Predictors Of Utilization Of Vaccination Services Among Caregivers Of Children Aged Less Than 1 Year In Asego Sub-County, Homabay County, Kenya.

ABSTRACT

Childhood immunization remains a cost-effective public health intervention geared towards improving health status of infants and children hence reducing both morbidity and mortality associated with vaccine preventable diseases (VPDs).The World Health Organization (WHO) estimates that 17% of the global 1.5 million deaths among children aged under one year are due to VPDs. In 2012 during the transition from Provincial administration to County governments, Nyanza Province had the highest infant mortality rate of 95 per 1000 live births. WHO recommends that immunization coverage among children under one year of age be at least 90% nationally and 80% in every administrative unit yet an estimated 77% of children aged less than one year receive all routine immunizations in Kenya. This proportion varied from 86% in Central to 48% in North Eastern Kenya (the study was not conducted in North Eastern mainly because of external factors such as migration across the Somali border, insecurity and terrorism). In 2012, the former Nyanza Province had an overall immunization coverage of 65% with the lowest coverage of 58.4% in Homabay County. The reason for this low proportion of fully immunized children is not clearly understood. The main objective of this study was to identify the factors contributing to low immunization coverage in Asego Sub-County, Homabay County. Specifically, the study looked at independent variables; sociodemographic and economic, knowledge and perceptions, as well as health provider factors influencing utilization of vaccination services (dependent variable). This descriptive cross sectional survey utilized the WHO, Expanded Programme of Immunization (EPI) cluster sampling method to select a sample size of 210 consenting caregivers from a total population of 3211 children aged below one year residing in Asego Sub-County. Purposive sampling was used to select key informants (KIs) who were administrators of all 10 health facilities in Asego Sub-County. Data collection tools were interviewer administered questionnaires for the caregivers and self-administered semi-structured questionnaires for the KIs. Focus Group Discussions (FGDs) were also conducted at two randomly selected facilities and a thematic analysis of the transcripts generated was done. Chi-square tests were used to investigate associations and a stepwise logistic regression method was used with socio demographic and economic factors. The proportion of Fully Immunized Children (FIC) coverage in Asego Sub-County is 45.3%. Results indicated that the socio-demographic and economic factors affecting utilization of immunization services included caregiver‘s occupation as a being self-employed, (OR=1.76, p=0.047), earlier birth order (OR=2.47, p=0.0226), child place of birth at home (OR=0.48, p=0.0056), child‘s age as less than 14 weeks, (OR=13.41, p=0.00) and more than 4 ANC visits (OR=2.18, p=0.044). The knowledge-related factors were such as thoughts that children completed vaccination at 10-59 months(OR=0.20 ,p=0.008), perceptions that the child is not at risk of disease (OR=0.38 , p=0.0165), not knowing return dates (OR=0.19, p=0.008),lateness of health workers (OR=2.22, p=0.022), travel time to facility of between 30 minutes to 1 hour(OR=0.72 , p=0.045) and absence of a facility near their homes (OR=0.66, p=0.025 .Other factors were such as misconceptions about immunizations, fear of having an HIV test conducted on them, poor communication from the health workers, lack of vaccines at the health facilities and no prior warning about adverse events following immunizations. All associations were reported as odds ratios (OR) with 95% confidence intervals (CI). These findings reveal that there is still low immunization coverage in Homabay County that could partially be attributed to caregivers‘ socio-demographic and economic factors, perceptions on immunizations as well as the health provider factors. The results of the study could be used by the Sub County Health Management Team of Asego to improve on the bottlenecks negatively affecting service delivery and also educate the community on the benefits of childhood immunizations.