Missed opportunies for immunisation in Nairobi province

Abstract

Background: Vaccination is one of the most effective Public Health interventions. In spite of this, immunization coverage in Kenya has remained below the WHO recommended thresholds. This low coverage is seen not only in the remote areas of the country. but also in urban areas like Nairobi Province where with a relatively better infrastructure and access to health facilities one would expect better immunization coverage. Missed opportunity for immunization may represent a significant barrier to achieving the requisite coverage. This study was carried out to evaluate the prevalence of missed opportunity for immunization in Nairobi Province. Objectives: Broad objective: To assess the occurrence of missed opportunity for Immunisation in Nairobi province. Specific Objectives: • To determine the prevalence of missed opportunity for immunisation in Nairobi Province • To determine the socio-demographic characteristics of the caretakers of children with missed opportunity immunisation. • To establish reasons for occurrence of missed opportunity for immunisation. • To assess health worker knowledge and practice and correlate this to missed opportunities for immunisation. Design: Cross sectional descriptive study. Study site: Twelve health facilities selected by random sampling from Kibera, Embakasi and Westlands divisions. 8 Methods: Children aged below 24 months exiting from these health facilities and whose caretakers consented were recruited into the study. The caretakers were interviewed regarding the immunization status of these children, reasons for missing immunisation and any barriers to immunisation. The health workers running immunisation services in these facilities were also interviewed on their knowledge, practice and attitudes towards immunisation and their practice observed. Standard pre-coded instruments were used to collect the information. Results: A total of 277 eligible caretakers participated in the exit interview while 21 health workers were interviewed. Overall prevalence' of missed opportunity for immunisation in the study population was 23.8%. There was variation with Kibera division having a prevalence of 32%, while Embakasi and Westlands divisions had prevalence of 11.6% and 14.2% respectively. Socio-demographic factors tha~ significantly affected vaccination rates were place of delivery, where children born out at home had higher missed opportunity rates than those born in a health facility (p=O.008). Lack of information and antigen stock-outs were the commonest reasons for missing vaccines. The general attitude. of the health worker towards the client was found to be good. There was a lack of knowledge on immunisation practice among the health workers. Conclusions: Prevalence of missed opportunity for immunisation in Nairobi province is'23.8%. Kibera division has. a significantly higher prevalence of missed opportunity compared to the other 2 divisions. Community and health system barriers to immunisation exist. Of note is lack of adequate knowledge by the health workers on immunisation, especially on contraindications to vaccination. Home delivery was adversely associated with missed opportunity for immunisation. 9 Recommendations: Strategies are required to improve immunisation coverage especially in Kibera division. Measures to promote screening all children for vaccination. facilitate defaulter tracing and improve health worker knowledge on vaccination are required. ..- . 10