Understanding Inequities in Child Vaccination Rates among the Urban Poor: Evidence from Nairobi and Ouagadougou Health and Demographic Surveillance Systems

Abstract

Studies on informal settlements in sub-Saharan Africa have questioned the health benefits of urban residence, but this should not suggest that informal settlements (within cities and across cities and/or countries) are homogeneous. They vary in terms of poverty, pollution, overcrowding, criminality, and social exclusion. Moreover, while some informal settlements completely lack public services, others have access to health facilities, sewers, running water, and electricity. There are few comparative studies that have looked at informal settlements across countries accounting for these contextual nuances. In this paper, we comparatively examine the differences in child vaccination rates between Nairobi and Ouagadougou’s informal settlements. We further investigate whether the identified differences are related to the differences in demographic and socioeconomic composition between the two settings. We use data from the Ouagadougou and Nairobi Urban Health and Demographic Surveillance Systems (HDSSs), which are the only two urban-based HDSSs in Africa. The results show that children in the slums of Nairobi are less vaccinated than children in the informal settlements in Ouagadougou. The difference in child vaccination rates between Nairobi and Ouagadougou informal settlements are not related to the differences in their demographic and socioeconomic composition but to the inequalities in access to immunization services.

Geographic location of health facility and immunization program performance in Hoima district, western Uganda, a facility level assessment

“…Such inequalities were observed in a comparative study of immunization coverage in the urban slums of Ouagadougou and Nairobi and were responsible for the difference in vaccine coverage. [29] According to studies on immunization coverage in sub Saharan Africa, factors that affected immunization programs include support supervision, organization of outreaches, nancing, logistics and cold chain maintenance, advocacy and communication, planning and management and use of surveillance data for decision making. [30,31] However, our study did not nd a signi cant association between immunization program performance and these factors.…”

Geographic location of health facility and immunization program performance in Hoima district, western Uganda, a Health Facility level assessment

“…Such inequalities were observed in a comparative study of immunization coverage in the urban slums of Ouagadougou and Nairobi and were responsible for the difference in vaccine coverage. [32] According to studies on immunization coverage in sub Saharan Africa, factors that affected immunization programs include support supervision, organization of outreaches, nancing, logistics and cold chain maintenance, advocacy and communication, planning and management and use of surveillance data for decision making. [33,34] However, our study did not nd a signi cant association between immunization program performance and these factors.…”

Slums, Space, and State of Health—A Link between Settlement Morphology and Health Data

“…Looking at the cross-national scale, only eight studies are available. There is one cross-national study on communicable diseases [84] in Burkina Faso and Kenya, one on malnutrition between Chile and Kenya [106], one on nurturing care in Angola and Kenya [107], one on contraceptive methods in Bangladesh and Kenya [108], one on early child loss in South Africa and India [109], and three non-specific on noise annoyance and sensitivity [110] between dwellers of informal settlements in South Africa and inhabitants of Switzerland, one on community health in three Melanesian countries [111], and one on urban growth and water access in sub-Saharan Africa [112].…”