Childhood vaccination in informal urban settlements in Nairobi, Kenya: Who gets vaccinated?
Childhood vaccination in informal urban settlements in Nairobi, Kenya: Who gets vaccinated?
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DOI：
10.1186/1471-2458-11-6
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发表时间：
2011-01-04
影响因子：
4.5
通讯作者：
Ettarh, Remare R.
中科院分区：
文献类型：
--
作者：
Mutua, Martin K.;Kimani-Murage, Elizabeth;Ettarh, Remare R.
背景：全球疫苗接种覆盖率的最新趋势显示出增长，大多数国家的 DTP3 覆盖率在 2008 年达到 90%，尽管撒哈拉以南非洲部分地区，特别是城市贫民窟，疫苗接种不足的情况仍然存在。本研究的目的是确定居住在内罗毕两个贫民窟的 12-23 个月大儿童的疫苗接种状况，并确定与疫苗接种不完全相关的风险因素。 方法：该研究是在内罗毕 Korogocho 和 Viwandani 贫民窟开展的纵向母婴健康研究的一部分。这些贫民窟拥有由非洲人口与健康研究中心 (APHRC) 运营的内罗毕城市健康和人口监测系统 (NUHDSS)。 NUHDSS 地区自 2006 年 9 月以来分娩的所有妇女都参加了该项目，并进行了问卷调查，询问其孩子的疫苗接种史。出于本研究的目的，我们使用了 1848 名 12-23 个月大儿童的数据，这些儿童预计已接种世界卫生组织推荐的所有疫苗。疫苗接种详细信息是在出生后大约四个月的第一次访视期间收集的，此后每隔四个月重复一次随访。全面疫苗接种的定义是在出生后 24 个月结束时接受所有基本的儿童疫苗接种，而最新 (UTD) 疫苗接种是指在出生后的前 12 个月内接受 BCG、OPV 1-3、DTP 1-3 和麻疹疫苗接种。所有疫苗接种数据均来自家庭访问期间看到的疫苗接种卡以及母亲的回忆。使用多变量模型来确定与不完全疫苗接种相关的风险因素。结果：当仅使用疫苗接种卡或加上母亲回忆来确定时，麻疹覆盖率大大低于其他疫苗的覆盖率。 12 个月时所有疫苗接种的最新 (UTD) 覆盖率在有和没有接种 OPV 出生剂量的情况下分别为 41.3% 和 51.8%。根据卡片数据，两个贫民窟定居点的总体疫苗接种覆盖率 (57.5%) 高于 12 个月的最新覆盖率 (51.8%)。多变量分析显示，家庭资产和支出、种族、分娩地点、母亲的受教育程度、年龄和胎次都是贫民窟儿童充分接种疫苗的预测因素。结论：研究结果显示了贫民窟儿童疫苗接种服务不足的程度，并表明需要重新评估城市贫民窟的免疫接种服务提供情况，以确保所有儿童都能获得疫苗接种。
Background: Recent trends in global vaccination coverage have shown increases with most countries reaching 90% DTP3 coverage in 2008, although pockets of undervaccination continue to persist in parts of sub-Saharan Africa particularly in the urban slums. The objectives of this study were to determine the vaccination status of children aged between 12-23 months living in two slums of Nairobi and to identify the risk factors associated with incomplete vaccination.Methods: The study was carried out as part of a longitudinal Maternal and Child Health study undertaken in Korogocho and Viwandani slums of Nairobi. These slums host the Nairobi Urban Health and Demographic Surveillance System (NUHDSS) run by the African Population and Health Research Centre (APHRC). All women from the NUHDSS area who gave birth since September 2006 were enrolled in the project and administered a questionnaire which asked about the vaccination history of their children. For the purpose of this study, we used data from 1848 children aged 12-23 months who were expected to have received all the WHO-recommended vaccinations. The vaccination details were collected during the first visit about four months after birth with follow-up visits repeated thereafter at four month intervals. Full vaccination was defined as receiving all the basic childhood vaccinations by the end of 24 months of life, whereas up-to-date (UTD) vaccination referred to receipt of BCG, OPV 1-3, DTP 1-3, and measles vaccinations within the first 12 months of life. All vaccination data were obtained from vaccination cards which were sighted during the household visit as well as by recall from mothers. Multivariate models were used to identify the risk factors associated with incomplete vaccination.Results: Measles coverage was substantially lower than that for the other vaccines when determined using only vaccination cards or in addition to maternal recall. Up-to-date (UTD) coverage with all vaccinations at 12 months was 41.3% and 51.8% with and without the birth dose of OPV, respectively. Full vaccination coverage (57.5%) was higher than up-to-date coverage (51.8%) at 12 months overall, and in both slum settlements, using data from cards. Multivariate analysis showed that household assets and expenditure, ethnicity, place of delivery, mother's level of education, age and parity were all predictors of full vaccination among children living in the slums.Conclusions: The findings show the extent to which children resident in slums are underserved with vaccination and indicate that service delivery of immunization services in the urban slums needs to be reassessed to ensure that all children are reached.