Anand Sudhir, Bärnighausen Till
University of Oxford, Department of Economics, Oxford, UK; Harvard University, Global Equity Initiative, Cambridge, MA, USA.
Africa Centre for Health and Population Studies, University of KwaZulu-Natal, Mtubatuba, South Africa; Harvard School of Public Health, Department of Population and International Health, Boston, MA, USA.
Lancet. 2007 Apr 14;369(9569):1277-1285. doi: 10.1016/S0140-6736(07)60599-6.
Vaccine-preventable diseases cause more than 1 million deaths among children in developing countries every year. Although health workers are needed to do vaccinations, the role of human resources for health as a determinant of vaccination coverage at the population level has not been investigated. Our aim was to test whether health worker density was positively associated with childhood vaccination coverage in developing countries.
We did cross-country multiple regression analyses with coverage of three vaccinations--measles-containing vaccine (MCV); diphtheria, tetanus, and pertussis (DTP3); and poliomyelitis (polio3)--as dependent variables. Aggregate health worker density was an independent variable in one set of regressions; doctor and nurse densities were used separately in another set. We controlled for national income per person, female adult literacy, and land area.
Health worker density was significantly associated with coverage of all three vaccinations (MCV p=0.0024; DTP3 p=0.0004; polio3 p=0.0008). However, when the effects of doctors and nurses were assessed separately, we found that nurse density was significantly associated with coverage of all three vaccinations (MCV p=0.0097; DTP3 p=0.0083; polio3 p=0.0089), but doctor density was not (MCV p=0.7953; DTP3 p=0.7971; polio3 p=0.7885). Female adult literacy was positively associated, and land area negatively associated, with vaccination coverage. National income per person had no effect on coverage.
A higher density of health workers (nurses) increases the availability of vaccination services over time and space, making it more likely that children will be vaccinated. After controlling for other determinants, the level of income does not contribute to improved immunisation coverage. Health workers can be a major constraining factor on vaccination coverage in developing countries.
在发展中国家，疫苗可预防疾病每年导致100多万儿童死亡。虽然需要卫生工作者进行疫苗接种，但卫生人力资源作为人群层面疫苗接种覆盖率的一个决定因素，其作用尚未得到研究。我们的目的是检验在发展中国家卫生工作者密度是否与儿童疫苗接种覆盖率呈正相关。
我们进行了跨国多元回归分析，将三种疫苗接种的覆盖率作为因变量，这三种疫苗分别是含麻疹疫苗（MCV）、白喉、破伤风和百日咳疫苗（DTP3）以及脊髓灰质炎疫苗（polio3）。在一组回归分析中，卫生工作者总密度是自变量；在另一组分析中，分别使用医生和护士的密度。我们对人均国民收入、成年女性识字率和国土面积进行了控制。
卫生工作者密度与所有三种疫苗接种的覆盖率均显著相关（MCV p = 0.0024；DTP3 p = 0.0004；polio3 p = 0.0008）。然而，当分别评估医生和护士的影响时，我们发现护士密度与所有三种疫苗接种的覆盖率均显著相关（MCV p = 0.0097；DTP3 p = 0.0083；polio3 p = 0.0089），但医生密度并非如此（MCV p = 0.7953；DTP3 p = 0.7971；polio3 p = 0.7885）。成年女性识字率与疫苗接种覆盖率呈正相关，国土面积与疫苗接种覆盖率呈负相关。人均国民收入对覆盖率没有影响。
随着时间推移和空间变化，更高密度的卫生工作者（护士）增加了疫苗接种服务的可及性，使儿童更有可能接种疫苗。在控制了其他决定因素后，收入水平对提高免疫接种覆盖率没有作用。卫生工作者可能是发展中国家疫苗接种覆盖率的一个主要制约因素。
