Vaccination Coverage and its Determinants among Pastoralists Children Aged 0 to 59 Months in Lagdera Sub-county of Garissa County, Kenya

Abstract

Vaccination is the most cost-effective, highest-impact health intervention to reduce the morbidity and mortality of Vaccine Preventable Diseases (VPDs). Globally, it is estimated that about 2 to 3 million mortalities occur annually due to VPDs with approximately 1.5 million deaths among under-five children. Most of these deaths due to VPDs occur in developing countries. The complete vaccination coverage in Kenya in 2014 was 71%; a decline from 77% in 2008 with huge inequality in pastoral dominated counties. Despite success in Kenya implementing the Expanded Program on Immunization (EPI), VPDs remain prevalent in pastoralist communities. Pastoralism was defined as raising any livestock other than fowl; nomadism was defined by seasonal movement of animals for grazing. The objective of the study was to determine the vaccination coverage and its associated factors among pastoralists in Lagdera Sub-county of Garissa County. A cross-sectional survey was conducted in February 2015, which utilized a cluster survey methodology to randomly select 25 clusters based on Probability Proportional to Size (PPS) sampling for settled pastoralist and 25 clusters in nomadic pastoralist using simple random sampling. Twelve mothers were selected for interview per cluster. The study used a structured instrument to survey pastoralist mothers with children aged 0–59 months old. For every eligible mother, vaccination data were collected by record or recall for all her children under five years. Mobile devices (Tablets) programmed with Open Data Kit (ODK) software was used to collect and transmit data to an online server. Data was downloaded and then analysed using Statistical Package for Social Science (SPSS) version 22.0 while the level of significance was set at p < 0.05. Ordinal logistic regression analysis was used to identify independent predictors of complete vaccination. A total of 476 eligible mothers were interviewed with 725 children; 241 mothers (50.6%) belonged to nomadic Households (HHs) while 235 (49.4%) belonged to settled HHs. Forty percent of nomadic mothers stated that vaccination was “very important” compared to 87.2% of mothers from settled HHs. Nearly 60% of mothers from nomadic HHs had never vaccinated their children in comparison to 7.2% of mothers from settled pastoralist. The main reason for non-vaccination among mothers from nomadic HHs was “hospital or clinic was too far away” (78.6%). Ordinal logistic regression revealed the following factors as independent predictors of vaccination coverage in both groups: purpose of vaccination (settled, P=0.001; nomadic, P<0.0001), importance of vaccination (P<0.0001), age of first vaccination (settled, P=0.015; xiii nomadic, P<0.0001), safety of vaccines (P<0.0001), communication indicators like radio ownership (settled, P=0.02; nomadic, P<0.011) and euclidean distance to health facility (P=0.018). In conclusion, nomadic pastoralist exhibited very low vaccination coverage than their settled counterpart. Improvements in vaccination service delivery, stronger involvement of the nomadic communities and special outreach services for this population are required to improve vaccination rates in these remote areas of Kenya.