Under vaccination of children among Maasai nomadic pastoralists in Kenya: is the issue geographic mobility, social demographics or missed opportunities?

Abstract

BackgroundNomadic lifestyle has been shown to be a significant factor in low immunization coverage. However, other factors which might aggravate vaccination uptake in nomadic pastoralists are poorly understood. Our study aimed at establishing the relative influence of social demographics, missed opportunities, and geographical mobility on severe under vaccination in children aged less than two years living in a nomadic pastoralist community of Kenya.MethodsWe used cross-sectional analytical study design. An interviewer-administered questionnaire was used to obtain quantitative data from 515 mothers with children aged less than two years. Under vaccination was the sum the total number of days a delayed vaccine was given after the recommended age range for each vaccine. Severe under vaccination was defined as those children who remained under-vaccinated for more than six months. Geographical mobility was assessed as household members who had gone to live or herd elsewhere in the previous 12 months, missed opportunity included questions on whether a child visiting a health facility had missed being vaccinated, while social demographic data included household size and mothers social demographics.ResultsThree-quarters of the mothers had no formal education. One-third of the children had been taken to a health facility and missed being vaccinated. Forty percent of the households had moved in the previous 12 months. Prevalence of missed opportunity was 30.1%; 42.2% of children had not received any vaccines by their first birthday, and 24.1% of children were severely under vaccinated.No significant association was found between social demographics and under-vaccination. Variables associated with under-vaccination were; movement of the whole family, (p = .015), missed opportunity, (p = <.001), lack of vaccines, (p = (.002), and location of health facility, (p = <.001). Movement of women and children made a significant contribution (p = 0.006) to severe under-vaccination. Children in households where women and children had moved were nine times more likely to be severely under-vaccinated than in those households where there was no movement.ConclusionGeographic mobility of women and children was a key determinant of severe under vaccination among nomadic pastoralists in Kenya.

Barriers to Childhood Immunization in Sub-Saharan Africa: A Systematic Review

“…One study noted that the likelihood of vaccination of a child by day 7 is higher among children residing in rural areas than those in urban and pre-urban settings [18]. Socio-cultural factors and religion were noted to have negatively impacted immunization uptake [12,18,19,22,23,37,48]. Ethnicity and cultural beliefs were reported barriers to vaccine utilization and coverage; certain ethnic groups within the same country were identified with low coverages.…”

Barriers to Childhood Immunization in Sub-Saharan Africa: A Systematic Review

“…Forty-eight articles met all inclusion criteria for this study; 28 articles were excluded for various reasons. [See supplementary materials 3] Nine articles employed second-hand data analysis [7,12,18,27,37,40,41,47,42]; thirty-six used crosssectional design [1][2][3]11,[13][14][15][16][17]19,[21][22][23][24][25][26][28][29][30][31][32][33][34][35][36][38][39]42,[45][46][48][49][50][51]53,54] and three used case-control study [20,[43][44]. All described studies were conducted on Africa populations (103,655 adults and 76,327 children).…”

“…One critically examined barriers speci c to vaccination doses at birth 0 -1day [18] in the Gambia. Thirty articles reported national immunization coverage [1][2]7,[11][12][13][14][15][16][20][21][22][23][24][25][28][29]32,[34][35][38][39][40][43][44][45][46]49,50,[52][53][54], eighteen did not [3,[17][18][19]22,24,[26][27][30][31]33,[36][37][41][42]47,48,…”

“…One study noted that the likelihood of vaccination of a child by day 7 is higher among children residing in rural areas than those in urban and pre-urban settings [18]. Socio-cultural factors and religion were noted to have negatively impacted immunization uptake [12,18,19,22,23,37,48]. Ethnicity and cultural beliefs were reported barriers to vaccine utilization and coverage; certain ethnic groups within the same country were identi ed with low coverage.…”

“…We describe health system barriers as inherent factors that obstruct the process of delivering vaccine and vaccine related services to it bene ciaries. These includes broken cold chain, irregular supplies and distribution of vaccines; limited human resource and infrastructures, and long distances separating health facilities from families [1][2][3]11,13,[14][15][16]19,22,23,25,29,32,35,43,44,[47][48][49][50][51][52]. Vaccine shortages at health facility level and di culties of transporting vaccines were commonly reported to signi cantly hinder immunization services [1-174 3,11,14,16,19,22,23,25,33,43,47,48,52,51].…”