Determinants of the uptake of pneumococcal conjugate vaccine (pcv-10) in Makindu District, Kenya
Mutisya, Felisters M.
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Over 1.8 million children under five years of age die from pneumococcal disease (PD) every year worldwide, most of them living in developing countries. In Kenya, pneumococcal infections are the leading cause of hospital admissions among children under five years. In 2008, pneumonia was the second leading cause of death among children under five years, with over 30,000 childhood deaths, accounting for 16% of child mortality in Kenya. Immunization is the cornerstone of health care policy and a key component in infectious disease prevention. Kenya rolled out the Pneumococcal Conjugate Vaccine (PCV-10) vaccine in January 2011, in all government hospitals with an aim of covering over 70% invasive pneumococcal diseases (IPD) by the end of 2011. The vaccine uptake at Makindu district has been sub-optimal and the reasons not yet determined, hence the need for this study. The objective of this study was therefore, to establish the caregivers and healthcare workers level of knowledge, attitude and practices and healthcare system influence on the uptake of the PCV-10. In a cross-sectional study, caregivers of children aged 3-12 months (n=374), health workers (n=32) and the healthcare system organization were investigated. The caregivers and healthcare workers were interviewed using structured interview schedules, questionnaires and observational checklist were used to collect additional information on healthcare system functioning. Data was entered, coded and analyzed using Microsoft excel and SPSS. Differences in proportions between groups were compared using the Chi square and Fishers‘ exact tests. Of the 374 children, 292 (78.1%) had received the PCV-10 vaccination. Multivariate logistic regression analysis showed that marital status of the caregiver (P=0.022), health facility delivery (P<0.0001), and knowledge of Kenya Expanded Program for Immunization (KEPI) immunization schedule (P=0.048), PCV-10 vaccine (P<0.0001), and hospital treatment for pneumococcal sick children (P=0.036) were associated with increased uptake of PCV-10 vaccination. However, low uptake of PCV-10 vaccination was associated with caregiver work related reasons (P<0.0001), and health facility challenges such as lack of vaccines (P=0.012), and inconvenient vaccination schedules (P=0.002). Healthcare workers level of qualification (P<0.0001) and attendance of KEPI refresher courses (P=0.041) significantly influenced the uptake of PCV-10 vaccination. The findings demonstrate healthcare systems shortfalls contributing to low vaccine uptake. This study recommends that health promotional interventions that target imparting of PCV-10 and KEPI knowledge to caregivers and healthcare staff, and enhancing healthcare system functioning may improve uptake of PCV-10 immunization.