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The influence of maternal migration on child vaccination in Kenya: An inverse probability of treatment-weighted analysis
Authors: Julia M. Porth, Emily Treleaven, Nancy L. Fleischer, Martin K. Mutua, and Matthew L. Boulton
Source: International Journal of Infectious Diseases, Vol. 106
Topic(s): Immunization
Country: Africa
Published: MAY 2021
Abstract: Objectives: Kenya has substantially improved child mortality between 1990 and 2019, with under-5 mortality decreasing from 104 to 43 deaths per 1000 live births. However, only two-thirds of Kenyan children receive all recommended vaccines by 1 year, making it essential to identify undervaccinated subpopulations. Internal migrants are a potentially vulnerable group at risk of decreased access to healthcare. This analysis explored how maternal migration within Kenya influences childhood vaccination. Methods: Data were from the 2014 Kenya Demographic and Health Survey, a nationally representative cross-sectional survey. Logistic regressions assessed relationships between maternal migration and full and up-to-date child vaccination using inverse probability of treatment weighting. Two exposure variables were examined: migration status and stream (e.g. rural-urban). Multiple imputation was used to impute up-to-date status for children without vaccination cards to reduce selection bias. Results: After accounting for selection and confounding biases, all relationships between migration status and migration stream and full and up-to-date vaccination became statistically insignificant. Conclusions: Null findings indicate that, in Kenya, characteristics enabling migration, rather than the process of migration itself, drive differential vaccination behavior between migrants and non-migrants. This finding is an important deviation from previous literature, which did not rigorously address important biases.