Beyond coverage: Rural-urban disparities in the timeliness of childhood vaccinations in Tanzania.
Beyond coverage: Rural-urban disparities in the timeliness of childhood vaccinations in Tanzania.
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DOI：
10.1016/j.vaccine.2022.07.020
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发表时间：
2022-09-02
期刊：
影响因子：
5.5
通讯作者：
Vasudevan, Lavanya
中科院分区：
文献类型：
--
作者：
Yelverton, Valerie;Hair, Nicole L.;Ghosh, Suvomita Happy;Mfinanga, Sayoki Godfrey;Ngadaya, Esther;Baumgartner, Joy Noel;Ostermann, Jan;Vasudevan, Lavanya
关键词：
及时接种疫苗可最大限度地提高预防传染病的效力。在没有国家疫苗接种登记册的情况下，代表性抽样调查数据保存着关于疫苗接种覆盖率和及时性的重要信息。这项研究描述了坦桑尼亚的疫苗接种覆盖率和及时性，并提供了一个分析模板，以告知背景相关的干预措施和评估免疫接种计划。2015-16年坦桑尼亚人口与健康调查的6，092名3岁以下儿童的横截面数据用于检查生命第一年推荐的14剂疫苗的覆盖率和及时性。使用Kaplan-Meier方法对接种时间进行建模。考克斯比例风险模型用于检查与及时接种疫苗相关的因素。在所有疫苗的接种覆盖率和及时性方面，都观察到城乡之间的巨大差异。在14种推荐剂量中，记录的覆盖率范围为52%至79%。疫苗接种延迟的中位数长达35天;农村儿童的差距大于城市儿童，疫苗系列的后期剂量也是如此。在农村儿童中，第三剂脊髓灰质炎、五价和肺炎球菌疫苗的中位延迟时间超过35天。所有剂量的城市儿童中位延迟时间<21天。在农村和城市儿童中，母亲受教育程度较低和在家分娩与延迟接种疫苗的风险增加有关。在农村地区，家庭财富较少和距离卫生设施较远也与延迟接种疫苗的风险增加有关。这项研究强调了坦桑尼亚儿童疫苗接种的接受和及时性方面的持续差距以及巨大的城乡差距。虽然这些结果提供了一个信息丰富的情况评估，并概述了识别未接种疫苗的儿童的战略，但国家电子登记对于全面评估疫苗接种计划的绩效至关重要。在这项研究中采用的及时性措施儿童未接种或接种不足的时间量可以作为这些计划的敏感性能指标。
Timely vaccination maximizes efficacy for preventing infectious diseases. In the absence of national vaccination registries, representative sample survey data hold vital information on vaccination coverage and timeliness. This study characterizes vaccination coverage and timeliness in Tanzania and provides an analytic template to inform contextually relevant interventions and evaluate immunization programs. Cross-sectional data on 6,092 children under age 3 from the 2015–16 Tanzania Demographic and Health Survey were used to examine coverage and timeliness for 14 vaccine doses recommended in the first year of life. The Kaplan-Meier method was used to model time to vaccination. Cox proportional hazard models were used to examine factors associated with timely vaccination. Substantial rural-urban disparities in vaccination coverage and timeliness were observed for all vaccines. Across 14 recommended doses, documented coverage ranged from 52% to 79%. Median vaccination delays lasted up to 35 days; gaps were larger among rural than urban children and for later doses in vaccine series. Among rural children, median delays exceeded 35 days for the 3rd doses of the polio, pentavalent, and pneumococcal vaccines. Median delays among urban children were <21 days for all doses. Among rural and urban children, lower maternal education and delivery at home were associated with increased risk of delayed vaccination. In rural settings, less household wealth and greater distance to a health facility were also associated with increased risk of delayed vaccination. This study highlights persistent gaps in uptake and timeliness of childhood vaccinations in Tanzania and substantial rural-urban disparities. While the results provide an informative situation assessment and outline strategies for identifying unvaccinated children, a national electronic registry is critical for comprehensive assessments of the performance of vaccination programs. The timeliness measure employed in this study—the amount of time children are un- or undervaccinated—may serve as a sensitive performance metric for these programs.
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5.5
作者：
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通讯作者：
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DOI：
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