Topuzoglu A, Ozaydin G A N, Cali S, Cebeci D, Kalaca S, Harmanci H
Department of Public Health, Marmara University Faculty of Medicine, Tibbiye Cad. No. 49, 34668 Haydarpasa, Istanbul, Turkey.
Public Health. 2005 Oct;119(10):862-9. doi: 10.1016/j.puhe.2005.01.015.
The primary objective of this study was to determine the coverage of the Expanded Programme of Immunization (EPI) of the Ministry of Health and the coverage of private vaccines in the Umraniye Health District in order to establish approaches for improving vaccination services. Other objectives were to define the areas that present higher risks for non-vaccination and to determine the factors that influence vaccination coverage.
A '30 x 7' cluster sampling design was adopted as the sampling method. Thirty streets were selected at random from each health care region. Sociodemographic and socio-economic characteristics of the population, utilization of vaccination services and vaccination status of children under the age of 5 years were determined by face-to-face interviews. Odds ratios for the sociodemographic and socio-economic characteristics, health centre region and inner country immigration were assessed as possible related factors with the vaccination coverage rates for children under 5 years and under 1 year using the backward elimination method in logistic regression.
Vaccination coverage was as follows: hepatitis B third dose, 84.6%; Bacille Calmette-Guérin, 94.8%; diphtheria, tetanus, pertussis (DPT) third dose, 90.1%; oral polio virus (OPV) third dose, 90.0%; measles, 88.7%; DPT booster dose, 79.1%; OPV booster dose, 79.0%; measles, mumps, rubella (MMR), 13.3%; haemophilus influenza type b (Hib), 9.3%; and Varicella vaccine, 3.3%. The full vaccination rates for children under 5 years and under 1 year were 68.3 and 79.5%, respectively. Higher socio-economic status was associated with a higher rate of full vaccination and private vaccination for children under 5 years of age.
Full vaccination rates for children aged less than 1 year and less than 5 years were higher in our district than in Istanbul. However, we did not meet the EPI aims for any of the vaccines, and differences were observed in vaccination coverage rates between different socio-economic groups in the district. Therefore, an intervention programme should be considered to achieve the EPI's goals, particularly in socio-economically disadvantaged groups. Also, the coverage of private vaccination (MMR, Hib, Varicella) is low and more children from higher socio-economic groups receive these vaccines.
本研究的主要目的是确定卫生部扩大免疫规划（EPI）的覆盖范围以及乌姆拉尼耶健康区私人疫苗的覆盖范围，以便制定改善疫苗接种服务的方法。其他目的是确定未接种疫苗风险较高的地区，并确定影响疫苗接种覆盖率的因素。
采用“30×7”整群抽样设计作为抽样方法。从每个医疗保健区域随机选择30条街道。通过面对面访谈确定人口的社会人口学和社会经济特征、疫苗接种服务的利用情况以及5岁以下儿童的疫苗接种状况。使用逻辑回归中的向后消除法，评估社会人口学和社会经济特征、健康中心区域和国内移民等可能的相关因素与5岁以下和1岁以下儿童疫苗接种覆盖率的比值比。
疫苗接种覆盖率如下：乙肝第三剂，84.6%；卡介苗，94.8%；白喉、破伤风、百日咳（DPT）第三剂，90.1%；口服脊髓灰质炎病毒（OPV）第三剂，90.0%；麻疹，88.7%；DPT加强剂，79.1%；OPV加强剂，79.0%；麻疹、腮腺炎、风疹（MMR），13.3%；b型流感嗜血杆菌（Hib），9.3%；水痘疫苗，3.3%。5岁以下和1岁以下儿童的全程接种率分别为68.3%和79.5%。较高的社会经济地位与5岁以下儿童较高的全程接种率和私人疫苗接种率相关。
我们地区1岁以下和5岁以下儿童的全程接种率高于伊斯坦布尔。然而，我们没有达到任何一种疫苗的EPI目标，并且在该地区不同社会经济群体之间观察到了疫苗接种覆盖率的差异。因此，应考虑实施一项干预计划以实现EPI的目标，特别是在社会经济弱势群体中。此外，私人疫苗接种（MMR、Hib、水痘）的覆盖率较低，来自较高社会经济群体的更多儿童接种了这些疫苗。
