What Does It Take To Eradicate Measles In Kenya?

Children are a blessing from God and therefore, there’s no reason for them to suffer from preventable diseases” – Dr Mercy Mwangangi, Chief Administrative Secretary for Health.

On 25th June 2021, the Government of Kenya, Ministry of Health (GoK-MoH) in collaboration with UNICEF, WHO, US Centre for Disease Control & Prevention, and Gavi the vaccine alliance launched a 10-day measles-rubella (MR) vaccination campaign targeting 4 million children of ages less than 59months amid of COVID 19 pandemic. This process was repeated from 17th – 21st July 2021 to enhance the coverage. Was that enough?

This reaction was due to the recent resurgence of measles cases in Kenya since 2016 and the number noted to have doubled by 2019. In 2012, GoK adopted the goal of measles eradication by the year 2020 in line with the WHO – AFRO resolution.

Ever since the first case of COVID 19 was reported in Kenya on March 13, 2020, our healthcare system has been overstretched, and repressive measures put into place by the government that included social distancing, lockdown of counties, and nationwide curfew night to dawn, from 7 pm to 5 am.

As much as COVID 19 is colligated to the rise of Measles cases, we cannot assume that this was a before factor which could have been addressed. There’s a trend of parents not taking their children for not only measles but other immune booster immunizations like vitamin A supplementation.

The forgotten ‘Gaps’

Despite the government efforts to ensure that not only measles vaccination is free in public healthcare, the number of children who received their first and completed the second dose of measles was also below target. In 2020, only 85% of children in Kenya had received their first dose of MR vaccine and less than 50% have had their second dose. We cannot blame it entirely on COVID – 19, even though it’s currently keeping most parents and children away from hospitals due to fear of getting this deadly virus.

We must all come into unanimity that there are forgotten gaps other than COVID 19, unless they are addressed, we’ll continue having VPDs like tetanus, measles, etc… re-emerging. Some of these forgotten gaps splays around:

Inconvenient and limited clinic hours for immunization

This is a major concern especially in public hospitals where immunizations are free. You’ll find the days and hours set aside for vaccination are not favouring most parents, thus very few parents who know the risks of child missing vaccines are will squeeze their time not to be left out.

In addition, parents and children who live approximately two hours from hospitals or immunization centres are most likely not to get fully immunized. The majority of public healthcare conduct their immunization between 8 am – 12 noon, thus parents who come late are most likely to be sent away, and/or be told to check in the next day. Suppose these parents stay two to three hours away from a hospital, they may not return especially if they are unaware of the importance of that vaccine for the child’s health.

For private hospitals where vaccination is being carried out on daily basis is usually done at a fee. This has created inequalities in vaccines distributions between public and private healthcare. Not everyone can afford to get their children fully vaccinated especially those people living in slums or neighbourhoods on the edges of the cities.

Health care provider barriers

Clinicians including nurses at Mother & Child Health clinics, and community health workers need to actively engage parents both literate and illiterate in every visit. Educating the parents on the available vaccines and the importance of their children getting booster shots like vitamin A is something that needs to be accentuated amid COVID 19.

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Clinicians have the responsibility to check the Mother and Child Health booklet every time a child less than 5 years are brought in to hospitals and constantly remind them to avail their children of booster shots available. Most times, you’ll find the immunization section of the Mother and child health booklet blank yet the child is fully immunized, or not?

Despite the existence of a large body of information about immunization of under 5 years at the National level in Kenya, there’s not as much information at different levels of the health care system where it’s needed by the parents.

Parents’ barrier

Many may lack knowledge about childhood vaccinations, misplaced their Mother and Child Health booklet, and cannot remember the last time they were in a hospital, have unreasonable fears or doubts about vaccines safety, or may lack transportation. The government of Kenya in conjunction with the Ministry of Health needs to access all these factors and ensure the measures already initiated are bearing fruits.

In conclusion:

The government’s effort to react to the resurgence of VPDs in Kenya is ‘banal’. The government will continue to gush in more resources that could be redirected in doing something else to improve Kenya’s economy. Clinicians and community health workers must be on the frontline by establishing a sustainable follow-up system within their facilities that will constantly remind parents to avail their children to receive vaccinations. The government could also partner with private healthcare providers and ensure the vaccines are offered at an affordable cost if not free, for all parents that can access those facilities. I’m looking forward to a Kenya where VPDs like measles will be chronicle and only found in books.

Written by: Stephen Ayere – Nutritionist

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