Community health worker interventions are key to optimal infant immunization coverage, evidence from a pretest-posttest experiment in Mwingi, Kenya

Abstract

IntroductionImmunization is a powerful and cost-effective health intervention which averts an estimated 2 to 3 million deaths every year. Kenya has a high infant and under five mortality and morbidity rates. Increasing routine child immunization coverage is one way of reducing child morbidity and mortality rates in Kenya. Community Health Workers (CHWs) have emerged as critical human resources for health in developing countries. The Community Strategy (CS) is one of the CHW led interventions promoting Maternal and Child Health (MCH) in Kenya. This study sought to establish the effect of CS on infant vaccination Coverage (IVC) in Mwingi west sub-county; Kenya.MethodsThis was a pretest - posttest experimental study design with 1 pretest and 2 post-test surveys conducted in intervention and control sites. Mwingi west and Mwingi north sub-counties where intervention and control sites respectively. Sample size in each survey was 422 households. Women with a child aged 9-12 months were main respondents.ResultsIntervention site end-term evaluation indicated that; the CS increased IVC by 10.1% (Z =6.0241, P <0.0001), from a suboptimal level of 88.7% at baseline survey to optimal level of 98.8% at end term survey. Infants in intervention site were 2.5 times more likely to receive all recommended immunizations within their first year of life [(crude OR= 2.475, P<0.0001; 95%CI: 1.794-3.414) (adj. OR=2.516, P<0.0001; 95%CI: 1.796-3.5240)].ConclusionCS increased IVC in intervention site to optimal level (98.8%). To improve child health outcomes through immunization coverage, Kenya needs to fast-track nationwide implementation of the CS intervention.

Effects of Good Practices for Catch-Up Vaccinations: Assessment with a Quasi-Experimental Study in Democratic Republic of Congo

“…In Kenya, between 2013 and 2015, the contribution of community health workers was assessed in rural environments, with a before-and-after comparison between intervention and control areas. The results of this study correspond with ours, although with a much smaller increase of 10% in the percentage of fully immunised children in the intervention area compared to the control area and a likelihood of being fully vaccinated 2.5 times higher in the intervention area compared with the control area [17]. The differences between our results and this study may be due to the initial conditions in the intervention areas in the Kenyan study.…”

Regional variations of childhood immunisations in Senegal: a multilevel analysis

“…Regardless of the mother's level of education, children may have a higher risk of being incompletely immunised when they live in a less educated region than when they live in more educated one. It might be related to the education level of community health workers, who play an important role in the vaccination campaigns conducted by the health facilities and access to health care services in general [26]. A multilevel analysis of DHS data from 24 countries in sub-Saharan Africa [27] also provided evidence that unimmunised children born to mothers with no formal education and living in communities with high illiteracy rates were more likely to be unimmunised.…”

The Role of “My Village My Home” in the Knowledge and Attitudes of Integrated Health Post Cadres and Mothers

“…A cadre is a person chosen by the community and trained to move the community to participate in community empowerment in the health sector (Ministry of Health RI, 2019). In developing countries, the role of cadres is very important in increasing access to health services (Nzioki, Ouma, Ombaka, & Onyango, 2017), although Integrated Health Post cadres do not directly provide immunizations. Health workers in Integrated Health Posts assess the health of infants each month and therefore have a better knowledge of their health status.…”