Caretakers' and health workers' characteristics influencing childhood full immunization in Embakasi and Kibera slum settlements of Nairobi
Background: The city of Nairobi exemplifies rapid urbanization amidst deteriorating economic and health conditions which is also characteristic of most cities in the developing world. While a lot of studies have been done around the world and in Kenya to determine factors affecting immunization coverage in different slum settlements in urban areas, very little information is available on why some slum settlements have high immunization coverage while others have low coverage rates. Embakasi division of Nairobi has recorded good immunization coverage (>97%) in the years 2006 and 2007. Kibera division on the other hand has had dismal performance with reported coverage of 58% and 56% in 2006 and 2007 respectively. Most of the population in the two divisions resides in slum settlements and the factors contributing to the difference in immunization coverage are not known. The main purpose of this survey was to try and find out some of the factors that have contributed to the difference in the uptake of immunization in the two divisions. Objective: The main objective of this study was to describe the factors contributing to the large difference in immunization coverage between Embakasi and Kibera divisions of Nairobi. Methodology: The study was a cross sectional descriptive survey that utilized both the qualitative (Focus group discussions) and quantitative methods of data collection. For the quantitative part, a structured questionnaire was used to obtain data about caretakers socio-demographic characteristics and childs' immunization status as verified by card. Data analysis: The data collected was analyzed using SPSS version 17.0 software. A chi-square test was utilized to test for associations. A p-value of less than 0.05 was considered statistically significant. A summary of the Focus Group Discussion (FDG) results was done. Results: A total of 1205 caregivers were enrolled in the study and majority of them(95 .2%) were mothers. The level of education was higher in Embakasi compared to Kibera OR (Odds Ratio) 26, p-value <0.001. Higher education and employment were associated with higher immunization. Unemployment was lower in Embakasi as opposed to Kibera OR 0.2. P value<O.OOl. Full immunization coverage was 92.4% in Embakasi and 70% in Kibera. Children in Embakasi were 3.2 times more likely to be immunized than Kibera OR 3.2 p-value of 0.003. Conclusion and Recommendation: There is a slight improvement in immunization coverage in Kibera although it has not yet reached the desired coverage of 90% nationally. Strategies to improve the uptake of immunization, services in Kibera should target improving the literacy levels and employment in area. A further study to correlate the finding of improved immunization coverage in Kibera may be required in the near future.