Background. Globally, immunization is among the major contributors to public health, preventing 20% of childhood mortality annually. The highest fatality rates from vaccine preventable diseases are usually among children under five. Despite immunization guidelines put in place by the World Health Organization, globally, 1.5 million children die annually related to inadequate vaccination coverage. Existing literature indicate that there is an increase in nonadherence to immunization schedule in developing countries, and therefore, there is an increased demand to improve adherence to immunization schedule. Objective. To explore strategies that will improve adherence to immunization schedule among children under 24 months attending the Maternal and Child Health clinic at Kenyatta National Hospital. Methods. A cross-sectional mixed method study involving caregivers (n=214) of well babies attending the Maternal and Child Health clinic. Data was collected using semistructured questionnaires, focus group discussions, and key informant interviews and analyzed using SPSS V.20. Results. There was a significant relationship between the level of education and marital status of the caregivers and adherence to immunization schedule. Barriers found that is related to adherence to immunization schedule included far distance from health facility, baby’s sickness, and vaccine stock-outs while employment of a caregiver was a constrainer factor. Conclusion. The enabling factors to current strategies of improving adherence to immunization schedule were having more health facilities near residential areas, using text messages reminders a day before the clinic date to remind caregivers of the due date for the clinic, and constant availability of vaccines. The health system strategies that would improve adherence to immunization schedules were more flexible clinic hours, availability of vaccines on daily basis, phone call reminders by health care providers, and increasing awareness on the importance of both vaccinations and adherence to immunization schedule.

Background of the study: Most drugs given as Microinfusion require infusion pumps to administer. They are very potent with very narrow therapeutic index and any small changes on the process results in enormous effects to patients. The nursing profession has a duty to advocate for patients rights as well as do no harm. One of the core goals of nurses is medication administration; this puts nurses in the last line of defence against medication administration errors (MAEs). This study aimed to look into the roles played by nurse that hamper the efforts to reduce the Microinfusion MAEs on which minimal studies have been done. Objective: This study determined the competency level influencing the administration of Microinfusion medication by critical care nurses at Kenyatta National Hospital’s (KNH) Intensive Care Unit (ICU). Significance of study: Local data in the area of Microinfusion MAEs is not available, specifically KNH’s ICU. This study therefore sought to breech this gap and hopes to influence policy on management of critical patients, patient safety, environment, and curriculum development so as to reduce Microinfusion MAEs. Methodology: This study used a descriptive cross-sectional study design, simple random sampling was used to pick 64 participants. Quantitative data was analyzed by both descriptive and inferential statistics, which included regression analysis. Descriptive statistics were presented by use of the mean, percentages and standard deviation. Chi-square was used to determine statistical significance of the differences in proportions and logistic regression was used to identify factors that lead to Medication administration errors. Necessary ethical approval was sought. Results: The prevalence of MAEs was at 64.1% in the last six months, 65.6% 0f the respondents reported lack of supportive supervision, 37.5% of the respondents reported not to know mechanisms in place for reporting Microinfusion medication errors. This prevalence was of statistical significance when cross tabulated with critical care nurses competency level (p<0.05) on aspects such as; having prescription checks [95%CI= 0.000-17.9; p=0.008], working experience, type of medication error, checking weight of patients [p=0.019], reporting of the errors [95%CI = 0.1-0.8; p=0.019], documenting drug errors and monitoring patients after drug administration. Conclusion and recommendation: The prevalence of Microinfusion administration errors in KNH-ICU is high. There is need to ensure that nurses are always equipped with adequate knowledge and experience in drug administration through trainings and mentorship programs as this will reduce  medication errors and increase  safety of patient  in health facilities.