To ensure a healthy society and minimize outbreaks of vaccine-preventable diseases, high levels of vaccine uptake is expected. Because vaccination provides protection against infection, especially for vulnerable groups (e.g., children and pregnant women). Vaccination has averted 14 million deaths, prevented 250 million disability-adjusted-life years, generated over $150 billion economic benefits and saves two-three million child deaths yearly. However, one-in-five children globally remain un/partially vaccinated, which contributes to about 1.5 million preventable deaths annually, half of which are in Sub-Saharan Africa. In addition to having the highest child mortality globally, vaccination in the region has stagnated in recent years for several reasons, e.g., vaccine hesitancy. More so, the knowledge gap associated with vaccine hesitancy are yet to be identified, studied, measured, and addressed. Therefore, this dissertation aims to increase understanding on drivers of vaccination decision-making in Sub-Saharan Africa by examining intention, especially among pregnant women, as well as behaviour among caregivers using the 5C psychological antecedence model and additional variables such as rumour, religious belief and masculinity, among other measures. The outcomes of five peer-reviewed articles and one policy brief published in open access journals made up this dissertation. Two articles are reviews, two articles are quantitative, one article is qualitative research, and the final article is a policy brief. The outcomes were mixed. Vaccination decision-making at prenatal (pregnancy) and postnatal (after childbirth) stages are driven by different factors. The behaviour aligned with the concept of Transtheoretical Model (theory of stages of change). The added variables were significant predictors at prenatal (intention) than postnatal (behavior). This dissertation has helped to unravel some missing gaps on why vaccination demand creation does not have as much success, especially at increasing vaccination uptake in the Sub-Saharan Africa region.
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