Tracking progress towards universal childhood immunisation and the impact of global initiatives: a systematic analysis of three-dose diphtheria, tetanus, and pertussis immunisation coverage
Tracking progress towards universal childhood immunisation and the impact of global initiatives: a systematic analysis of three-dose diphtheria, tetanus, and pertussis immunisation coverage
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DOI：
10.1016/s0140-6736(08)61869-3
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发表时间：
2008-12-13
期刊：
影响因子：
168.9
通讯作者：
Murray, Christopher J. L.
中科院分区：
文献类型：
--
作者：
Lim, Stephen S.;Stein, David B.;Murray, Christopher J. L.
背景 通过全民儿童免疫 (UCI) 运动和全球疫苗和免疫联盟 (GAVI) 等全球举措，已投入大量资源来提高儿童免疫覆盖率。长期以来，人们担心 UCI 和 GAVI 的免疫服务支持 (ISS) 等目标导向和绩效导向的举措可能会鼓励过度报告。我们根据使用所有可用数据的调查估计了三种剂量的白喉、破伤风和百日咳疫苗 (DTP3) 的覆盖率。方法我们通过分析调查中的单位记录数据来估计 DTP3 覆盖率，并用其他调查和行政数据报告的覆盖率进行补充。我们使用双向距离相关回归来估计 193 个国家 1986 年至 2006 年期间基于调查的覆盖率趋势。我们使用标准时间序列横断面分析来调查各国官方报告和作为因变量的基于调查的覆盖率与作为自变量的全球疫苗和免疫联盟国际空间站的存在之间的差异之间的关联，控制国家和时间的影响。调查结果 基于调查的 DTP3 粗略覆盖率从 1986 年的 59%（95% 不确定性区间 51-65）增加到 1990 年的 65%（60-68），1990 年为 70% 2000 年为 (65-74)，2006 年为 74% (70-77)。VCI 期间官方报告的覆盖率和基于调查的覆盖率之间存在显着差异。 GAVI ISS 显着增加了官方报告的覆盖范围和调查覆盖范围之间的差异。调查显示，截至 2006 年，在 51 个接受 GAVI ISS 付款的国家中，已有 740 万（570 万至 920 万）儿童接受了 DTP3 免疫，而官方报告的估计数字为 1,390 万。根据调查中每人免疫 20 美元的额外儿童人数，全球疫苗和免疫联盟国际空间站付款估计为 1.5 亿美元（1.15 亿至 1.84 亿），而实际支出为 2.9 亿美元。 解释 基于调查的 DTP3 免疫覆盖率的提高较为缓慢，但尚未达到各国官方报告或世卫组织和儿童基金会估计的水平。在全球倡议以目标为导向并根据绩效分配资金的时代，迫切需要对健康指标进行独立且有争议的监测。资助比尔及梅琳达·盖茨基金会。
Background Substantial resources have been invested in increasing childhood immunisation coverage through global initiatives such as the Universal Childhood Immunisation (UCI) campaign and the Global Alliance on Vaccines and Immunisations (GAVI). There are longstanding concerns that target-oriented and performance-oriented initiatives such as UCI and GAVI's immunisation services support (ISS) might encourage over-reporting. We estimated the coverage of three doses of diphtheria, tetanus, and pertussis vaccine (DTP3) based on surveys using all available data.Methods We estimated DTP3 coverage by analysing unit record data from surveys and supplemented this with reported coverage from other surveys and administrative data. We used bidirectional distance-dependent regression to estimate trends in survey-based coverage in 193 countries during 1986-2006. We used standard time-series cross-sectional analysis to investigate any association in the difference between countries' official reports and survey-based coverage as the dependent variable and the presence of GAVI ISS as the independent variable, controlling for country and time effects.Findings Crude coverage of DTP3 based on surveys increased from 59% (95% uncertainty interval 51-65) in 1986 to 65% (60-68) in 1990, 70% (65-74) in 2000, and 74% (70-77) in 2006. There were substantial differences between officially reported and survey-based coverage during VCI. GAVI ISS significantly increased the difference between officially reported coverage and survey coverage. Up to 2006, in 51 countries receiving GAVI ISS payments, 7.4 million (5.7 million to 9.2 million) additional children were immunised with DTP3 based on surveys compared with officially reported estimates of 13.9 million. On the basis of the number of additional children immunised from surveys at a rate of US$20 each, GAVI ISS payments are estimated at $150 million (115 million to 184 million) compared with actual disbursements of $290 million.Interpretation Survey-based DTP3 immunisation coverage has improved more gradually and not to the level suggested by countries' official reports or WHO and UNICEF estimates. There is an urgent need for independent and contestable monitoring of health indicators in an era of global initiatives that are target-oriented and disburse funds based on performance. Funding Bill & Melinda Gates Foundation.