Health Services Support Program, Papua New Guinea.
Vaccine. 2010 Jun 23;28(29):4673-9. doi: 10.1016/j.vaccine.2010.04.063. Epub 2010 May 6.
To measure immunization coverage among children aged 12-23 months in Papua New Guinea (PNG) and to assess if and why there are differences between hard-to-reach and more accessible communities.
WHO cluster sampling methodology was employed to measure immunization coverage in PNG's four regions. Survey data were re-analyzed according to a local assessment of geographical accessibility indicated by census unit type: urban, rural and hard-to-reach. Census units were designated as hard-to-reach if they were five or more km from a health centre.
Nationwide coverage for most antigens falls below the national target of 80% although there are regional differences with Islands performing the best. Late doses are a major concern: just 4% were fully immunized with valid ("on time") doses by 1 year of age. Coverage was lower in both rural and remote communities: at 6 months 48% of children from urban units had received three valid doses of DTP-3 but only 16% in rural areas and 13% in hard-to-reach communities. Reasons for failure to immunize varied: 21% of mothers said their child was not immunized because distance, travel conditions or cost of transportation prevented access to local health centres; 27% cited a lack of knowledge or misconceptions about immunization; while 29% believed it was because of an issue with the health system.
Throughout PNG there is an urgent need to increase immunization coverage and to ensure that children are immunized on time according to the schedule. Both coverage and timeliness of doses are worse for children living in hard-to-reach and rural areas. Achieving national immunization targets requires improvements in health service delivery, including outreach, especially for remote and rural communities, as well as greater community education and social mobilisation in support of immunization services.
测量巴布亚新几内亚（PNG）12-23 个月儿童的免疫覆盖率，并评估在难以到达和更易到达的社区之间是否存在差异以及原因。
采用世界卫生组织（WHO）的聚类抽样方法测量 PNG 四个地区的免疫覆盖率。根据当地对人口普查单位类型（城市、农村和难以到达）所指示的地理可达性评估，对调查数据进行重新分析。如果人口普查单位距离卫生中心超过 5 公里，则被指定为难以到达。
全国大多数抗原的覆盖率低于 80%的国家目标，尽管存在地区差异，岛屿地区的表现最好。晚剂量是一个主要问题：只有 4%的儿童在 1 岁时完全接种了有效的（“按时”）剂量。农村和偏远社区的覆盖率较低：在 6 个月时，城市单位的 48%的儿童接受了三剂有效剂量的 DTP-3，但农村地区只有 16%，难以到达的社区只有 13%。未能免疫的原因各不相同：21%的母亲表示，由于距离、旅行条件或交通成本，他们的孩子无法获得当地卫生中心的免疫服务；27%的人提到对免疫缺乏了解或存在误解；而 29%的人则认为是因为卫生系统存在问题。
在 PNG 全境，迫切需要提高免疫覆盖率，并确保儿童按时按照时间表进行免疫接种。居住在难以到达和农村地区的儿童的疫苗覆盖率和及时接种率都更差。要实现国家免疫目标，需要改善包括外展服务在内的卫生服务提供，特别是针对偏远和农村社区，以及加强社区教育和社会动员，以支持免疫服务。
