Peer-reviewed article
Spatial access inequities and childhood immunisation uptake in Kenya
Noel K. Joseph, Peter M. Macharia, Paul Ouma, Jeremiah M. Mumo, Rose Eddah Jalango et al. ·
Summary
Written by AI, not yet AICS's view · claude-haiku-4-5-20251001This study examined how far people in Kenya have to travel to reach immunisation services and whether this affects childhood vaccination coverage. Using spatial mapping and national survey data, researchers found that children living more than 2 hours away from immunising facilities were significantly less likely to be fully vaccinated. The findings show that travel time is a barrier to vaccination in hard-to-reach areas across Kenya, with substantial variation between counties.
Key points
- Mean travel time to immunising facilities was 63 minutes (walking only) and 40 minutes (with motorized transport)
- 75% of the population were within one-hour walking distance to an immunising health facility; 93% within one hour by optimistic scenario
- Children living more than 2 hours away were 44% less likely to be fully immunised (AOR: 0.56) and 49% less likely to receive DPT3 vaccine (AOR: 0.51)
- 62% of counties had less than 90% of their population within one-hour walking distance to immunising facilities
- Travel time remained a significant barrier after controlling for household wealth, mother's education, parity and urban/rural residence
Limitations
The study is cross-sectional and cannot establish causation definitively. The spatial accessibility model uses generic travel assumptions and may not capture all real-world barriers to accessing immunisation services such as cost, awareness, or health worker availability.
Abstract
BACKGROUND: Poor access to immunisation services remains a major barrier to achieving equity and expanding vaccination coverage in many sub-Saharan African countries. In Kenya, the extent to which spatial access affects immunisation coverage is not well understood. The aim of this study was to quantify spatial accessibility to immunising health facilities and determine its influence on immunisation uptake in Kenya while controlling for potential confounders. METHODS: Spatial databases of immunising facilities, road network, land use and elevation were used within a cost friction algorithim to estimate the travel time to immunising health facilities. Two travel scenarios were evaluated; (1) Walking only and (2) Optimistic scenario combining walking and motorized transport. Mean travel time to health facilities and proportions of the total population living within 1-h to the nearest immunising health facility were computed. Data from a nationally representative cross-sectional survey (KDHS 2014), was used to estimate the effect of mean travel time at survey cluster units for both fully immunised status and third dose of diphtheria-tetanus-pertussis (DPT3) vaccine using multi-level logistic regression models. RESULTS: Nationally, the mean travel time to immunising health facilities was 63 and 40 min using the walking and the optimistic travel scenarios respectively. Seventy five percent of the total population were within one-hour of walking to an immunising health facility while 93% were within one-hour considering the optimistic scenario. There were substantial variations across the country with 62%(29/47) and 34%(16/47) of the counties with < 90% of the population within one-hour from an immunising health facility using scenarios 1 and 2 respectively. Travel times > 1-h were significantly associated with low immunisation coverage in the univariate analysis for both fully immunised status and DPT3 vaccine. Children living more than 2-h were significantly less likely to be fully immunised [AOR:0.56(0.33-0.94) and receive DPT3 [AOR:0.51(0.21-0.92) after controlling for household wealth, mother's highest education level, parity and urban/rural residence. CONCLUSION: Travel time to immunising health facilities is a barrier to uptake of childhood vaccines in regions with suboptimal accessibility (> 2-h). Strategies that address access barriers in the hardest to reach communities are needed to enhance equitable access to immunisation services in Kenya.
Findings the Hub has extracted
Each claim below is labelled by its type of design and links back to this report.
- Intervention
- Analysis of spatial accessibility to immunising health facilities and its effect on vaccination coverage using geographic information systems and travel time modelling
- Population
- Nationally representative sample of households with children from Kenya Demographic and Health Survey 2014, aggregated at survey cluster level
Key finding
Children living >2 hours from immunising facilities were 44% less likely to be fully immunised (AOR: 0.56, 95% CI: 0.33-0.94)