Abstract
IntroductionIn Kenya, failure to complete immunization schedules by children who previously accessed immunization services is an obstacle to ensuring that children are fully immunized. Home visit approaches used to track defaulting children have not been successful in reducing the drop-out rate.MethodsThis study tested the use of phone contacts as an approach for tracking immunization defaulters in twelve purposively-selected facilities in three districts of western Kenya. For nine months, children accessing immunization services in the facilities were tracked and caregivers were asked their reasons for defaulting.ResultsIn all of the facilities, caregiver phone ownership was above 80%. In 11 of the 12 facilities, defaulter rates between pentavalent1 and pentavalent3 vaccination doses reduced significantly to within the acceptable level of < 10%. Caregivers provided reliable contact information and health workers positively perceived phone-based defaulter communications. Tracking a defaulter required on average 2 minutes by voice and Ksh 6 ($ 0.07). Competing tasks and concerns about vaccinating sick children and side-effects were the most cited reasons for caregivers defaulting. Notably, a significant number of children categorised as defaulters had been vaccinated in a different facility (and were therefore “false defaulters”).ConclusionUse of phone contacts for follow-up is a feasible and cost-effective method for tracking defaulters. This approach should complement traditional home visits, especially for caregivers without phones. Given communication-related reasons for defaulting, it is important that immunization programs scale-up community education activities. A system for health facilities to share details of defaulting children should be established to reduce “false defaulters”.
Highlights
Vaccinating children is one of the most successful and cost-effective public health interventions for addressing childhood mortality and morbidity [1, 2]
In order to facilitate easy tracking of children whose caregivers did not provide a reliable contact number, efforts were made to link them to responsible community health workers
Several approaches had been used to track defaulters and bring them back to complete the immunization schedule. These approaches were predominantly based on home visits and included the use of community health workers, village elders and public health technicians who were expected to physically trace the whereabouts of the defaulting children, using information derived from the permanent registers
Summary
Vaccinating children is one of the most successful and cost-effective public health interventions for addressing childhood mortality and morbidity [1, 2]. Between 2000 and 2006, the Kenya immunization program reported a slow but steady improvement in coverage These gains were compromised, due to the 2007-08 political conflicts, the proliferation of districts with no clear capacity-building plans for new immunization managers and the abolition of cost share funds previously used to fund immunization operational costs. Previous studies conducted in Kenya have reported varied reasons for this underperformance, including poor health-seeking behaviour or lack of knowledge of caregivers, inadequate demand generation activities, stock-outs of antigens at facilities, cold chain-related logistical problems (such as lack of gas, malfunctioning or absent equipment), inadequate access to hard-to-reach areas, poor defaulter tracing and/or inadequately trained staff coupled with irregular supportive supervision [6,7,8]
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