Inequities in childhood immunisation coverage associated with socioeconomic, geographic, maternal, child, and place of birth characteristics in Kenya
Inequities in childhood immunisation coverage associated with socioeconomic, geographic, maternal, child, and place of birth characteristics in Kenya
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肯尼亚儿童免疫覆盖率与社会经济、地理、孕产妇、儿童和出生地特征相关的不平等
DOI：
10.1101/2021.02.14.21251721
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发表时间：
2021
期刊：
影响因子：
--
通讯作者：
Allan S
中科院分区：
文献类型：
--
作者：
Allan S
背景儿童免疫接种是一种高成本效益的公共卫生干预措施，促进了全体人口的健康公平。世卫组织《2030年免疫议程》强调将覆盖率和公平性作为在国家一级和所有地区实现高度公平免疫覆盖率的战略优先目标之一。我们利用2014年肯尼亚人口与健康调查的数据分析了肯尼亚12-23个月儿童的全面免疫覆盖率，并估计了与社会经济、地理、孕产妇、儿童和出生地特征有关的全面免疫覆盖率的不平等。方法我们分析了3943名12-23个月儿童的全面免疫覆盖率(1剂卡介苗、3剂DTP-Heb-Hib、3剂脊髓灰质炎、1剂麻疹和3剂肺炎球菌疫苗)。我们按社会经济(家庭财富、宗教、种族)、地理位置(居住地、省份)、产妇(产妇出生时年龄、产妇教育、产妇婚姻状况、产妇户主地位)、儿童(儿童性别、出生顺序)和出生地特征分列平均覆盖面。结果2014年，第三针脊髓灰质炎疫苗接种率为82%[81-84]，第一针DTP-HeB-Hib疫苗接种率为97.4%[96.7-98.2]，而全接种率为68%[66-71]。在控制了其他背景特征后，母亲受过小学或更高教育的孩子比没有受过教育的母亲的孩子获得完全免疫的几率至少高出54%。与出生在家庭环境中的儿童相比，出生在临床环境中的儿童获得完全免疫的几率高出41%。与东北地区的儿童相比，沿海、西部、中部和东部地区的儿童获得完全免疫的几率至少高出74%，而与农村地区的儿童相比，城市地区的儿童获得完全免疫的几率低26%。与最贫穷的财富五分之一家庭的儿童相比，中等和较富裕的五分之一家庭的儿童获得全面免疫接种的可能性高出43%-57%。与第一胎相比，第六胎或更高出生的儿童获得完全免疫接种的几率低37%。结论完全免疫接种中的不平等对未受过教育的母亲、出生在家庭环境中、卫生基础设施有限的地区、生活在较贫困家庭和出生顺序较高的儿童产生不利影响。此外，新冠肺炎大流行扰乱了2020年的常规和活动免疫服务，增加了疫苗可预防疾病爆发的风险，但随着免疫服务恢复产能，它也提供了一个机会，可以解决疫苗接种方面已发现的不平等问题。
BackgroundImmunisation of children is a highly cost-effective public health intervention and fosters health equity for the overall population. The WHO Immunisation Agenda 2030 highlights coverage and equity as one of the strategic priority goals to reach high equitable immunisation coverage at national levels and in all districts. We analysed full immunisation coverage among children aged 12-23 months in Kenya and estimated the inequities in full immunisation coverage associated with socioeconomic, geographic, maternal, child, and place of birth characteristics using data from the 2014 Kenya Demographic and Health Survey.MethodsWe analysed full immunisation coverage (1-dose BCG, 3-dose DTP-HepB-Hib, 3-dose polio, 1-dose measles, and 3-dose pneumococcal vaccines) of 3,943 children aged 12–23 months. We disaggregated mean coverage by socioeconomic (household wealth, religion, ethnicity), geographic (place of residence, province), maternal (maternal age at birth, maternal education, maternal marital status, maternal household head status), child (sex of child, birth order), and place of birth characteristics. We conducted bivariate and multivariate logistic regression to assess associations between full immunisation coverage and socioeconomic, geographic, maternal, child, and place of birth characteristics.ResultsImmunisation coverage ranged from 82% [81–84] for the third dose of polio to 97.4% [96.7–98.2] for the first dose of DTP-HepB-Hib, while full immunisation coverage was 68% [66–71] in 2014. After controlling for other background characteristics, children of mothers with primary school education or higher have at least 54% higher odds of being fully immunised compared to children of mothers with no education. Children born in clinical settings have 41% higher odds of being fully immunised compared to children born in home settings. Children in the Coast, Western, Central, and Eastern regions had at least 74% higher odds of being fully immunised compared to children in the North Eastern region, while children in urban areas had 26% lower odds of full immunisation compared to children in rural areas. Children in the middle and richer wealth quintile households were 43–57% more likely to have full immunisation coverage compared to children in the poorest wealth quintile households. Children who were sixth born or higher had 37% lower odds of full immunisation compared to first-born children.ConclusionsThe inequities in full immunisation adversely affect children of mothers with no education, born in home settings, in regions with limited health infrastructure, living in poorer households, and of higher birth order. Further, the COVID-19 pandemic has disrupted routine and campaign immunisation services in 2020 and enhances the risk of vaccine-preventable disease outbreaks, but it also presents an opportunity to tackle the identified inequities in vaccine uptake as immunisation services are restored to capacity.
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影响因子：
4.5
作者：
Ndiritu, Moses;Cowgill, Karen D.;Ismail, Amina;Chiphatsi, Salome;Kamau, Tatu;Fegan, Gregory;Feikin, Daniel R.;Newton, Charles R. J. C.;Scott, J. Anthony G.
通讯作者：
Scott, J. Anthony G.
不平等的探索：儿童免疫接种
DOI：
--
发表时间：
2018
期刊：
影响因子：
--
作者：
L. Winckworth;M. Coren
通讯作者：
M. Coren
卫生单位出生儿童与家庭出生儿童疫苗接种情况比较。
影响因子：
--
作者：
A. Odiit;B. Amuge
通讯作者：
B. Amuge
影响因子：
4.5
作者：
Huang Y;Danovaro-Holliday MC
通讯作者：
Danovaro-Holliday MC
影响因子：
4.5
作者：
Joseph, Noel K.;Macharia, Peter M.;Okiro, Emelda A.
通讯作者：
Okiro, Emelda A.