布基纳法索农村地区儿童完全疫苗接种率和决定因素（1998-2003 年）。
Rates of coverage and determinants of complete vaccination of children in rural areas of Burkina Faso (1998-2003).
机构信息
Département de médecine sociale et préventive, Université de Montréal, Québec, Canada.
出版信息
BMC Public Health. 2009 Nov 17;9:416. doi: 10.1186/1471-2458-9-416.
BACKGROUND
Burkina Faso's immunization program has benefited regularly from national and international support. However, national immunization coverage has been irregular, decreasing from 34.7% in 1993 to 29.3% in 1998, and then increasing to 43.9% in 2003. Undoubtedly, a variety of factors contributed to this pattern. This study aims to identify both individual and systemic factors associated with complete vaccination in 1998 and 2003 and relate them to variations in national and international policies and strategies on vaccination of rural Burkinabé children aged 12-23 months.
METHODS
Data from the 1998 and 2003 Demographic and Health Surveys and the Ministry of Health's 1997 and 2002 Statistical Yearbooks, as well as individual interviews with central and regional decision-makers and with field workers in Burkina's healthcare system, were used to carry out a multilevel study that included 805 children in 1998 and 1,360 children in 2003, aged 12-23 months, spread over 44 and 48 rural health districts respectively.
RESULTS
In rural areas, complete vaccination coverage went from 25.9% in 1998 to 41.2% in 2003. District resources had no significant effect on coverage and the impact of education declined over time. The factors that continued to have the greatest impact on coverage rates were poverty, with its various dimensions, and the utilization of other healthcare services. However, these factors do not explain the persistent differences in complete vaccination between districts. In 2003, despite a trend toward district homogenization, differences between health districts still accounted for a 7.4% variance in complete vaccination.
CONCLUSION
Complete vaccination coverage of children is improving in a context of worsening poverty. Education no longer represents an advantage in relation to vaccination. Continuity from prenatal care to institutional delivery creates a loyalty to healthcare services and is the most significant and stable explanatory factor associated with complete vaccination of children. Healthcare service utilization is the result of a dynamic process of interaction between communities and the healthcare system; understanding this process is the key to understanding better the factors underlying the complete vaccination of children.
背景
布基纳法索的免疫规划定期得到国家和国际支持。然而，全国免疫覆盖率一直不稳定，从 1993 年的 34.7%下降到 1998 年的 29.3%，然后在 2003 年增加到 43.9%。毫无疑问，各种因素促成了这种模式。本研究旨在确定与 1998 年和 2003 年完全接种疫苗相关的个人和系统因素，并将其与国家和国际在农村布基纳法索 12-23 个月儿童接种疫苗方面的政策和战略的变化联系起来。
方法
使用 1998 年和 2003 年人口与健康调查以及卫生部 1997 年和 2002 年统计年鉴的数据，以及对中央和区域决策者以及布基纳法索医疗保健系统实地工作者的个人访谈，开展了一项多水平研究，其中包括 1998 年的 805 名儿童和 2003 年的 1360 名 12-23 个月大的儿童，分别分布在 44 个和 48 个农村卫生区。
结果
在农村地区，完全接种疫苗的覆盖率从 1998 年的 25.9%上升到 2003 年的 41.2%。地区资源对覆盖率没有显著影响，教育的影响随着时间的推移而下降。持续对覆盖率产生最大影响的因素是贫困及其各种维度，以及对其他医疗保健服务的利用。然而，这些因素并不能解释地区间完全接种疫苗的持续差异。2003 年，尽管存在地区同质化的趋势，但各卫生区之间的差异仍占完全接种疫苗覆盖率差异的 7.4%。
结论
在贫困加剧的情况下，儿童完全接种疫苗的覆盖率正在提高。教育在与疫苗接种相关方面不再具有优势。从产前保健到机构分娩的连续性为医疗保健服务创造了忠诚度，是与儿童完全接种疫苗最显著和最稳定的相关解释因素。医疗保健服务的利用是社区和医疗保健系统之间互动的动态过程的结果；理解这一过程是理解更好地理解儿童完全接种疫苗的因素的关键。
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