Factors determining access and utilization of immunisation services in Kibera, Nairobi
Oliwa, Jacqueline N
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Introduction Kibera is the largest informal settlement in Nairobi. Kibera is reported as a Category 4 area as far as immunization coverage is concerned with high dropout rates of 16%. Dropout rates of more than 10% indicate poor utilization of immunization services. Low Pentavalent 1 (Pental) coverage of less than 80% indicates poor access. According to a 2007 survey by the Division of Vaccines and Immunization (DVI), fully immunized coverage rate in Kibera was estimated at 52%, with access at 65.8% and dropout rates of 16%. It was ranked as one of the 17 poorest performing divisions in the country. Methods This was a cross-sectional descriptive survey utilizing both qualitative and quantitative methods of data collection. The quantitative part consisted of a cluster household survey to assess immunization coverage. The qualitative part included key informant interviews as well as focus group discussions. Results Main factors independently influencing immunization status were:- being born at a health facility (O.R 1.98, 95% C.I 1.08-3.61); source of vaccine information from health workers (O.R 2.45,95% C.I 1.27-4.76); belief that vaccines prevent diseases (O.R 3.34,95% C.I 1.50-7.46); and being charged for immunization services (O.R 0.45,95% C.I 0.20-0.99). From qualitative analyses, the main emergent themes were lack of awareness, lack of motivation, competing priorities and health system factors as major predictors of immunization status. Immunization coverage rate was found to be 77.1% by card and 84.4% by card and history. Access was excellent at 99.1% by card and history and 97.8% by card only. Utilization however was poor with dropout rates from Penta1 to measles found to be 10.8% by card only and 4.7% by card and history. Conclusions Kibera has higher coverage rates than what is posted in service delivery records and should be reclassified as a category 2 area with good access but poor utilization. There is still however room for improvement to meet the GAVI goal of 90% coverage at national level. Caregivers' knowledge and belief that vaccines prevent disease were the strongest predictors of immunization status. Recommendations Increasing surveillance and strengthening data systems could help improve reporting. Appropriate, relevant information, education and communication strategies targeted to increase the awareness of the importance of immunization, because results show that knowledge and positive belief increased likelihood of immunization.