Factors associated with non-vaccination among nomadic pastoralists and under-vaccination among settled pastoralists in Lagdera, Kenya Público

Abstract

Introduction: Despite vaccines being widely accepted as one of the most cost-effective and successful public health interventions to prevent child death, the World Health Organization estimates that 1.5 million deaths among children under 5 years annually are due to vaccine-preventable diseases. For a country like Kenya, with a national under-5 mortality rate of 49 per 1,000 births, vaccination marks a key opportunity to improve early childhood survival. Settled and nomadic pastoralists are two groups within Kenya that are historically underserved and improving vaccination services to these groups is of critical public health importance.

Methods: A cross-sectional interview survey was conducted among households in settled and nomadic pastoralist settlements in Lagdera sub-district of Garissa Country, Kenya. 235 settled mothers, representing 354 children under five years, and 302 nomadic mothers, representing 405 children under five years, were included in this survey. Multivariate logistic regression was used to assess the association of various factors to receipt of at least one vaccination among nomadic pastoralists and age- appropriate vaccination among settled pastoralists.

Results: Only 41% (95% CI 21-36) of nomadic children surveyed had ever received a vaccination, while 36% (95% CI 29-44) of settled children had either incomplete vaccination for age or no vaccination. The main factors associated with partial vaccination among nomads were maternal phone ownership, positive maternal views of vaccine safety, and maternal knowledge of past campaign. For settled children, the main factors associated with age-appropriate vaccination were possession of a vaccination card and positive view of vaccine importance.

Conclusion: The findings of this study indicate that nomadic and settled pastoralists face meaningfully different obstacles in securing childhood vaccinations. For both groups, physical distance to vaccination sites alone does not fully explain vaccination outcomes. These groups both require tailored vaccination programs that account for their unique barriers in order to achieve basic levels of vaccination coverage.

Table of Contents

Table of Contents

Chapter I: BACKGROUND/LITERATURE REVIEW ......................................................................... 1

Chapter II: MANUSCRIPT......................................................................................................... 8

Abstract ..................................................................................................................... 8

Introduction ............................................................................................................... 9

Methods ................................................................................................................... 11

Results .................................................................................................................... 15

Discussion ................................................................................................................ 18

Conclusions .............................................................................................................. 22

References ............................................................................................................... 23

Tables ..................................................................................................................... 25

Figures..................................................................................................................... 34

Chapter III: SUMMARY, PUBLIC HEALTH IMPLICATIONS, AND POSSIBLE FUTURE DIRECTIONS..... 35

About this Master's Thesis

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School	Rollins School of Public Health
Department	Epidemiology
Subfield / Discipline	Global Epidemiology - MPH & MSPH
Degree	MPH
Submission	Master's Thesis
Language	English
Research Field	Health Sciences, Public Health Health Sciences, General Health Sciences, Epidemiology
Palavra-chave	nomadic vaccination pastoralists
Committee Chair / Thesis Advisor	Lash, Timothy L, Emory University
Committee Members	Gammino, Victoria, CDC
Partnering Agencies	CDC

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