Mitchell Steven, Andersson Neil, Ansari Noor Mohammad, Omer Khalid, Soberanis José Legorreta, Cockcroft Anne
CIETcanada, 1 Stewart Street, Ottawa, Ontario, Canada.
BMC Int Health Hum Rights. 2009 Oct 14;9 Suppl 1(Suppl 1):S7. doi: 10.1186/1472-698X-9-S1-S7.
Achieving equity means increased uptake of health services for those who need it most. But the poorest families continue to have the poorest service. In Pakistan, large numbers of children do not access vaccination against measles despite the national government's effort to achieve universal coverage.
A cross-sectional study of a random sample of 23 rural and 9 urban communities in the Lasbela district of south Pakistan, explored knowledge, attitudes and discussion around measles vaccination. Several socioeconomic variables allowed examination of the role of inequities in vaccination uptake; 2479 mothers provided information about 4007 children aged 10 to 59 months. A Mantel-Haenszel stratification analysis, with and without adjustment for clustering, clarified determinants of measles vaccination in urban and rural areas.
A high proportion of mothers had appropriate knowledge of and positive attitudes to vaccination; many discussed vaccination, but only one half of children aged 10-59 months accessed vaccination. In urban areas, having an educated mother, discussing vaccinations, having correct knowledge about vaccinations, living in a community with a government vaccination facility within 5 km, and living in houses with better roofs were associated with vaccination uptake after adjusting for the effect of each of these variables and for clustering; maternal education was an equity factor even among those with good access. In rural areas, the combination of roof quality and access (vaccination post within 5 km) along with discussion about vaccines and knowledge about vaccines had an effect on uptake.
Stagnating rates of vaccination coverage may be related to increasing inequities. A hopeful finding is that discussion about vaccines and knowledge about vaccines had a positive effect that was independent of the negative effect of inequity - in both urban and rural areas. At least as a short term strategy, there seems to be reason to expect an intervention increasing knowledge and discussion about vaccination in this district might increase uptake.
实现公平意味着让最需要医疗服务的人群更多地获得这些服务。但最贫困家庭获得的服务仍然最差。在巴基斯坦，尽管国家政府努力实现全面覆盖，但仍有大量儿童无法接种麻疹疫苗。
对巴基斯坦南部拉斯贝拉地区23个农村社区和9个城市社区的随机样本进行横断面研究，探讨有关麻疹疫苗接种的知识、态度和讨论情况。若干社会经济变量有助于考察不平等现象在疫苗接种方面所起的作用；2479名母亲提供了有关4007名10至59个月大儿童的信息。采用曼特尔-亨塞尔分层分析法，在考虑和不考虑聚类因素的情况下，明确城乡地区麻疹疫苗接种的决定因素。
很大比例的母亲对疫苗接种有适当的了解且态度积极；许多人讨论过疫苗接种，但10至59个月大的儿童中只有一半接种了疫苗。在城市地区，在对这些变量各自的影响以及聚类因素进行调整后，母亲受过教育、讨论过疫苗接种、对疫苗接种有正确认识、居住在距离政府疫苗接种机构5公里以内的社区以及居住在屋顶较好的房屋中，都与疫苗接种情况相关；即使在那些容易获得疫苗接种服务的人群中，母亲的教育程度也是一个公平因素。在农村地区，屋顶质量和可及性（5公里内有疫苗接种点）以及对疫苗的讨论和对疫苗的了解共同影响疫苗接种情况。
疫苗接种覆盖率停滞不前可能与不平等现象加剧有关。一个令人欣慰的发现是，对疫苗的讨论和对疫苗的了解产生了积极影响，且这种影响在城乡地区都独立于不平等现象的负面影响。至少作为一项短期策略，似乎有理由期望在该地区开展一项旨在增加对疫苗接种的了解和讨论的干预措施可能会提高疫苗接种率。
