Child immunization coverage in urban slums of Bangladesh: impact of an intervention package
Child immunization coverage in urban slums of Bangladesh: impact of an intervention package
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DOI：
10.1093/heapol/czp041
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发表时间：
2010-01-01
影响因子：
3.2
通讯作者：
Saha, Nirod Chandra
中科院分区：
文献类型：
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作者：
Uddin, Md Jasim;Larson, Charles P.;Saha, Nirod Chandra
这项研究评估了在现有服务提供系统内实施的扩大免疫方案干预一揽子计划的影响，以提高孟加拉国达卡城市贫民窟的儿童免疫覆盖率。该干预试验采用了前测和后测设计。2006年9月至2007年8月，在两个城市贫民窟试行了一套干预措施。一揽子干预措施包括：（a）扩大的扩大免疫服务时间表;（B）为服务提供者提供关于有效剂量和副作用管理的培训;（c）确定诊所服务人员免疫需求的筛选工具;以及（d）扩大免疫支助小组，以动员社会。数据来源于随机抽样调查、服务统计和定性访谈。定量数据的分析是基于对选定的免疫覆盖率指标的“前后”评估。使用内容分析法对定性数据进行分析。在实施干预措施后，99%的儿童接受了全面免疫接种，而实施干预措施前只有43%。实施后的抗原覆盖率也显著高于实施前。实施干预措施后，辍学率仅为1%，而实施前为33%。在基线时，非工作母亲的子女（75%）完全免疫的比例明显高于工作母亲的子女（14%）。虽然完全免疫接种的儿童的比例都不工作和工作的母亲是显着较高的终点，完全免疫接种的儿童工作的母亲显着改善在终点（99%）相比，基线（14%）。研究结果表明，“一揽子干预措施”在提高城市贫民窟儿童免疫覆盖率方面是有效的。然而，还需要进一步研究，以充分评估一揽子计划的有效性，评估各个组成部分，以确定那些对覆盖面作出最大贡献的组成部分，并评估这一一揽子计划在现有服务提供系统内的可持续性，特别是在更大范围内的可持续性。
The study assessed the impact of an EPI (Expanded Programme on Immunization) intervention package, implemented within the existing service-delivery system, to improve the child immunization coverage in urban slums of Dhaka, Bangladesh. This intervention trial used a pre- and post-test design. An intervention package was tested from September 2006 to August 2007 in two urban slums. The intervention package included: (a) an extended EPI service schedule; (b) training for service providers on valid doses and management of side-effects; (c) a screening tool to identify immunization needs among clinic attendants; and (d) an EPI support group for social mobilization. Data were obtained from random sample surveys, service statistics and qualitative interviews. Analysis of quantitative data was based on a 'before and after' assessment of selected immunization-coverage indicators. Qualitative data were analysed using content analysis. Ninety-nine per cent of the children were fully immunized after implementation of the interventions compared with only 43% before implementation. Antigen-wise coverage after implementation was also significantly higher compared with before implementation. Only 1% drop-out was observed after implementation of the interventions while it was 33% before implementation. At baseline, a significantly higher proportion of children of non-working mothers (75%) were fully immunized compared with children of working mothers (14%). Although the proportion of fully immunized children of both non-working and working mothers was significantly higher at endline, fully immunized children of working mothers dramatically improved at endline (99%) compared with baseline (14%). The findings suggest the effectiveness of a 'package of interventions' in improving child immunization coverage in urban slums. However, further research is needed to fully assess the effectiveness of the package, to assess the individual components in order to identify those that make the biggest contribution to coverage, and to assess the sustainability of this package within the existing service delivery system, particularly on a wider scale.