Health workers and vaccination coverage in developing countries:: an econometric analysis
Health workers and vaccination coverage in developing countries:: an econometric analysis
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DOI：
10.1016/s0140-6736(07)60599-6
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发表时间：
2007-04-14
期刊：
影响因子：
168.9
通讯作者：
Baernighausen, Till
中科院分区：
文献类型：
--
作者：
Anand, Sudhir;Baernighausen, Till
在发展中国家，疫苗可预防的疾病每年造成100多万儿童死亡。虽然需要卫生工作者进行疫苗接种，但尚未调查卫生人力资源作为人口一级疫苗接种覆盖率的决定因素的作用。我们的目的是检验发展中国家卫生工作者密度是否与儿童疫苗接种覆盖率呈正相关。方法采用三种疫苗的覆盖率进行跨国多元回归分析：含麻疹疫苗（MCV）；白喉、破伤风和百日咳（DTP3）；以及脊髓灰质炎（脊髓灰质炎）——作为因变量。在一组回归中，卫生工作者总密度是一个独立变量；另一组分别使用医生和护士密度。我们控制了人均国民收入、女性成人识字率和土地面积。卫生工作者密度与所有三种疫苗的覆盖率显著相关（MCV p=0.0024; DTP3 p=0.0004；脊髓灰质炎p=0.0008）。然而，当分别评估医生和护士的影响时，我们发现护士密度与所有三种疫苗的覆盖率显著相关（MCV p=0.0097; DTP3 p=0.0083；脊髓灰质炎p=0.0089），但医生密度不相关（MCV p=0.7953; DTP3 p=0.7971；脊髓灰质炎p=0.7885）。女性成人识字率与疫苗接种覆盖率呈正相关，而土地面积呈负相关。人均国民收入对覆盖率没有影响。卫生工作者（护士）的密度越高，随着时间和空间的推移，疫苗接种服务的可得性就越高，使儿童更有可能接种疫苗。在控制了其他决定因素之后，收入水平对提高免疫覆盖率没有贡献。卫生工作者可能是发展中国家疫苗接种覆盖率的一个主要制约因素。
Background Vaccine-preventable diseases cause more than 1 million deaths among children in developing countries every year. Although health workers are needed to do vaccinations, the role of human resources for health as a determinant of vaccination coverage at the population level has not been investigated. our aim was to test whether health worker density was positively associated with childhood vaccination coverage in developing countries.Methods We did cross-country multiple regression analyses with coverage of three vaccinations-measles-containing vaccine (MCV); diphtheria, tetanus, and pertussis (DTP3); and poliomyelitis (polio3)-as dependent variables. Aggregate health worker density was an independent variable in one set of regressions; doctor and nurse densities were used separately in another set. We controlled for national income per person, female adult literacy, and land area.Findings Health worker density was significantly associated with coverage of all three vaccinations (MCV p=0.0024; DTP3 p=0.0004; polio3 p=0.0008). However, when the effects of doctors and nurses were assessed separately, we found that nurse density was significantly associated with coverage of all three vaccinations (MCV p=0.0097; DTP3 p=0.0083; polio3 p=0.0089), but doctor density was not (MCV p=0.7953; DTP3 p=0.7971; polio3 p=0.7885). Female adult literacy was positively associated, and land area negatively associated, with vaccination coverage. National income per person had no effect on coverage.Interpretation A higher density of health workers (nurses) increases the availability of vaccination services over time and space, making it more likely that children will be vaccinated. After controlling for other determinants, the level of income does not contribute to improved immunisation coverage. Health workers can be a major constraining factor on vaccination coverage in developing countries.