Essential childhood immunization in 43 low- and middle-income countries: Analysis of spatial trends and socioeconomic inequalities in vaccine coverage.
Essential childhood immunization in 43 low- and middle-income countries: Analysis of spatial trends and socioeconomic inequalities in vaccine coverage.
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DOI：
10.1371/journal.pmed.1004166
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发表时间：
2023-01
期刊：
影响因子：
15.8
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中科院分区：
文献类型：
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在全球范围内，在过去的50年里，获得救命疫苗的机会有了很大的改善。然而，近年来，进展已经开始放缓，甚至出现逆转。了解国家以下地区儿童基本免疫接种的异质性对于缩小全球疫苗接种差距至关重要。我们使用了43个中低收入国家(LMIC)1,366个行政区的220,000多名儿童的疫苗接种信息，这些信息来自最新的人口和健康调查。我们估计了国家和国家以下各级的基本免疫覆盖率，并使用调整后的集中指数量化了这种覆盖率中的社会经济不平等。国家内部和国家之间的差异通过泰尔指数进行总结。我们使用局部空间关联指标(LISA)统计数据来识别具有高或低值的行政区域的集群。最后，我们估计了所有43个国家15至35个月大的儿童错过接种疫苗的数量，以及最常错过的疫苗类型。我们表明，国家一级的疫苗接种率可以掩盖广泛的国家以下地区的异质性。在西非和中非以及南亚，特别是在安哥拉、乍得、尼日利亚、几内亚和阿富汗等地区，儿童免疫接种存在很大差距，这些地区只有不到10%的儿童完全接种了疫苗。此外，生活在这些国家的儿童一直缺乏世卫组织为幼儿推荐的所有4种基本疫苗。在大多数国家，来自贫困家庭的儿童不太可能完全接种疫苗。主要的限制包括根据一些国家的大型行政区划和不同时期的调查数据进行的次国家估计数。在儿童基本免疫方面发现的异质性，特别是考虑到一些地区所有基本疫苗一直得不到足够的服务，可以用来指导旨在消除儿童因现有和新型疫苗可预防疾病而遭受的痛苦和死亡的本地化干预方案的设计和实施。Anna Dimitrova博士和他的同事分析了43个低收入和中等收入国家基本儿童免疫疫苗覆盖率的空间趋势和社会经济不平等。尽管全球努力提高低收入和中等收入国家的儿童免疫接种率，但近年来进展缓慢，甚至逆转。确定难以接触到的人群将是缩小疫苗接种差距的关键。儿童免疫接种覆盖率方面的社会经济差异主要是在国家一级进行的研究。我们分析了43个LMIC的调查数据，并调查了国家以下一级和社会经济群体之间儿童疫苗接种覆盖率的差异。我们确定了非洲和亚洲儿童疫苗接种水平特别低的地理区域。在大多数国家，贫困家庭的儿童不太可能完全接种疫苗，大量儿童错过了世界卫生组织推荐的所有4种基本疫苗。各国之间和国家内部以及社会经济群体之间在儿童免疫接种方面存在很大差距。由于传染病是导致儿童死亡的主要原因之一，因此需要作出更多努力，以确保低收入国家公平获得基本疫苗。
Globally, access to life-saving vaccines has improved considerably in the past 5 decades. However, progress has started to slow down and even reverse in recent years. Understanding subnational heterogeneities in essential child immunization will be critical for closing the global vaccination gap. We use vaccination information for over 220,000 children across 1,366 administrative regions in 43 low- and middle-income countries (LMICs) from the most recent Demographic and Health Surveys. We estimate essential immunization coverage at the national and subnational levels and quantify socioeconomic inequalities in such coverage using adjusted concentration indices. Within- and between-country variations are summarized via the Theil index. We use local indicator of spatial association (LISA) statistics to identify clusters of administrative regions with high or low values. Finally, we estimate the number of missed vaccinations among children aged 15 to 35 months across all 43 countries and the types of vaccines most often missed. We show that national-level vaccination rates can conceal wide subnational heterogeneities. Large gaps in child immunization are found across West and Central Africa and in South Asia, particularly in regions of Angola, Chad, Nigeria, Guinea, and Afghanistan, where less than 10% of children are fully immunized. Furthermore, children living in these countries consistently lack all 4 basic vaccines included in the WHO’s recommended schedule for young children. Across most countries, children from poorer households are less likely to be fully immunized. The main limitations include subnational estimates based on large administrative divisions for some countries and different periods of survey data collection. The identified heterogeneities in essential childhood immunization, especially given that some regions consistently are underserved for all basic vaccines, can be used to inform the design and implementation of localized intervention programs aimed at eliminating child suffering and deaths from existing and novel vaccine-preventable diseases. Dr. Anna Dimitrova and colleagues analyse spatial trends and socioeconomic inequalities in vaccine coverage for essential childhood immunization across 43 low- and middle-income countries. Despite global efforts to improve child immunization rates in low- and middle-income countries (LMICs), progress has slowed down and even reversed in recent years. Identifying hard-to-reach populations will be critical for closing the vaccination gap. Socioeconomic disparities in child immunization coverage have been mostly studied at the national level. We analyzed survey data from 43 LMICs and investigated disparities in child vaccination coverage at the subnational level and across socioeconomic groups. We identified geographical regions in Africa and Asia where levels of childhood vaccination are particularly low. Across most countries, children from poorer households are less likely to be fully immunized and a large number of children miss all 4 essential vaccines recommended by the World Health Organization. Large gaps in child immunization are found across and within countries, and among socioeconomic groups. More efforts are needed to ensure equitable access to essential vaccines in LMICs, where infectious diseases are among the leading causes of child death.
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DOI：
10.1016/s0140-6736(17)31758-0
发表时间：
2017-11-11
期刊：
Lancet (London, England)
影响因子：
--
作者：
Golding N;Burstein R;Longbottom J;Browne AJ;Fullman N;Osgood-Zimmerman A;Earl L;Bhatt S;Cameron E;Casey DC;Dwyer-Lindgren L;Farag TH;Flaxman AD;Fraser MS;Gething PW;Gibson HS;Graetz N;Krause LK;Kulikoff XR;Lim SS;Mappin B;Morozoff C;Reiner RC Jr;Sligar A;Smith DL;Wang H;Weiss DJ;Murray CJL;Moyes CL;Hay SI
通讯作者：
Hay SI
影响因子：
4.8
作者：
Asgeirsdóttir TL;Ragnarsdóttir DO
通讯作者：
Ragnarsdóttir DO
影响因子：
3.7
作者：
Alfonso, Vivian H.;Bratcher, Anna;Rimoin, Anne W.
通讯作者：
Rimoin, Anne W.
影响因子：
33.9
作者：
Casey, Rebecca M.;Dumolard, Laure;Wallace, Aaron S.
通讯作者：
Wallace, Aaron S.
DOI：
10.1097/01.mpg.0000255846.77034.ed
发表时间：
2006-12-01
影响因子：
2.9
作者：
Bhutta, Zulfiqar Ahmed
通讯作者：
Bhutta, Zulfiqar Ahmed