Impact of conflict on infant immunisation coverage in Afghanistan: a countrywide study 2000-2003
Impact of conflict on infant immunisation coverage in Afghanistan: a countrywide study 2000-2003
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DOI：
10.1186/1476-072x-6-23
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发表时间：
2007-06-07
影响因子：
4.9
通讯作者：
Takano, Takehito
中科院分区：
文献类型：
--
作者：
Mashal, Taufiq;Nakamura, Keiko;Takano, Takehito
背景：婴儿免疫接种是降低疫苗可预防疾病发病率和死亡率的有效公共卫生干预措施。然而，一些发展中国家未能实现理想的疫苗接种覆盖率；阿富汗就是这样一个国家。本研究旨在评估阿富汗地区和地区婴儿免疫接种覆盖率的进展和变化，以及冲突和资源可获得性对免疫覆盖率的影响。结果：这项研究分析了2000年至2003年阿富汗7个地区331个地区的婴儿免疫接种报告。利用地理信息系统(地理信息系统)分析，直观显示各地区免疫接种覆盖率的分布情况，并确定提高婴儿免疫覆盖率过程中的地理不平等现象。在研究的四年中，报告免疫覆盖率的地区数量大幅增加。卡介苗(BCG)免疫覆盖率在所有7个地区都取得了进展，但令人满意的覆盖率仍达80%，分布不均。白喉-百日咳-破伤风(DPT3)第三针免疫接种的进展在不同地区有所不同，此外，2000年免疫覆盖率分布不均。多因素Logistic回归分析结果表明，无论可用于免疫的资源如何，该地区缺乏安全与实现80%的免疫覆盖率之间存在显著的负相关，而资源的可用性与免疫覆盖率无关。结论：尽管在所有7个地区都观察到了进展，但这些改善中的地理不平等仍然值得关注。本研究的结果表明，一个国家的安全是影响提供免疫服务的一个重要因素。
Background: Infant immunisation is an effective public health intervention to reduce the morbidity and mortality of vaccine preventable diseases. However, some developing countries fail to achieve desirable vaccination coverage; Afghanistan is one such country. The present study was performed to evaluate the progress and variation in infant immunisation coverage by district and region in Afghanistan and to assess the impact of conflict and resource availability on immunisation coverage.Results: This study analysed reports of infant immunisation from 331 districts across 7 regions of Afghanistan between 2000 and 2003. Geographic information system ( GIS) analysis was used to visualise the distribution of immunisation coverage in districts and to identify geographic inequalities in the process of improvement of infant immunisation coverage. The number of districts reporting immunisation coverage increased substantially during the four years of the study. Progress in Bacillus Calmette- Guerin ( BCG) immunisation coverage was observed in all 7 regions, although satisfactory coverage of 80% remained unequally distributed. Progress in the third dose of Diphtheria- Pertussis- Tetanus ( DPT3) immunisation differed among regions, in addition to the unequal distribution of immunisation coverage in 2000. The results of multivariate logistic regression analysis indicated a significant negative association between lack of security in the region and achievement of 80% coverage of immunisation regardless of available resources for immunisation, while resource availability showed no relation to immunisation coverage.Conclusion: Although progress was observed in all 7 regions, geographic inequalities in these improvements remain a cause for concern. The results of the present study indicated that security within a country is an important factor for affecting the delivery of immunisation services.