Factors Associated with Uptake of Measles Rubella Vaccine among Children Age 9-18 Months in Eastleigh North Ward Nairobi County, Kenya

Abstract

Globally, 535 000 children died of measles in 2000. By 2010, there was a global push to improve vaccine coverage which resulted in a 74% reduction in deaths. These efforts contributed to 23% of the overall decline in under-five deaths between 1990 and 2008. However, in several countries in African, measles is still a major public health problem. Rubella remains a threat to pregnant women and their fetus, with more than 100 000 children born each year with congenital rubella syndrome. Kenya in May 2016, introduced Measles-Rubella combined vaccine in its nationwide supplementary immunization activities campaign. However, since its introduction, the coverage has been very low especially in urban areas. This study aimed at assessing factors associated with uptake of measles rubella vaccine among children age 9-18 months in Eastleigh North Ward Nairobi County. This was a descriptive cross sectional study where data was collected from 186 caregivers of children age 9-18 months using semi-structured questionnaires and key interviewers guides. Analysis involved descriptive statistics such as frequencies and proportions. Test of association of study variables was done using Pearson’s Chi-square test. Level of significance was fixed at 0.05 (p<0.05) with a 95% Confidence interval and P value less that 0.05 was considered significant. Qualitative data was analyzed using thematic analysis where HCW provided and ranked reasons for low uptake of MR and content analysis methodology. Approximately 52.2% caregivers had secondary education, majority were self-employed 58.1%. About (60.8%) were Muslims while (32.3%) were Christians. Of the 186 caregivers interviewed (159, 85.5%) had their children vaccinated with MR1 and 35.5 % with MR2. Awareness about MR vaccine was high (90.3%) among the caregivers; however, knowledge of child ever being diagnosed with measles or rubella was low 44.6%. There was a strong correlation between level of education and MR1 vaccine uptake, (P=0.007). This study also identified that caregivers who were aware of the schedules of MR vaccine (P=0.039) had a higher chance of bringing their children for MR2 vaccine. Other factors associated with uptake of MR vaccine were lack of immunization services at the health facility (P=0.008), awareness of existence of MR vaccine hospital delivery, communication and health system related factors like availability of vaccine and vaccinator. Barriers identified for not receiving the vaccine, myths/negative attitude (66.7%) and religion (15%). Most care givers obtained information about MR vaccine from health care personnel 58.1% (108). Among the children, 18.3% (34) had been diagnosed with measles or rubella. The uptake of MR2 is relatively low according to the findings suggesting that majority of the caregivers rarely bring their children for the second dose (MR2). The result established a low correlation between the awareness of MR vaccine doses. This implies the importance of instituting strategies that involves, aggressive awareness campaigns and education programs that focus on increasing caregiver awareness of MR vaccine dosing and risk factors for none vaccination. The ministry of health and other non-state actors to come up with ways of improving immunization program. This will consequently increase uptake of MR vaccine and reduce the disease burden. Finally, findings of the study will benefit scholars as source of literature on the factors associated with uptake of MR vaccine.