Peer-reviewed article
Determinants of measles-rubella second dose vaccine uptake among children in Mathare informal settlement, Nairobi, Kenya: a mixed-methods study.
Kenneth Kamande, Micah Matiang'i, Jeanette Dawa ·
Summary
Written by AI, not yet AICS's view · claude-haiku-4-5-20251001This study examined why some children in Mathare informal settlement, Nairobi, did not receive their second measles-rubella vaccine dose. Researchers surveyed 370 caregivers and conducted interviews to understand barriers to vaccination. While 84% of children received the second dose, uptake was lower than for the first dose. Key barriers included low awareness of the vaccination schedule, economic hardship, lack of vaccination cards, and gaps in health services.
Key points
- MR-2 coverage was 84%, which is 14 percentage points lower than MR-1 coverage
- Caregivers unaware of the MR-2 schedule were over four times more likely to miss the dose (OR = 4.146)
- Those who previously failed to access vaccination services had 4.2 times higher odds of missing MR-2 (OR = 4.215)
- Lack of a vaccination card and poor knowledge of the schedule were significant predictors of non-uptake
- Ward of residence, education level, and place of delivery were significantly associated with MR-2 uptake
Limitations
The study was conducted only in one informal settlement in Nairobi, so findings may not generalise to other settings in Kenya or elsewhere. The cross-sectional design captures associations but cannot establish causality.
Abstract
INTRODUCTION: measles-rubella remains a major public health concern, with vaccination as the most effective preventive strategy. Despite the introduction of the measles-rubella second dose (MR-2) vaccine to improve immunity, uptake in informal settlements like Mathare, Nairobi, remains suboptimal. This study assessed determinants of MR-2 uptake among children aged 18-59 months in Mathare. METHODS: this cross-sectional analytical study used a convergent mixed- methods design. Quantitative data were collected through structured household surveys, while qualitative insights were obtained from Key Informant Interviews and Focus Group Discussions. RESULTS: a total of 370 caregivers responded (103% of the targeted 359). MR-2 coverage was 84%, 14% lower than the measles-rubella first dose (MR-1). Uptake was significantly associated with religion, education level, ward of residence, place of delivery, immunization site, and previous unsuccessful vaccination attempts (p < 0.05). Caregivers unaware of the MR-2 schedule were over four times more likely to miss the dose (OR = 4.146, p < 0.001), as well as those who had previously failed to access services (OR = 4.215, p = 0.007). Lack of a vaccination card (OR = 0.314, p = 0.015) and poor schedule knowledge (OR = 0.322, p = 0.014) were also key predictors. Children in Kiamaiko ward (OR = 5.421) and Ngei ward (OR = 4.281) had higher odds of MR-2 uptake compared to Mlango Kubwa ward. Qualitative findings highlighted barriers such as low awareness, misinformation, economic hardship, and health system gaps. CONCLUSION: improving MR-2 uptake requires enhanced health education, mobile reminders, consistent vaccine supply, extended clinic hours, and targeted outreach.