stratified by relationship status and vaccination status. A comparative thematic analysis was conducted to determine if there were differences in informational needs, motivations, behavioral skills, and HPV vaccine decision-making between the groups. Results: Using NHIS 2010 data, women who were living with a partner (PR 1.44 95%CI 1.07-1.87) and never married (PR 1.41 95%CI 1.12-1.73) were less likely to be interested in HPV vaccination compared women who were married. Moreover, primary reasons for non-vaccination differed significantly by relationship status group (p Conclusion: This study found that relationship status impacts HPV vaccine decision-making among young adult women. Specifically, it operates by modifying risk perceptions for HPV, which serve as barriers to vaccination. Young adult women have the knowledge and behavioral skills necessary to access and understand the importance of HPV vaccination; however, women were unable to accurately perceive their risk for HPV, resulting in impaired motivation for vaccination. A potential approach to address this issue is the use of health literacy. Future research should integrate health literacy techniques with healthcare providers serving this population to assist in the evaluation process for risk of HPV. This will facilitate shared decision-making and patient-provider communication surrounding the HPV vaccine. This can ultimately promote HPV vaccination among young adult women and reduce the morbidity and mortality of HPV-related diseases.

Class of 2014 Abstract / Specific Aims: Tetanus, diphtheria, and pertussis are diseases, which are preventable through proper vaccination. In spite of the availability these vaccines, however, there has recently been a surge in the number of pertussis cases in the United States. The objective of this study is to determine provider adherence to tetanus, diphtheria and pertussis guidelines set forth by the Advisory Committee on Immunization Practices in a primary care setting before and after a clinical pharmacist intervention. Methods: A retrospective cohort of chart reviews was conducted between January 1 – September 30, 2013 to determine immunization adherence to tetanus, diphteria, and pertussis vaccination guidelines. A clinical pharmacist then preformed a series of cross-sectional chart reviews as an intervention. Following the intervention, a retrospective chart review was conducted to evaluate if Tdap vaccination rates improved between March 17-23, 2014. Main Results: Overall immunization rates greatly improved following the intervention (p<0.0001; x2=44.988). For non-pregnant adults between the ages of 19-64 the vaccination rate improved from 26% to 61.1% (p<0.0001; x2=47.07). A statistically significant improvement was not seen in the groups with patients 65 or older or pregnant women (p>0.05). Tdap vaccination status was appropriately evaluated and vaccinations given by primary doctors improved from 17.7% to 61.2% and those prescribed by nurse practitioners improved from 22.4% to 56.3%. Conclusion: Intervention by a Clinical Pharmacist helped improve overall provider adherence to the tetanus, diphteria, and pertussis vaccination guidelines.

Class of 2016 Abstracts / Objectives: To compare the minimum vaccination age to receive an influenza vaccine of rural and urban pharmacies. Rural pharmacies are defined in all Arizona pharmacies in counties other than Pima or Maricopa, urban pharmacies are defined as all pharmacies within the Tucson city limits. Methods: Pharmacies were called for a phone interview asking what the minimum age someone needs to be to receive an influenza vaccination from their store is. Pharmacies were called during their operating hours during a 4-week period at the end of January and early February. Results: 269 pharmacies were included in the study. Pharmacies consisted of 153 rural pharmacies and 116 urban pharmacies. The median minimum vaccination age for both rural and urban pharmacies was 8. Overall, there was found to be no significant difference between the minimum vaccination age between rural and urban pharmacies (p = 0.242). Conclusions: The minimum age to receive an influenza appears to be similar between rural and urban pharmacies.

Class of 2016 Abstract / Objectives: To determine the prevalence and incidence of community pharmacies not vaccinating children down to six years of age and to identify the reasons for non-compliance with Arizona State Board administrative rule R4-23-411. Subjects: 103 community retail pharmacies from six corporations in the Tucson metropolitan area established by December 2014. Methods: Funnel questionnaire administered via phone call to collect pharmacist response if he or she would vaccinate a six-year-old child; data for reasons why he or she would or would not vaccinate and gender of pharmacist was also collected. Results: Responses were collected from 103 pharmacists (male n = 55, female n = 48). 87% (n =90) of pharmacies stated they would not vaccinate a six-year-old, while 13% (n =13) would vaccinate. The rationale for not vaccinating varied from corporate policy (45%) to state law (37%). Conclusions: The majority of six retail pharmacy chains in Tucson, Arizona are not vaccinating down to six-years old, although Arizona administrative amendments allow pharmacists to do so. More pharmacies that would choose not to vaccinate may be related to a better understanding of corporate policies versus state administrative rule change.

Magister Public Health - MPH / Immunisation is considered to be amongst the most successful and cost-effective disease prevention interventions available. The Expanded Programme on Immunisation (EPI) in Namibia was established in 1990 to ensure that the immunisation of children takes place within the prescribed age frame. However, continued measles outbreaks, particularly in the Kavango region, are evidence of poor EPI progress, with vaccination coverage being below80% per district. The reasons for the low uptake of measles immunisation in the Nyangana district in the Kavango region are not clearly understood. The aim of this study was, therefore, to investigate the perception of mothers/caregivers of factors that impact on the uptake of measles immunisation in the Nyangana Health District, with a view to improving measles immunisation coverage. Methodology: A qualitative exploratory study design was used to collect data from the study participants. In-depth interviews were conducted with 10 mothers of children under 5 years of age, for both children who received, and those who did not receive measles vaccination. Data was audio-taped and transcribed verbatim. The recorded interviews were translated from the Gciriku language to English. Data was analysed through the use of the Thematic Content Analysis approach. The transcribed interviews and narratives from the research assistant’s notes were organised into codes, sub-themes and main themes. In the final phase, themes were integrated and interpreted, by identifying facilitating factors for those who took their children for immunisation, and barriers for those who did not take theirs. The researcher facilitated assistance to children who did not receive their measles dose, to receive it. Ethical requirements were adhered to throughout the research study process. Results: The study showed that mothers had both positive and negative perceptions about immunisation. The findings revealed that information, and past experience of measles ,irrespective of the level of education, support from a spouse or family members, availabilityof services and convenience of time schedules, increased the uptake of immunisation on thepart of mothers/caregivers. However, it also emerged that supply-side factors, such as lack of information sharing between health care providers and mothers, hindered effective communication. Additionally, inconvenient time schedules and time constraints, staffshortages, health care providers’ attitudes, inaccurate data being kept of children immunisedat other health facilities, inadequate outreach services and perceived lack of supervision in the health facilties all contributed to the low uptake of immunisation. Demand-side factors that affected the uptake of immunisation included: socio-economic constraints that led to an inability to pay transport costs to access immunisation services; lack of support from a spouse; other family members and other support structures in the community also impacted on immunisation uptake, despite the reported awareness and willingness to use immunisation services. Conclusions and recommendations: The study concludes that the relationship between health care providers and mothers/caregivers, and support from other social structures, should be good, in order to motivate mothers to use immunisation services. The study recommends that the following aspects be addressed, as they have the potential to improve the low uptake of measles immunisation: patient/provider relationship, information sharing, and supervision in the health facility, access to services, availability of outreach services, improved data tracking and active involvement of all stakeholders. Laziness was overwhelmingly offered as an explanation for missing measles immunisation, although there are suggestions that there might be underlying causes for what is perceived as laziness, which require further exploration, especially in terms of socio-cultural barriers to immunisation. It is recommended that an in-depth look at the perceptions of health care providers and key informants should be conducted to search for further understanding of contributing factors.