Vaccination Coverage and its Associated Factors among Children Aged 2 - 5 Years in Eldas Sub County, Wajir County

Abstract

Childhood vaccination is crucial intervention to reduce the morbidity and mortality of vaccine-preventable diseases. It has been estimated that vaccination campaigns prevent almost 3 million deaths globally each year. However, in 2018, 19.4 million children worldwide missed all necessary vaccinations. In Africa, routine vaccination coverage remains particularly low. In Kenya, the North Eastern region has the lowest vaccination coverage; (41%). The study aimed to establish vaccination coverage and

its associated factors among children aged between 2 and 5 years in Eldas Sub- County, Wajir County. The specific objectives entailed establishing individual level

factors associated with complete vaccination coverage, assessing status of routine vaccination and to determine health system level factors associated with complete vaccination coverage among children aged 2 to 5 years in Eldas sub county, Wajir County. A cross-sectional design was employed on sample size of 367 caregivers. Respondents were chosen using probability proportion to size and systematic random sampling strategies. A structured questionnaire and key informants’ guide were deployed for data collection. Data analysis was performed using Statistical Package for the Social Sciences (SPSS) version 25.0 with descriptive and inferential statistics generated. Chi-square test examined the relationship between categorical variables at confidence interval of 95%. Demographic findings showed that households were majorly male led with majority practicing Islami religion (98.1%) and 8.37% never attended school. A considerate percentage (40.1%) was in monogamous marriage arrangement, with only 23.2% in polygamous marriage. Sixty seven percent (67.9%) were unemployed while 23.2% earned between Ksh 6,001 and 12,000 a month. Radio ownership among caregivers was quite low. More than 21% (78 caregivers) attended to non-biological children. Caregivers with formal education were 3.47 times more likely to comply and have their children complete vaccination schedule (95% CI = 1.18 – 9.57, P = 0.032). Children of those earning more than Kshs 24000 a month were 3.18 times more likely to complete vaccination (95% CI = 1.27 – 11.67, P < 0.001) while those earning g between Kshs. 12000 - 24000 per month were 2.96 times more likely to complete vaccination (95% CI = 1.15 - 10.39, P = 0.002). Children with caregivers aware of vaccination's purpose were 4.51 and 2.57 times more likely, respectively, for complete vaccination (95% CI = 1.36 – 12.75, P < 0.001; 95% CI = 1.18 – 8.62, P = 0.031). Children born with skilled birth attendants were 5.36 times more likely for complete vaccination (95% CI = 2.15 – 13.21, P < 0.001). Children from places 1 – 5 km or 5 – 10 km from the hospital were 4.28 and 2.57 times more likely, respectively, for complete vaccination (95% CI = 1.28 – 14.87, P = 0.009; 95% CI = 1.54 – 6.88, P = 0.024). Content analysis was adopted in summarizing qualitative findings. More than ninety six percent (96.2%) of the children had been vaccinated atleast once. Distant location and lack of knowledge on immunization time were cited as major barriers to complete vaccination. Around 78.5% of the studied children reported experiencing a medical issue, 42.9% opined that atleast they were late on immunization schedule. Absence of personal issues among caregivers was associated with 2.29 increased likelihood of completing vaccination (95% CI = 1.41 - 3.75, P < 0.001). Knowledge on immunization further improved completion of immunization schedule by 5.53%. Qualitative findings also revealed a considerably high coverage attributed to strong community engagement and healthcare team dedication. The high coverage implied

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increasing level of access, awareness and system strength in delivering immunization solutions to the children. The notable health system factors included lifestyle, information, access and logistics, income level, education and awareness. However, misinformation, societal beliefs, low economic capacity, language barrier and nomadic lifestyle contributed to vaccine hesitancy among caregivers. The study concluded that individual level factors associated with complete vaccination status were education, occupation, income level, and ownership of electronic devices significantly influenced complete vaccination status among children aged 2 to 5 years in Eldas sub-county, Wajir County. However, vaccination completeness performance was below the recommended set target by WHO and the Ministry of Health. Health system related predictors that explained complete vaccination status included availability of skilled healthcare professional, presence of well-equipped public healthcare facilities and caregivers’ proximity to those facilities. It was suggested that the County Health Department should implement education outreach programs, support caregivers, enhance vaccination accessibility for lower-income families, use media for awareness campaigns, and address clinic shortages to improve vaccination coverage. It also recommends implementing subsidies or incentives to bridge economic gaps, leveraging electronic devices for vaccination knowledge, and enhancing healthcare infrastructure.