Slide 1 of 3 
Slide 2 of 3 
Slide 3 of 3 
Amref Institutional Repository
Welcome to the Amref Institutional Repository (IR) — a digital platform dedicated to collecting, preserving, and sharing Amref’s rich body of knowledge and research outputs. The Repository serves as a vital tool for safeguarding the organization’s intellectual legacy, ensuring long-term digital preservation, and promoting open access to scholarly communication across the public health and development community.
Explore Collections
Recently Published
HMD 311: Communication and Advocacy in Health (Sept-Dec 2025)
(2025-12) Department of Health Systems Management and Development
The Vaccine Trust Framework: mixed-method development of a tool for understanding and quantifying trust in health systems and vaccines
(Elsevier Ltd, 2025-09) Muhula PhD, S O; Osur PhD, J; et al...
Summary
Trust is a key component of vaccine demand; however, there is no consensus on how to define trust and a lack of actionable, contextually grounded measurement tools validated in low-income and middle-income countries.
Trust is a key component of vaccine demand; however, there is no consensus on how to define trust and a lack of actionable, contextually grounded measurement tools validated in low-income and middle-income countries.
Aim
To develop and validate a Vaccine Trust Framework and a trust measurement tool that can be used to leverage trust to drive resilient vaccine demand.
To develop and validate a Vaccine Trust Framework and a trust measurement tool that can be used to leverage trust to drive resilient vaccine demand.
Methods
An exploratory sequential mixed-methods study was conducted.
An exploratory sequential mixed-methods study was conducted.
- Ethnographic research in Nigeria, Kenya, and Pakistan to define trust in the context of childhood, HPV, and COVID-19 vaccines.
- Validation through a nationally representative survey of caregivers of adolescents in Kenya and Pakistan.
- Psychometric assessment using confirmatory factor analysis and logistic regression.
Findings
-
The Vaccine Trust Framework consists of
four interlinked domains and
15 measurable dimensions:
Health system promise, health system delivery, vaccine promise, and vaccine delivery. - Survey data were collected from 3670 participants in Kenya and 3734 participants in Pakistan.
- Trust influenced vaccine behaviour and intentions, supported by associations between quantitative trust scores and vaccination status.
- Regional variation in trust was observed within Kenya and Pakistan, aligning with qualitative perceptions of local vaccine and health systems.
Interpretation
The Vaccine Trust Framework provides a validated and contextually grounded tool for assessing trust in health systems and vaccines in low-income and middle-income countries.
It can be used as a:
The Vaccine Trust Framework provides a validated and contextually grounded tool for assessing trust in health systems and vaccines in low-income and middle-income countries.
It can be used as a:
- Prognostic tool to anticipate vaccine demand
- Intervention design aid to support trust-building strategies
- Trust measurement tool within intervention or monitoring studies
Effectiveness of Monitoring Mechanisms in Reducing Immunization Dropouts Among Infants in Health Facilities of Maridi County, South Sudan
(Amref International University, 2025-07) Igga, Daniel Opinile Mark
Introduction: Immunization is one of the most efficient and successful health interventions for reducing child morbidity and mortality. Although global performance of immunization in 2019 was 86%, the coverage reduced to 84%. Despite the efforts employed to improve the immunization coverage, remained below 85%. Dropout rates continue to be an obstacle towards high vaccination coverage.
Objectives: The study aimed to ascertain the effectiveness of monitoring mechanisms in reducing immunization dropouts among infants in the health facilities. The study targeted vaccinators in the health facilities of Maridi county. A prospective cohort study design with stratified random sampling technique was used for sampling eligible participants. A semi-structured interview guide and observation checklist were used to collect quantitative and qualitative data from respondents. Data was analyzed using descriptive statistics, bivariable, multivariable regression analyses was used to determine association between variables and chi square test to answer the research questions and hypotheses.
Results: The results showed that 21% of health facilities did not have monitoring charts, 28.6% had more than 10% dropout rate and only 50% had desired dropout rate of less than 10%. 57% of the health facilities checked their monitoring chart at least 3 times in a quarter. 64% of health facilities had BHWs attached in their catchment area. The study observed a drop in the number of health facilities with high dropout by 9.6%. Lack of efforts from health workers to identify and link defaulters, lack of monitoring charts, absence of BHWs in some health facilities, no referrals from BHWs were associated with high dropout rates.
Conclusion: The study concluded and recommended that monitoring mechanisms in health facilities were effective in reducing the rates of infant dropping out of the immunization program hence health workers should use monitoring tools. Scale up boma health initiative to health facilities without boma health workers.