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Injecting healthcare into Nairobi’s slums

Child receiving vaccination

WHO under a Creative Commons Licence

What is the significance of seven seconds?

According to a 2012 World Health Organization report, every seven seconds, a child under the age of five dies. Many die from diseases that would be easily preventable through immunization.

Immunization programmes are recognized as the most effective and cost-efficient strategy in preventative medicine. Public immunization programmes should be the top priority for health, especially in low-resource settings, such as Kenya’s capital, Nairobi.

Sixty per cent of Nairobi’s population live in slums – informal settlements with overcrowded conditions, poor sanitation and limited access to services. The lack of clean water and sanitation, combined with the high population density, provides the perfect breeding ground for disease. Comparative studies show populations residing in urban slums have poorer health than their rural counterparts; the reverse is usually true for urban and rural populations. With urban growth projected to continue, so too will the ‘urbanization of poverty’. Due to the complex and often illegal nature of the slums, there are very few public health and social services and facilities. In rare instances, there may be limited access to private pharmacies or services, but they are often run by unregistered professionals or even non-professionals.

Apart from obvious health repercussions, there are other negative consequences, both short and long-term. Sick children are unable to attend school; they are also more likely to become infected with other illnesses, further reducing their capacity to function and recover. In fact, some of these children never fully recover and bear life-long impacts of childhood diseases. Children who grow into sickly adults are unable to work, thus affecting families and their ability to escape the poverty cycle.

But these negative consequences of disease can be stopped through vaccinating children to boost their immune system.

A study conducted in Brazil’s slums, which examined the cost of intervention compared to the cost of managing existing disease, came out in favour of intervention. The price tag of preventative health intervention through immunization is much lower than treating the disease. The cost of immunization is low: according to a report written by the Kenyan Department of Health, vaccinations cost between $1 and $2 each. The cost of managing chronic disease consequences is much higher, especially as the disease progresses. When the personal burden of disease and lost productivity are also factored in, primary health intervention through vaccination is a smarter choice.

Current medical literature and research also supports immunization. In one particular study exploring whooping cough in children in a West African community, the results were especially striking in children who had not previously received vaccination. Not only was the rate of disease decreased substantially, but the whopping cough episode was shorter in duration and, for the small number of immunized children who were still infected, reduced in severity.

The outcome of a study on measles prevention in Nairobi’s slums further supports the case for immunization for prevention: vaccinated children were less susceptible to the disease and displayed improved recovery times.  

There is no doubt current immunization campaigns facilitated by the Kenyan Department of Vaccines and Immunizations are effective for preventative health. However, the challenge lies in reaching all of the population and achieving widespread vaccination coverage, including vulnerable and at-risk populations who are often overlooked and forgotten.

Long-term solutions involving public healthcare and facilities are the most desirable, but require extensive planning and funding. Immunization programmes which are provided free of charge to the recipient are an effective and low-cost strategy, can be implemented rapidly, and have high yield results. A study conducted by Streefland in a Bangladesh slum showed a direct correlation between decreasing coverage of immunization in children and increasing distance from an immunization facility. The work now lies in establishing outreach immunization programmes directly in the slums.

Strategies that can be implemented to boost immunization coverage in slums include working alongside the local community through open communication, training and setting up of make-shift facilities. Communication is particularly important to spread the word on the health benefits of vaccination, as well as the provision of free vaccines to encourage any families who may be deterred by financial hardship. Training members of the community can also help negate cultural barriers to vaccination.

With proper funding and support for outreach immunization programmes, we can stop the clock before it hits seven seconds.

Phoebe Shiu is a student at James Cook University and is a Global Voices delegate to the current United Nations Environment Assembly in Nairobi.

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