Exploring Strategies to Improve Adherence to Immunization schedule Among Children Attending the Maternal and Child Health Clinic at Kenyatta National Hospital

Abstract

Background: Globally, immunization is among the major contributors to public health. It prevents 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 (WHO), 1.5 million children die globally on annual basis due to inadequate vaccination coverage. Existing literature indicate there is an increase in non-adherence to immunization schedule in developing countries and therefore an increased demand to improve adherence to immunization schedule. The Kenya Demographic and health Survey 2014 documented Kenya vaccination coverage for infants as 76%. Improving immunization adherence is an important measure in reducing morbidity and mortality from childhood immunizable diseases. Objective: To explore strategies that will improve adherence to immunization schedule among children under 24 months attending Maternal and Child Health (MCH) clinic at Kenyatta National Hospital (KNH). Method: Cross- sectional mixed methods research was used in the study. The study was carried out at the MCH clinic in KNH and the target population was all children under 24 months of age and their care givers. A total of 214 participants were selected by simple random sampling method and data collection was by researcher administered semi- structured questionnaire. Qualitative data was collected using two Focused group discussions (FGD) each with 10 care givers who had not been subjected to the questionnaire and key person interviews (KPI) with two nurses in MCH to obtain in- depth qualitative information on their views on ways of improving adherence to immunization schedule. Qualitative data was audio- taped. Data was analyzed by the use SPSS V20 by use of descriptive and inferential statistics. Significance between variables was established by the use of Chi square test. Data was presented in tables, bar graphs and pie charts. Qualitative data was transcribed, translated and analyzed manually by listening to the audio tapes. Results: Majority of the children 195(92.0%) were brought by their mothers. Among the study participants, (47.9%) were aged between 26-30years. 86.6percent were married while 56.1% had attained education level beyond secondary school. In occupation, 0.5% of the care givers were unemployed while the majority were earning above Ksh.40, 000 per month. Out of 214 participants, 141(66.8%) of them reported that their children have ever missed immunizations on the scheduled date. These main barriers to adherence to immunization schedule as found in the study were: lack of bus fare, care taker had traveled, care taker at work, getting late to the clinic, home far from health facility and baby’s sickness. Strategies that would improve immunization schedule as found in the study were flexible clinic hours, phone call reminders, phone alarms and putting more health facilities near residential areas. Conclusion: Marital status, educational level and occupation determined adherence to immunization schedule. Health systems’ factors such as rigid clinic hours, long distance to health facility and lack of strategies to follow-up caregivers or remind them on due date influence non-adherence to immunization schedule