Peer-reviewed article
Inequities in childhood immunisation coverage associated with socioeconomic, geographic, maternal, child, and place of birth characteristics in Kenya
Simon Allan, Ifedayo M. O. Adetifa, Kaja Abbas ·
Summary
Written by AI, not yet AICS's view · claude-sonnet-5-5This study used data from the 2014 Kenya Demographic and Health Survey to look at who is and is not fully immunised among 3943 children aged 12–23 months. Full immunisation coverage was 68%. Coverage was lower for children whose mothers had no education, who were born at home, who lived in the North Eastern region, who lived in the poorest households, and who were sixth born or higher. The authors conclude that targeted programmes for these groups could reduce inequities in coverage.
Key points
- Coverage ranged from 82% for the third polio dose to 97.4% for the first DTP-HepB-Hib dose, and full immunisation coverage was 68%.
- Children of mothers with primary education or higher had at least 54% higher odds of being fully immunised than children of mothers with no education.
- Children born in clinical settings had 41% higher odds of full immunisation than children born at home.
- Children in the Coast, Western, Central and Eastern regions had at least 74% higher odds of full immunisation than children in North Eastern, and urban children had 26% lower odds than rural children.
- Children in middle and richer wealth quintile households were 43–57% more likely to be fully immunised than children in the poorest households, and children sixth born or higher had 37% lower odds than first-born children.
Limitations
The analysis is a cross-sectional survey from 2014, so it shows associations rather than causes and may not reflect current coverage. The abstract does not explain why urban children had lower odds than rural children, and it does not describe any intervention.
Abstract
Abstract Background The global Immunisation Agenda 2030 highlights coverage and equity as a strategic priority goal to reach high equitable immunisation coverage at national levels and in all districts. We estimated inequities in full immunisation coverage associated with socioeconomic, geographic, maternal, child, and place of birth characteristics among children aged 12–23 months in Kenya. Methods We analysed full immunisation coverage (1-dose BCG, 3-dose DTP-HepB-Hib (diphtheria, tetanus, pertussis, hepatitis B and Haemophilus influenzae type B), 3-dose polio, 1-dose measles, and 3-dose pneumococcal vaccines) of 3943 children aged 12–23 months from the 2014 Kenya Demographic and Health Survey. We disaggregated mean coverage by socioeconomic (household wealth, religion, ethnicity), geographic (place of residence, province), maternal (maternal age at birth, maternal education, maternal marital status, maternal household head status), child (sex of child, birth order), and place of birth characteristics, and estimated inequities in full immunisation coverage using bivariate and multivariate logistic regression. Results Immunisation coverage ranged from 82% [81–84] for the third dose of polio to 97.4% [96.7–98.2] for the first dose of DTP-HepB-Hib, while full immunisation coverage was 68% [66–71] in 2014. After controlling for other background characteristics through multivariate logistic regression, children of mothers with primary school education or higher have at least 54% higher odds of being fully immunised compared to children of mothers with no education. Children born in clinical settings had 41% higher odds of being fully immunised compared to children born in home settings. Children in the Coast, Western, Central, and Eastern regions had at least 74% higher odds of being fully immunised compared to children in the North Eastern region, while children in urban areas had 26% lower odds of full immunisation compared to children in rural areas. Children in the middle and richer wealth quintile households were 43–57% more likely to have full immunisation coverage compared to children in the poorest wealth quintile households. Children who were sixth born or higher had 37% lower odds of full immunisation compared to first-born children. Conclusions Children of mothers with no education, born in home settings, in regions with limited health infrastructure, living in poorer households, and of higher birth order are associated with lower rates of full immunisation. Targeted programmes to reach under-immunised children in these subpopulations will lower the inequities in childhood immunisation coverage in Kenya.