Inequities in childhood immunisation coverage associated with socioeconomic, geographic, maternal, child, and place of birth characteristics in Kenya

Abstract

Background: Immunisation of children is a highly cost-effective public health intervention and fosters health equity for the overall population. The WHO Immunisation Agenda 2030 highlights coverage and equity as one of the strategic priority goals to reach high equitable immunisation coverage at national levels and in all districts. We analysed full immunisation coverage among children aged 12-23 months in Kenya and estimated the inequities in full immunisation coverage associated with socioeconomic, geographic, maternal, child, and place of birth characteristics using data from the 2014 Kenya Demographic and Health Survey. Methods: We analysed full immunisation coverage (1-dose BCG, 3-dose DTP-HepB-Hib, 3-dose polio, 1-dose measles, and 3-dose pneumococcal vaccines) of 3,943 children aged 12-23 months. We disaggregated mean coverage by socioeconomic (household wealth, religion, ethnicity), geographic (place of residence, province), maternal (maternal age at birth, maternal education, maternal marital status, maternal household head status), child (sex of child, birth order), and place of birth characteristics. We conducted bivariate and multivariate logistic regression to assess associations between full immunisation coverage and socioeconomic, geographic, maternal, child, and place of birth characteristics. Results: Immunisation coverage ranged from 82% [81-84] for the third dose of polio to 97.4% [96.7-98.2] for the first dose of DTP-HepB-Hib, while full immunisation coverage was 68% [66-71] in 2014. After controlling for other background characteristics, children of mothers with primary school education or higher have at least 54% higher odds of being fully immunised compared to children of mothers with no education. Children born in clinical settings have 41% higher odds of being fully immunised compared to children born in home settings. Children in the Coast, Western, Central, and Eastern regions had at least 74% higher odds of being fully immunised compared to children in the North Eastern region, while children in urban areas had 26% lower odds of full immunisation compared to children in rural areas. Children in the middle and richer wealth quintile households were 43-57% more likely to have full immunisation coverage compared to children in the poorest wealth quintile households. Children who were sixth born or higher had 37% lower odds of full immunisation compared to first-born children. Conclusions: The inequities in full immunisation adversely affect children of mothers with no education, born in home settings, in regions with limited health infrastructure, living in poorer households, and of higher birth order. Further, the COVID-19 pandemic has disrupted routine and campaign immunisation services in 2020 and enhances the risk of vaccine-preventable disease outbreaks, but it also presents an opportunity to tackle the identified inequities in vaccine uptake as immunisation services are restored to capacity.

Do precarious female employment and political autonomy affect the under-5 mortality rate? Evidence from 166 countries

“…Apart from vaccine assistance, governments and quasi-governmental organizations should priorities workforce development to boost kid vaccination rates. Allan et al [ 46 ] discovered that a lower rate of complete immunization is associated with various characteristics, including children born at home, children born in rural regions, children born in disadvantaged households, and children born in higher birth positions. A component of project management will be devoted to identifying and vaccinating these under-vaccinated children to assist in the reduction of childhood vaccination inequities.…”

Pandemia de COVID-19 y abandono de la vacunación en niños: mapas de heterogeneidad espacial

“…Otro tema digno de mención es la vacunación asociada a las condiciones socioeconómicas (47) . En Minas (48) .…”

Missed Opportunities: A Cross-Sectional Descriptive Study on Reasons for Nonadherence to the South African Expanded Program on Immunization

“…10 11 12 13 14 These include low-income households, children living in rural communities, children of mothers with no formal education, children of mothers with poor knowledge of immunizations, and children of mothers who do not receive antenatal or postnatal care. 10 11 12 13 14…”

“…In Nigeria, Kenya, Bangladesh, India, and Indonesia, certain socioeconomic characteristics have been consistently shown to be associated with incomplete immunizations. [10][11][12][13][14] These include low-income households, children living in rural communities, children of mothers with no formal education, children of mothers with poor knowledge of immunizations, and children of mothers who do not receive antenatal or postnatal care. [10][11][12][13][14] Studies focused on the issue of nonadherence to the EPI-SA immunization schedule are limited in South Africa, especially in the Eastern Cape Province.…”

“…[10][11][12][13][14] These include low-income households, children living in rural communities, children of mothers with no formal education, children of mothers with poor knowledge of immunizations, and children of mothers who do not receive antenatal or postnatal care. [10][11][12][13][14] Studies focused on the issue of nonadherence to the EPI-SA immunization schedule are limited in South Africa, especially in the Eastern Cape Province. We, therefore, sought to investigate the factors which underline incomplete immunizations in children under the age of 5 years admitted to DNH.…”