Vulnerabilities influencing childhood vaccination in Kilifi County, Kenya

Childhood vaccines are among the most effective public health interventions, proven to prevent and control the outbreak and spread of infectious diseases. Disparities in access to and uptake of childhood vaccines, however, persist between and within countries, especially in sub-Saharan Africa. These disparities contribute to health inequities and leave countries vulnerable to outbreaks of vaccine-preventable childhood diseases and their associated consequences. Therefore, an in-depth understanding of context-specific vulnerabilities that influence childhood vaccination is essential to address these gaps effectively. Using an ethnographic approach, my study sought to understand the vulnerabilities that influence childhood vaccination in Kilifi County, Kenya. I employed a range of data collection methods, including observations, in-depth interviews with household heads and healthcare workers, and narrative interviews with mothers/caregivers of children in the study households. Data were analysed using thematic and narrative analysis methods. The socio-ecological model, intersectionality, and structural violence frameworks guided the process of data collection, analysis, and interpretation of the findings. The study revealed striking differences in children's vaccination status within and between households, and across the three study villages. Households faced multiple vulnerabilities, including various forms of socioeconomic deprivation, which made accessing and using vaccination services challenging. These were further compounded by vulnerabilities within the immunisation programme and at local facilities where households sought healthcare services. An examination of the intersection of these factors shows that, although proximal factors at the household and facility levels are significant, they are generated and sustained by inequitable systems embedded in societal institutions. Findings from this study confirm the inequities in accessing health care services in low and middle-income countries (LMICs) resulting from various forms of discrimination embedded within the health system and in the broader social and structural systems. Additionally, it underscores the importance of addressing the root causes of vulnerabilities that hinder individuals' access to essential healthcare services, such as immunisation, which are crucial to their survival and well-being.