A qualitative assessment of influenza vaccine uptake among children in Kenya
Nzisa Liku,
Caroline Mburu,
Kathryn E. Lafond,
Malembe Ebama,
Mamu Athman,
Salma Swaleh,
Isaac Jewa,
Elen Ngware,
Virginia Njenga,
Elizabeth Kiptoo,
Catherine Munyao,
Christine Miano,
Edwina Anyango,
Samson Thuo,
Wycliffe Matini,
Harriet Mirieri,
Nancy Otieno,
Mwanasha Athman,
Patrick Chanzera,
Zahra Awadh,
Monica Muthoni,
Patrick Kingori,
M. Kariuki Njenga,
Gideon O. Emukule,
Eric Osoro,
Collins Tabu,
Jeanette Dawa
Affiliations
Nzisa Liku
Influenza Program, U.S. Centers for Disease Control and Prevention, Nairobi, Kenya; Corresponding author.
Caroline Mburu
Department of Social Anthropology, University of St Andrews, Scotland, UK
Kathryn E. Lafond
Influenza Division, National Center for Immunization and Respiratory Diseases, U.S. Centers for Disease Control and Prevention, Atlanta, GA, USA
Malembe Ebama
Partnership for Influenza Vaccine Introduction, Task Force for Global Health, Atlanta, USA
Mamu Athman
Mombasa County Health Management Team, Department of Health, Mombasa County, Kenya
Salma Swaleh
Mombasa County Health Management Team, Department of Health, Mombasa County, Kenya
Isaac Jewa
Mombasa County Health Management Team, Department of Health, Mombasa County, Kenya
Elen Ngware
Nakuru County Health Management Team, Department of Health, Nakuru County, Kenya
Virginia Njenga
Nakuru County Health Management Team, Department of Health, Nakuru County, Kenya
Elizabeth Kiptoo
Nakuru County Health Management Team, Department of Health, Nakuru County, Kenya
Catherine Munyao
National Vaccines and Immunisation Program, Ministry of Health, Kenya
Christine Miano
National Vaccines and Immunisation Program, Ministry of Health, Kenya
Edwina Anyango
National Vaccines and Immunisation Program, Ministry of Health, Kenya
Samson Thuo
National Vaccines and Immunisation Program, Ministry of Health, Kenya
Wycliffe Matini
Division of Disease Surveillance and Response, Ministry of Health, Kenya
Harriet Mirieri
Washington State University (WSU) Global Health Kenya, Nairobi, Kenya
Nancy Otieno
Center for Global Health Research, Kenya Medical Research Institute, Kisumu, Kenya
Mwanasha Athman
Jomvu Sub-County Health Management Team, Department of Health, Mombasa County, Kenya
Patrick Chanzera
Jomvu Sub-County Health Management Team, Department of Health, Mombasa County, Kenya
Zahra Awadh
Likoni Sub-County Health Management Team, Department of Health, Mombasa County, Kenya
Monica Muthoni
Nakuru North Sub-County Health Management Team, Department of Health, Nakuru County, Kenya
Patrick Kingori
Njoro Sub-County Health Management Team, Department of Health, Nakuru County, Kenya
M. Kariuki Njenga
Washington State University (WSU) Global Health Kenya, Nairobi, Kenya; Paul G. Allen School for Global Health, Washington State University (WSU), Pullman, USA
Gideon O. Emukule
Influenza Program, U.S. Centers for Disease Control and Prevention, Nairobi, Kenya; Influenza Division, National Center for Immunization and Respiratory Diseases, U.S. Centers for Disease Control and Prevention, Atlanta, GA, USA
Eric Osoro
Washington State University (WSU) Global Health Kenya, Nairobi, Kenya; Paul G. Allen School for Global Health, Washington State University (WSU), Pullman, USA
Collins Tabu
National Vaccines and Immunisation Program, Ministry of Health, Kenya
Jeanette Dawa
Washington State University (WSU) Global Health Kenya, Nairobi, Kenya
Background: Influenza is a significant contributor to acute respiratory infections (ARI), and children < 5 years are at increased risk of severe influenza disease. In Kenya the influenza vaccine is not included in the Kenya Expanded Programme on Immunization (KEPI). To inform roll-out of a national influenza vaccination program, we implemented an influenza vaccine demonstration project in Nakuru and Mombasa counties in Kenya from 2019 to 2021 and set out to establish factors driving influenza vaccine acceptance and hesitancy among caregivers of children aged 6–23 months. Methods: Using semi-structured questionnaires, we conducted eight focus group discussions among community members and twelve key informant interviews among healthcare workers to elicit both lay and expert opinions. Thematic analysis of the interviews was conducted using the World Health Organization’s “3 Cs” model of vaccine hesitancy to determine reasons for acceptance or hesitancy of the influenza vaccine. Results: The influenza vaccine was well received among community members and healthcare workers though concerns were raised. Vaccine hesitancy was fuelled by misconceptions about reasons for introducing the vaccine (confidence), perceptions that influenza was not a serious disease (complacency) and administrative fees required at some facilities (convenience). Despite the use of various advocacy, communication and social mobilisation strategies targeted at educating the community on the influenza disease and importance of vaccination, there remained a perception of inadequate reach of the sensitization among some community members. Contextual factors such as the COVID-19 pandemic affected uptake, and parents expressed concern over the growing number of vaccines recommended for children. Conclusion: Despite lingering concerns, caregivers had their children vaccinated indicating that vaccine hesitancy exists, even among those who accepted the vaccine for their children. Efforts targeted at increasing confidence in and reducing misconceptions towards vaccines through effective communication strategies, are likely to lead to increased vaccine uptake.
