Access and utilization of immunization services among refugees in Eastleigh North section of Nairobi, Kenya
Wagacha, Burton John
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Immunization has been shown to be one of the most cost effective health prevention and intervention against childhood morbidity and mortality. Over 30 million children especially from Sub-Sahara Africa are not reached each year with routine immunization. As a result, 1.5 million children under five years die each year from vaccine preventable diseases. Recent outbreak of Polio, Measles and pertusis in Kenya with index cases among refugees from neighbouring countries raises the possibility that their immunization coverage may be way below WHO standards of 90%. Additionally, refugees who live diffusely among urban population lack specific programmes targeting them with primary health interventions. For instance, in 2007 Immunization coverage in Kenya was 76% and in Nairobi it was 65%. However, Eastleigh area which hosts thousands of refugees recorded only coverage of 51 %. The purpose of this study, therefore, was to establish levels of access and utilization of immunization services among refugees in Eastleigh North. A descriptive crosssectional study design was used. A sample of 432 children of refugees living in Eastleigh North was selected. Informed consent was obtained from the guardian after explanation and clarification of study objectives. The data was collected using semistructured questionnaires, key informant interviews and visits to health facilities. The data was analyzed using Statistical Package for Social Scientist (SPSS version 16) and presented in frequency tables, bar graphs and pie charts. All the respondents were women either mothers or guardians to the children below 5 years. Of all the respondents interviewed, 39.6% had no formal education and overwhelming majority (97.2%) were once married. However, 46.8% of the respondents were in polygamous marriage. A high proportion, 95.4% of the respondents were of Somalia origin, 4.2% from Ethiopia while 0.5% was of Eritrean origin. About 60% of the respondents relied on remittances from relatives and friends abroad while 6.37% were doing business in Kenya. Among the 432 children studied, 53.5% were males and 46.5% were female below 60months old with a mean age of 30.1 months. The study established that there was significant statistical association between level of income (P=0.043), availability of services (P=0.004), cultural beliefs (P=0.002), communication barrier (P=0.020) and police harassment (P=0.04) and access and utilization of immunization services. The study also established that there was no significant statistical association between level of education (P=0.827), Knowledge on importance of immunization (P=0.472) and utilization of immunization services. The study concluded that complete immunization coverage for the children was 39%, which was way below WHO target of 90% and socio-cultural and economic and healthcare institutional and providers' factors hindered refugees' access and utilization of immunization services. The study recommended that Medical Officer of Health (MOH) at the Nairobi City Council to conduct catch-up immunization campaign in Eastleigh North. In addition, UN Refugee Agency and Department of Refugees Affairs to identify and issue identification documents to the unregistered refugees to curb police arrests and also enable refugees move freely, work and do business in Nairobi. The study also recommended that the MOH to establish program to sensitize refugees about the negative effect of the cultural beliefs and to increase staffing level in the facilities while ensuring that significant number of them speak Somali or hire Somali interpreters, because Somali language was the commonest mode of communication by refugees in the area. The study recommended further research to compare refugees and host community living in similar settings.