New Vaccine Introduction and Childhood Vaccination Timeliness in Two Urban, Informal Settlements in Nairobi, Kenya

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  • 1 Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, Michigan;
  • 2 The Institute of Global Health Equity, University of Michigan, Ann Arbor, Michigan;
  • 3 Data Measurements and Evaluation, African Population and Health Research Center, Nairobi, Kenya;
  • 4 Department of Internal Medicine, Infectious Disease Division, Michigan Medicine, Ann Arbor, Michigan

New vaccine introduction accompanied by social mobilization activities could contribute to improved routine immunization timeliness. This study assesses the impact of Kenya’s introduction of pneumococcal conjugate vaccine (PCV) on the timeliness of routine childhood vaccination in two informal, urban settlements in Nairobi. Data collected from 2007 to 2015 as part of a demographic surveillance system were used to estimate annual vaccination delays of ≥ 4 weeks among children aged 12–23 months in the period before and after the introduction of PCV in Kenya. Binomial segmented regression models using generalized estimating equations examined the association between vaccine introduction and timeliness of routine immunization. Over half of all children vaccinated in the two urban areas received one or more doses ≥ 4 weeks after the recommended age. The timeliness of routine immunization showed slight improvements or nonsignificant changes during the years following PCV introduction compared with the preceding years (adjusted prevalence ratio [aPR]: 0.67, 95% CI: 0.45–0.99 for Bacille Calmette-Guerin receipt; aPR: 0.59, 95% CI: 0.41–0.83 for third dose Pentavalent receipt; aPR: 1.19, 95% CI: 0.99–1.42 for measles). However, as of 2015, delayed vaccination remained prevalent in children, particularly among the poorest residing in the settlements. Many sub-Saharan African countries have introduced new life-saving vaccines into their routine childhood immunization schedule. Additional evidence regarding the positive or neutral influence of new vaccine introduction on the performance of delivery systems provides further justification to sustain the inclusion of these more costly vaccines in the immunization schedule.

Author Notes

Address correspondence to Cara Bess Janusz, School of Public Health, University of Michigan, 1415 Washington Heights, Ann Arbor, MI 48109. E-mail: cjanusz@umich.edu

Financial support: This work was supported by the African Population and Health Research Center and the Office of Global Public Health at the University of Michigan to conduct research on-site in Nairobi, Kenya.

Authors’ addresses: Cara Bess Janusz, School of Public Health, University of Michigan, Ann Arbor, MI, and The Institute of Global Health Equity, University of Michigan, Ann Arbor, MI, E-mail: cjanusz@umich.edu. Martin K. Mutua, Data Measurements and Evaluation, African Population and Health Research Center, Nairobi, Kenya, E-mail: mkavao@aphrc.org. Abram L. Wagner, University of Michigan, Ann Arbor, MI, E-mail: awag@umich.edu. Matthew L. Boulton, Infectious Disease Division, Michigan Medicine, Ann Arbor, MI, E-mail: mboulton@umich.edu.

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