Timeliness of vaccine administration among children in urban informal settlements in Nairobi, Kenya
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Date
2026-02-11
Journal Title
Journal ISSN
Volume Title
Publisher
PLOS
Abstract
Timeliness of vaccination among children in urban informal settlements is understudied in sub-Saharan Africa. We determined the proportion of children below 5 years who received vaccines on time and the associated factors in two large urban informal settlements in Nairobi, Kenya. We conducted an analytic cross-sectional study in Viwandani and Korogocho, randomly selected households with a child below 5 years, and administered questionnaires to mothers/caregivers. Timely vaccination was defined according to the Kenya Expanded Programme on Immunization schedule. Vaccination was considered timely if administered within 28 days of birth for Bacille Calmette-Guérin (BCG), between 14 and 18 weeks for Diphtheria-Tetanus-Pertussis-Haemophilus influenzae type b-Hepatitis B dose 3 (DTP-Hib-HepB-3), and between 9 and 10 months for Measles-Containing Vaccine dose 1 (MCV1). Multivariable modified Poisson regression identified the factors associated with timely vaccination. Of 412 children, 216 (52%) with verifiable immunization booklets were analyzed for timeliness. Timely vaccination rates were 90.4% for BCG (189/209), 90.2% for DTP-HIB-Hep-3 (184/204), and 84.2% for MCV1 (160/190). Factors associated with timely vaccination included caregiver uncertainty about access to health services, which reduced the likelihood of timely BCG (adjusted prevalence risk ratio [aPR] 0.87, 95% confidence interval [CI] 0.78-0.96), DTP-Hib-HepB-3 (aPR 0.88, 95% CI 0.79-0.98), and MCV1 (aPR 0.81, 95% CI 0.70-0.94). Compared with Korogocho, children in Viwandani were more likely to receive timely MCV1 (aPR 1.18, 95% CI 1.03-1.35), whereas children of Christian caregivers were less likely than those of non-religious caregivers (aPR 0.83, 95% CI 0.70-0.99). Overall, vaccination timeliness varied by antigen, with a slight decline over time for later-schedule vaccines such as MCV1. Residence, religion, and access to routine health services were key determinants of timely vaccination. Strengthening outreach, faith-based engagement, and reminder systems in informal settlements like Korogocho could enhance vaccine timeliness, particularly for vaccines administered later in infancy.
Description
This research investigates the timeliness of vaccine administration among children living in Nairobi’s urban informal settlements, revealing how delays in routine childhood immunizations compromise protection against preventable diseases. By looking beyond statistics to the lived experiences of families, the study identifies critical barriers—such as place of residence, caregivers’ access to services, and the reach of health outreach programs—that shape whether children receive vaccines on time. These insights resonate with the ambitions of SDG 3 (Good Health and Well-being) by targeting the reduction of vaccine-preventable illness and death, SDG 1 (No Poverty) by addressing inequities in health access, and SDG 10 (Reduced Inequalities) by focusing on the needs of marginalized urban populations. The evidence generated offers actionable guidance for programs working to strengthen immunization systems and community outreach, supporting broader priorities like Uganda’s National Development Plan IV, which seeks to improve child health outcomes and ensure equitable access to essential health services.
Keywords
Vaccination and immunization, Vaccines, Caregivers, Children, Religion, Kenya, COVID 19
Citation
Ng’oda, M., Izudi, J., Omenda, C., Njeri, A., Mbaya, N., & Ziraba, A. (2026). Timeliness of vaccine administration among children in urban informal settlements in Nairobi, Kenya. PLOS Global Public Health, 6(2), e0005462.