Spatial access inequities and childhood immunisation uptake in Kenya
Spatial access inequities and childhood immunisation uptake in Kenya
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DOI：
10.1186/s12889-020-09486-8
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发表时间：
2020-09-15
影响因子：
4.5
通讯作者：
Okiro, Emelda A.
中科院分区：
文献类型：
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作者：
Joseph, Noel K.;Macharia, Peter M.;Okiro, Emelda A.
在许多撒哈拉以南非洲国家，难以获得免疫接种服务仍然是实现公平和扩大疫苗接种覆盖率的主要障碍。在肯尼亚，空间可及性对免疫覆盖率的影响程度尚不清楚。本研究的目的是量化的空间可达性免疫卫生设施，并确定其对免疫接种吸收在肯尼亚的影响，同时控制潜在的confers.MethodsSpatial数据库的免疫设施，道路网络，土地利用和海拔内的成本摩擦algorithim估计的旅行时间免疫卫生设施。评估了两种旅行场景：（1）仅步行和（2）步行和机动交通相结合的乐观场景。计算了到卫生设施的平均旅行时间和居住在1小时内到最近的免疫卫生设施的总人口比例。全国代表性横断面调查数据（KDHS 2014），用于估计平均旅行时间的影响，在调查集群单位完全免疫状态和第三剂白喉-破伤风-百日咳（DPT 3）疫苗使用多水平逻辑回归模型。使用步行和乐观的旅行情景，到免疫保健设施的平均旅行时间分别为63和40分钟。总人口的75%在步行到免疫保健设施的一小时内，而考虑到乐观的情况，93%在一小时内。在全国范围内有很大的差异，62%（29/47）和34%（16/47）的县与1小时的免疫覆盖率低显着相关，在单变量分析完全免疫状态和DPT 3疫苗。生活超过2小时的儿童显着不太可能完全免疫[AOR：0.56（0.33-0.94），并收到DPT 3 [AOR：0.51（0.21-0.92）后，控制家庭财富，母亲的最高教育水平，奇偶校验和城市/农村residence.ConclusionTravel时间免疫保健设施是一个障碍，以摄取儿童疫苗在次优的访问区域（>2小时）。需要制定战略，解决最难到达社区的准入障碍，以加强肯尼亚公平获得免疫服务的机会。
BackgroundPoor access to immunisation services remains a major barrier to achieving equity and expanding vaccination coverage in many sub-Saharan African countries. In Kenya, the extent to which spatial access affects immunisation coverage is not well understood. The aim of this study was to quantify spatial accessibility to immunising health facilities and determine its influence on immunisation uptake in Kenya while controlling for potential confounders.MethodsSpatial databases of immunising facilities, road network, land use and elevation were used within a cost friction algorithim to estimate the travel time to immunising health facilities. Two travel scenarios were evaluated; (1) Walking only and (2) Optimistic scenario combining walking and motorized transport. Mean travel time to health facilities and proportions of the total population living within 1-h to the nearest immunising health facility were computed. Data from a nationally representative cross-sectional survey (KDHS 2014), was used to estimate the effect of mean travel time at survey cluster units for both fully immunised status and third dose of diphtheria-tetanus-pertussis (DPT3) vaccine using multi-level logistic regression models.ResultsNationally, the mean travel time to immunising health facilities was 63 and 40min using the walking and the optimistic travel scenarios respectively. Seventy five percent of the total population were within one-hour of walking to an immunising health facility while 93% were within one-hour considering the optimistic scenario. There were substantial variations across the country with 62%(29/47) and 34%(16/47) of the counties with 1-h were significantly associated with low immunisation coverage in the univariate analysis for both fully immunised status and DPT3 vaccine. Children living more than 2-h were significantly less likely to be fully immunised [AOR:0.56(0.33-0.94) and receive DPT3 [AOR:0.51(0.21-0.92) after controlling for household wealth, mother's highest education level, parity and urban/rural residence.ConclusionTravel time to immunising health facilities is a barrier to uptake of childhood vaccines in regions with suboptimal accessibility (>2-h). Strategies that address access barriers in the hardest to reach communities are needed to enhance equitable access to immunisation services in Kenya.