Abstract

Objectives

Kenya has substantially improved child mortality between 1990 and 2019, with under-five mortality decreasing from 104 to 43 deaths per 1,000 live births. However, only two-thirds of Kenyan children receive all recommended vaccines by one year, making it essential to identify under-vaccinated sub-populations. A potentially vulnerable group is internal migrants, who are 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 both 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 is an important deviation from previous literature that did not rigorously address important biases.