Perceptions of caregivers and healthcare providers regarding vaccinations for children with immune mediated inflammatory disorders (IMIDs) in Nairobi, Kenya

Background: Children with immune mediated inflammatory disorders (IMIDs) are at an increased risk of various types of vaccine preventable diseases. Appropriate immunization practices are therefore key for survival, and for improving the treatment outcomes in these children. This study explored the perceptions of caregivers and healthcare workers regarding vaccination for children with IMIDs at Kenyatta national hospital and Getrude’s children hospital, in Nairobi Kenya. Methods: This was a mixed-methods study involving interviewer administered questionnaires for caregivers, self-administered questionnaires for health workers, and focus group discussions for caregivers of children suffering from IMIDs and attending the rheumatology clinics at the Kenyatta National Hospital and Gertrude’s Children’s Hospital. The study included 103 primary caregivers of children aged 0-18 years with IMIDs and 76 healthcare workers. Results: Most of the caregivers (80%) were female; and two thirds (66%) had attained secondary education or higher. Most (90.6%) caregivers believed that vaccines are safe, 88.2% that vaccines are effective, 97.1% had full trust in vaccines and would readily accept their children to be vaccinated. Further, the caregivers (92.5%) knew that their children could benefit from additional vaccines (other than the routine childhood EPI listed vaccines) and would support additional vaccines for their children if recommended by a doctor. However, only 10.6% (10/103) of caregivers reported that their children had already received at least one of the additional vaccines. Some caregivers (9.4%) expressed fears and misgivings about the additional vaccines for their children. These misgivings include the risk of adverse events following immunization that the children were too young for additional vaccines, or that the child was unwell at the time. The health workers supported the need for additional vaccines for children with IMIDs and vaccine education for caregivers and health workers. Conclusion: Most caregivers and healthcare workers of children with IMIDs accepted and supported additional vaccines, over and above those administered in the routine EPI programme, for children with IMIDs. The biggest promoter of vaccine acceptance and uptake was recommendation of vaccination by health workers while potential barriers included vaccine safety concerns, inadequate vaccine knowledge and concerns of vaccine cost and accessibility.