Daly A D, Nxumalo M P, Biellik R J
EPI Programme, Ministry of Health and Social Welfare, Mbabane, Swaziland.
S Afr Med J. 2003 Aug;93(8):606-10.
To determine whether potential exists to increase vaccination coverage in Swaziland by reducing missed opportunities.
The standard World Health Organisation Expanded Programme on Immunisation (WHO EPI) protocol for assessing missed opportunities for vaccination was used to conduct this study. It involved client exit interviews and review of health cards.
Selected variety of health facilities in Swaziland.
Children less than 2 years of age and women of child-bearing age exiting each facility.
Children and women eligible for vaccination exiting sampled health facilities.
Fifty-four per cent of eligible children less than 2 years of age were missed for vaccination. This constitutes 26% of all children less than 2 years old leaving the facilities studied. Almost 100% of eligible women of childbearing age were missed for vaccination, constituting 88% of women leaving the study facilities. The distribution of the proportion of missed opportunities varied considerably between regions and health facility types. Missed opportunities occurred more frequently among those children requiring the first dose of all antigens and this may be linked to the high proportion of children missed for vaccination who did not possess a health card. Missed opportunities were more likely to occur in facilities providing integrated services.
The frequent attendance at health facilities of the target group presents a valuable opportunity to increase vaccination coverage through avoidance of missed opportunities. All regions need to set vaccination coverage targets and develop plans to increase coverage, which should include strategies to ensure that all health workers routinely screen all clients for eligibility and vaccinate as required.
通过减少漏种机会来确定斯威士兰是否有提高疫苗接种覆盖率的潜力。
采用世界卫生组织扩大免疫规划（WHO EPI）评估疫苗接种漏种机会的标准方案进行本研究。研究包括对离开医疗机构的人员进行访谈以及查看健康卡。
斯威士兰选定的各类医疗机构。
每个医疗机构中2岁以下儿童及育龄妇女。
离开抽样医疗机构的符合疫苗接种条件的儿童和妇女。
2岁以下符合疫苗接种条件的儿童中有54%漏种。这占离开所研究医疗机构的所有2岁以下儿童的26%。几乎100%符合条件的育龄妇女漏种，占离开研究医疗机构妇女的88%。漏种机会比例的分布在不同地区和医疗机构类型之间差异很大。在需要接种所有抗原首剂的儿童中漏种情况更频繁，这可能与未持有健康卡而漏种疫苗的儿童比例较高有关。在提供综合服务的医疗机构中漏种情况更易发生。
目标群体频繁前往医疗机构为通过避免漏种机会提高疫苗接种覆盖率提供了宝贵契机。所有地区都需要设定疫苗接种覆盖率目标并制定提高覆盖率的计划，其中应包括确保所有医护人员常规筛查所有就诊者是否符合接种条件并按要求进行接种的策略。
