ArticleThe Pan African medical journal2026
Determinants of measles-rubella second dose vaccine uptake among children in Mathare informal settlement, Nairobi, Kenya: a mixed-methods study.
Article in The Pan African medical journal, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Introduction: measles-rubella remains a major public health concern, with vaccination as the most effective preventive strategy. Despite the introduction of the measles-rubella second dose (MR-2) vaccine to improve immunity, uptake in informal settlements like Mathare, Nairobi, remains suboptimal. This study assessed determinants of MR-2 uptake among children aged 18-59 months in Mathare. Methods: this cross-sectional analytical study used a convergent mixed- methods design. Quantitative data were collected through structured household surveys, while qualitative insights were obtained from Key Informant Interviews and Focus Group Discussions. Results: a total of 370 caregivers responded (103% of the targeted 359). MR-2 coverage was 84%, 14% lower than the measles-rubella first dose (MR-1). Uptake was significantly associated with religion, education level, ward of residence, place of delivery, immunization site, and previous unsuccessful vaccination attempts (p < 0.05). Caregivers unaware of the MR-2 schedule were over four times more likely to miss the dose (OR = 4.146, p < 0.001), as well as those who had previously failed to access services (OR = 4.215, p = 0.007). Lack of a vaccination card (OR = 0.314, p = 0.015) and poor schedule knowledge (OR = 0.322, p = 0.014) were also key predictors. Children in Kiamaiko ward (OR = 5.421) and Ngei ward (OR = 4.281) had higher odds of MR-2 uptake compared to Mlango Kubwa ward. Qualitative findings highlighted barriers such as low awareness, misinformation, economic hardship, and health system gaps. Conclusion: improving MR-2 uptake requires enhanced health education, mobile reminders, consistent vaccine supply, extended clinic hours, and targeted outreach.
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