Socio-economic determinants and inequities in coverage and timeliness of early childhood immunisation in rural Ghana
Socio-economic determinants and inequities in coverage and timeliness of early childhood immunisation in rural Ghana
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DOI：
10.1111/tmi.12324
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发表时间：
2014-07-01
影响因子：
3.3
通讯作者：
Kirkwood, Betty R.
中科院分区：
文献类型：
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作者：
Gram, Lu;Soremekun, Seyi;Kirkwood, Betty R.
目的评估加纳关键儿童免疫接种覆盖率和及时性方面的社会经济不公平程度。方法对2008年1月至2010年1月出生的婴儿在支持ObaapaVita和Newhints试验的监测系统中登记的疫苗接种卡数据进行二次分析。20251例随访6周，16652例随访26周，5568例随访1年。我们通过城乡地位、财富和教育程度的指标对疫苗接种的覆盖率和及时性进行了描述性分析。结果卡介苗(BCG)、三种五价白喉、百日咳、破伤风、流感嗜血杆菌乙型肝炎(DPTHH)疫苗和除出生时脊髓灰质炎外的所有脊髓灰质炎疫苗(63%)在1岁时的总覆盖率很高(95%)。麻疹和黄热病接种率为85%。卡介苗的中位延迟时间为1.7周。对于出生时的脊髓灰质炎，中位延迟为5天；所有其他疫苗接种的中位延迟为2-4周。我们发现，就及时性而言，所有疫苗的所有社会经济指标都存在严重的健康不平等，但一年的覆盖率并不平等。例如，在最后一次注射中，延迟超过8周的儿童比例城市儿童为27%，农村儿童为31%(P<；0.001)，最富有的五分之一儿童为21%，最贫穷的五分之一儿童为41%(P<；0.001)，受教育程度最高的儿童为9%，教育程度最低的儿童为39%(P<；0.001)。然而，所有社会经济指标的1年相同剂量覆盖率保持在90%以上。结论加纳在城乡、社会经济和教育方面存在严重的健康不平等。虽然总体覆盖率很高，但大多数疫苗的及时性很差。我们建议，实现高覆盖率的国家应在其监测系统中纳入及时性指标。
OBJECTIVES To assess the extent of socio-economic inequity in coverage and timeliness of key childhood immunisations in Ghana.METHODS Secondary analysis of vaccination card data collected from babies born between January 2008 and January 2010 who were registered in the surveillance system supporting the ObaapaVita and Newhints Trials was carried out. 20 251 babies had 6 weeks' follow-up, 16 652 had 26 weeks' follow-up, and 5568 had 1 year's follow-up. We performed a descriptive analysis of coverage and timeliness of vaccinations by indicators for urban/rural status, wealth and educational attainment. The association of coverage with socio-economic indicators was tested using a chi-square-test and the association with timeliness using Cox regression.RESULTS Overall coverage at 1 year of age was high (>95%) for Bacillus Calmette-Guerin (BCG), all three pentavalent diphtheria-pertussis-tetanus-haemophilus influenzae B-hepatitis B (DPTHH) doses and all polio doses except polio at birth (63%). Coverage against measles and yellow fever was 85%. Median delay for BCG was 1.7 weeks. For polio at birth, the median delay was 5 days; all other vaccine doses had median delays of 2-4 weeks. We found substantial health inequity across all socioeconomic indicators for all vaccines in terms of timeliness, but not coverage at 1 year. For example, for the last DPTHH dose, the proportion of children delayed more than 8 weeks were 27% for urban children and 31% for rural children (P < 0.001), 21% in the wealthiest quintile and 41% in the poorest quintile (P < 0.001), and 9% in the most educated group and 39% in the least educated group (P < 0.001). However, 1-year coverage of the same dose remained above 90% for all levels of all socio-economic indicators.CONCLUSIONS Ghana has substantial health inequity across urban/rural, socio-economic and educational divides. While overall coverage was high, most vaccines suffered from poor timeliness. We suggest that countries achieving high coverage should include timeliness indicators in their surveillance systems.