Factors Influencing Uptake of Expanded Programme on Immunization Services in Rarieda Division, Siaya County, Kenya

Abstract

The Expanded Programme on Immunization (EPI) was established in 1974 to ensure that all children in all countries benefited from a universal access to life-saving vaccines. The diseases targeted by the EPI are diphtheria, whooping cough, tetanus, measles, poliomyelitis, tuberculosis, hepatitis B, Haemophilus influenza type b and pneumonia. These diseases are among the leading causes of high childhood morbidity and mortality in Kenya and they remain a major public health problem due to low vaccination uptake in some regions. In Kenya the immunization coverage is estimated at 78% and infant mortality rate is 52 per 1000 live births. In Siaya County the immunization coverage is at 65%. The infant mortality rate in Rarieda Division is 120 per 1000 live births. The low immunization coverage and high infant mortality rate can be attributed to lack of awareness, attitude of mothers and socio-economic and cultural factors. Therefore the overall objective of this study was to examine factors that influence uptake of EPI services in Rarieda Division, Siaya County. Specific objectives were: l.establish awareness levels of mothers on vaccines and vaccinations of children 2.identify the socio-economic and cultural factors that influence the uptake of EPI services and 3.determine the perception/attitude of mothers on vaccination of children against the immunizable diseases as per EPI schedule. The study design was cross-sectional and utilized both quantitative and qualitative methods of data collection. Systematic random sampling procedure was used to select and interview 346 mothers from a target population of 3,518 mothers with children aged between 0-24 months at the household level in Rarieda Division. The tools for collecting quantitative data were household questionnaires and key informants interviews were used to collect qualitative data where the nurses in charge of the health facilities in Rarieda Division were purposively sampled to be interviewed. Quantitative data was analyzed using descriptive statistics and qualitative data was analyzed through manual content analysis by categorizing relevant responses to answer research questions and analyzed data was presented in the form of frequency distribution tables, pie charts and graphs. The findings indicated that 96% of respondents were aware of polio vaccine, 77% measles, 55% BCG, 21% pentavalent, 17% PCV 10 and 2% yellow fever. 89% of mothers were aware that children should be given the first vaccine at birth and 83% of the mothers were aware that children should receive their last vaccine at nine months. 19% of mothers gave birth at home, mothers made most decisions on vaccination of children and Muslims did not support vaccination.97% showed positive attitude towards vaccination. In conclusion awareness level of mothers on vaccines and vaccinations was low; the attitude of mothers towards vaccinations was also seen to be positive. It also emerged that religion, level of education, agricultural activities and cultural factors influence the uptake of immunization services. Recommendations are health education for mothers, sensitization of religious leaders and employment of community health workers. The study sought to assist researchers, planners and policy makers to build a case for more focused planning on how to improve the uptake of vaccinations in our community and reduce the child mortality and morbidity rates.