Delivery of childhood immunization services for migrant populations and host communities in Kenya

April 29, 2020

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The theme for the 2020 World Immunization Week is “Vaccines Work for All,” a slogan that celebrates the heroic efforts of the people who have ensured that no child is left behind. Indeed immunization is an indisputable public health intervention that has enormously reduced the global burden of vaccine-preventable deaths [1]. In Kenya, the current childhood immunization coverage stands at 82% compared to 68% in 2015 [2, 3]This is in part due to the expansion and intensification of immunization services in the country. While the improvement in the immunization coverage is an essential achievement in the war against vaccine-preventable deaths, we recognize that our work is not complete until no child is left behind. 

Considerable immunization gaps have become apparent, with evidence of the most acute deficiencies observed among migrants and host communities. In 2011, following an outbreak of measles in Eastleigh, an ethnic Somali community dominated by migrants in Nairobi, the Ministry of Health stepped up its active surveillance and analysis of surveillance information to identify all areas reaching the threshold for outbreaks [4]. The World Health Organization surveillance data showed a pattern of spread from Eastleigh to all of Nairobi and from Nairobi to most rural parts of Kenya [5].

Diverse typologies of migrant communities are hosted in Kenya from neighboring countries such as Sudan, Somali, Tanzania, Ethiopia, and Uganda. In a search for greener pastures, we have witnessed communities move from war-prone areas, areas where climate change is slowly tightening its grip on farmers, all in a bid for families to find alternative means of livelihoods. Mobile pastoralists are on the move with the animals and families year-round in continuous search of fresh pasture and water. Furthermore, rural-rural migration takes place to tea, flower, and sugar plantations. Therein lies an impending problem. 

Mobility presents a significant threat to gains made on immunization not only to the migrant population but also to the host communities. Mass immunization campaigns targeting children left behind are widespread in Kenya, especially in border counties perceived to be prone to outbreaks due to the immigration of high-risk unimmunized children from conflict areas. However, because of the unknown denominator populations to be targeted for immunization in the host communities, the majority of the children continue to miss out on vaccination. Sporadic outbreaks of vaccine-preventable diseases such as measles are still prevalent in host communities despite the targeted campaigns. The denominator data for immunization coverage are inaccurate since the projections are made from national census data that do not account for population growth as a result of immigration. This creates two fundamental problems: over-reporting of the immunization coverage painting a false hope, and failure to identify unimmunized children, thus no appropriate response from the health system of the host country or humanitarian organizations.

Access to and delivery of vaccinations to migrants is ingrained in the concept of person-centered-healthcare services. This is underscored in the government’s commitment to the Universal health coverage as one the pillars for socio-economic transformation. Ultimately, equitable immunization for this vulnerable group is one of the priority issues in Kenya and an important consideration for achieving global and regional targets to eliminate vaccine-preventable deaths. Without developing and refining novel approaches to track and reach the vulnerable children of the migrants and host communities, outbreaks of vaccine-preventable disease in these settings may persist and spread across subnational and international borders. Implementing interventions that focus on the delivery strategies to fit the context and realities of migrant populations and host communities may save lives and help close this equity gap.

References

1. Andre, F.E., et al., Vaccination greatly reduces disease, disability, death and inequity worldwide. Bulletin of the World health organization, 2008. 86: p. 140-146.

2. Ministry of Health. Exploring strategies to achieve 100% immunization coverage. 2019  [cited 2020 28th April]; Available from: http://www.health.go.ke/exploring-strategies-to-achieve-100-immunization-coverage/.

3. Kenya National Bureau of Statistics (KNBS) and ICF International. Kenya Demographic and Health Survey (KDHS), Kenya Demographic and Health Survey (KDHS). 2014

4. Manakongtreecheep, K. and R. Davis, A review of measles control in Kenya, with focus on recent innovations. The Pan African Medical Journal, 2017. 27(Suppl 3).

5. International Federation of Red Cross and Red Crescent Society, Measles Outbreak. DREF Operation no. MDRKE017. 2011.

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