Prevalence and Factors Associated With Immunization Delays Among Low Birth Weight Infants at Kenyatta National Hospital

Abstract

Background Globally, 15-20% of all births are low birth weight (LBW) majority in low and middle-income countries. The Kenya Demographic and Health Survey (KDHS) 2014 states that 8% of all births were LBW. LBW infants are at increased risk of vaccine preventable diseases, the biggest cause of childhood morbidity and mortality. WHO recommends that clinically stable premature and LBW infants be vaccinated according to chronological age with the same schedule as the term infants. However, studies have shown that, immunization in LBW infants continues to be delayed putting them at greater risk of preventable diseases. Determining the factors that delay immunization in this vulnerable population would guide in formulating solutions to improve immunization coverage, preventing common childhood diseases and ultimately reducing infant mortality. Objectives The primary objective was to determine the proportion of LBW infants with delayed immunization. The secondary objectives were to describe the infants’ and maternal characteristics associated with immunization delays. Study design and methods This was a hospital based cross-sectional study done at Kenyatta National Hospital (KNH) Pediatric Emergency Unit (PEU), Neonatal Outpatient Clinic (NOPC), Maternal and Child Health (MCH) clinic and the four general pediatric wards. A sample size of 423 mothers with LBW infants (1-11 months) was recruited by consecutive sampling. Data were collected through an interviewer administered pretested structured questionnaire to the mothers of the LBW infants. Additional data on immunization were extracted from Mother & Child Handbook. Data analysis Data were analyzed by SPSS version 22.0. Continuous data were expressed using means, standard deviations, medians and interquartile ranges (IQR) and categorical data using proportions. Associations were calculated using Odds Ratio (OR) with the corresponding 95% confidence interval. Pearson-Chi square test was used to test for statistically significant associations. Results The prevalence of immunization delay among the LBW infants was 56.7% (95% CI 0.52-0.61). The most delayed vaccine was BCG at 54.6%. Very low birth weight (VLBW) and admission to the NBU were significantly associated with increased odds of immunization delay. Some infants were found to have received their immunization earlier than the recommended age. Conclusion. One in two LBW infants experience delay in their immunizations in our setup. BCG is the most delayed vaccine. There is need to adapt and disseminate guidelines for LBW infants’ immunization.