Understanding inequities in child vaccination rates among the urban poor: evidence from Nairobi and Ouagadougou health and demographic surveillance systems.

Abdramane Bassiahi Soura,Roch Millogo,Patricia Elungata,Yacouba Compaore,Bruno Lankoande,Donatien Beguy,Blessing Mberu

doi:10.1007/s11524-014-9908-1

Abstract

Studies on informal settlements in sub-Saharan Africa have questioned the health benefits of urban residence, but this should not suggest that informal settlements (within cities and across cities and/or countries) are homogeneous. They vary in terms of poverty, pollution, overcrowding, criminality, and social exclusion. Moreover, while some informal settlements completely lack public services, others have access to health facilities, sewers, running water, and electricity. There are few comparative studies that have looked at informal settlements across countries accounting for these contextual nuances. In this paper, we comparatively examine the differences in child vaccination rates between Nairobi and Ouagadougou’s informal settlements. We further investigate whether the identified differences are related to the differences in demographic and socioeconomic composition between the two settings. We use data from the Ouagadougou and Nairobi Urban Health and Demographic Surveillance Systems (HDSSs), which are the only two urban-based HDSSs in Africa. The results show that children in the slums of Nairobi are less vaccinated than children in the informal settlements in Ouagadougou. The difference in child vaccination rates between Nairobi and Ouagadougou informal settlements are not related to the differences in their demographic and socioeconomic composition but to the inequalities in access to immunization services.

Highlights

Improving the health outcomes in the poorest countries of the world through increasing the number and quality of health services and creating public awareness on health issues in developing countries have dominated the political discourse of the World Health Organization (WHO) since the 1970s.1 While not neglecting the health of city dwellers, the focus, in terms of policies and programs in subSaharan Africa has long been geared toward reducing the gap between urban and rural areas
Lankoande, Millogo, and Compaore are with the University of Ouagadougou, Ouagadougou, Burkina Faso; Mberu, Elungata, and Beguy are with the African Population and Health Research Center, Kenya, Nairobi
We comparatively examine the health status of children living in Nairobi and Ouagadougou informal settlements where health and demographic surveillance systems have been set up, using immunization coverage as a proxy outcome

Summary

Introduction

Improving the health outcomes in the poorest countries of the world through increasing the number and quality of health services and creating public awareness on health issues in developing countries have dominated the political discourse of the World Health Organization (WHO) since the 1970s.1 While not neglecting the health of city dwellers, the focus, in terms of policies and programs in subSaharan Africa has long been geared toward reducing the gap between urban and rural areas. In subSaharan Africa in 2013, about 62 % of the urban population live in slums or slumlike conditions.[4] Many poor and illiterate people live in these informal neighborhoods, which are characterized by unsanitary living conditions and the near absence of the public sector. They exhibit high population densities, which are conducive for the spread of infectious diseases. Infectious diseases, child illnesses, and malnutrition indicators remain grim for urban slum dwellers, with substantial urban penalty for children in terms of higher mortality than the rest of the city and rural areas.[2, 6,7,8,9,10]

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