Spatial access inequities and childhood immunisation uptake in Kenya

Area of Science:

• Public Health
• Spatial Epidemiology
• Health Services Research

Background:

• Sub-Saharan Africa faces challenges in achieving equitable immunisation coverage due to poor access to services.
• Spatial access's impact on immunisation coverage in Kenya is not well understood.
• This study quantifies spatial accessibility to health facilities and its influence on immunisation uptake in Kenya.

Purpose of the Study:

• To quantify spatial accessibility to immunising health facilities in Kenya.
• To determine the influence of spatial access on childhood immunisation uptake.
• To control for potential confounders in the analysis of immunisation coverage.

Main Methods:

• Utilized spatial databases (facilities, roads, land use, elevation) with a cost-friction algorithm to estimate travel times.
• Evaluated two travel scenarios: walking only and an optimistic scenario (walking and motorized transport).
• Employed multi-level logistic regression using data from the Kenya Demographic and Health Survey (KDHS 2014) to assess the effect of travel time on vaccination status.

Main Results:

• Mean travel time to facilities was 63 minutes (walking) and 40 minutes (optimistic scenario).
• 75% of the population were within a 1-hour walk, and 93% within a 1-hour optimistic travel time.
• Children living >2 hours from a facility were significantly less likely to be fully immunised (AOR:0.56) or receive DPT3 (AOR:0.51) after adjusting for covariates.

Conclusions:

• Travel time to immunising health facilities acts as a barrier to childhood vaccine uptake in areas with poor accessibility.
• Targeted strategies are needed to overcome access barriers in remote communities.
• Enhancing equitable access to immunisation services in Kenya requires addressing these spatial challenges.