Department of Epidemiology and Biostatistics, School of Public Health and Social Sciences, Muhimbili University of Health and Allied Sciences, PO Box 65015, Dar es Salaam, Tanzania.
BMC Health Serv Res. 2010 Oct 30;10:299. doi: 10.1186/1472-6963-10-299.
Of global concern is the decline in under five children mortality which has reversed in some countries in sub Saharan Africa (SSA) since the early 1990 s which could be due to disparities in access to preventive services including immunization. This paper is aimed at determining the trend in disparities in completion of immunization using Tanzania Demographic and Health Surveys (DHS).
DHS studies randomly selected representative households from all regions in Tanzania since 1980 s, is repeated every five years in the same enumeration areas. The last three data sets (1990, 1996 and 2004) were downloaded and analyzed using STATA 9.0. The analysis included all children of between 12-23 months who would have completed all vaccinations required at 12 months.
Across the time periods 1990, 1996 to 2004/05 the percentage of children completing vaccination was similar (71.0% in 1990, 72.7% in 1996 and 72.3% in 2005). There was no disparity in completion of immunization with wealth strata in 1990 and 1996 (p > 0.05) but not 2004. In 2004/05 there was marked disparity as most poor experienced significant decline in immunization completion while the least poor had significant increase (p < 0.001). All three periods children from households whose head had low education were less likely to complete immunization (p < 0.01).
Equity that existed in 1990 and more pronounced in 1996 regressed to inequity in 2005, thus though at national level immunization coverage did not change, but at sub-group there was significant disparity associated with the changing contexts and reforms. To address sub-group disparities in immunization it is recommended to adopt strategies focused at governance and health system to reach all population groups and most poor.
全球关注的问题是五岁以下儿童死亡率的下降，自 20 世纪 90 年代初以来，撒哈拉以南非洲（SSA）的一些国家的这一趋势出现了逆转，这可能是由于获得包括免疫接种在内的预防服务方面存在差异。本文旨在利用坦桑尼亚人口与健康调查（DHS）来确定免疫接种完成情况差异的趋势。
DHS 研究自 20 世纪 80 年代以来，在坦桑尼亚所有地区随机选择有代表性的家庭，每五年在同一普查区重复一次。下载并使用 STATA 9.0 分析最近三个数据集（1990 年、1996 年和 2004 年）。分析包括所有 12-23 个月大的儿童，这些儿童在 12 个月大时已完成所有所需的疫苗接种。
在 1990 年、1996 年至 2004/05 年期间，完成疫苗接种的儿童比例相似（1990 年为 71.0%，1996 年为 72.7%，2005 年为 72.3%）。1990 年和 1996 年，财富阶层之间在免疫接种完成情况方面没有差异（p > 0.05），但 2004 年并非如此。2004/05 年，大多数贫困家庭的儿童在免疫接种完成方面经历了显著下降，而最贫困家庭的儿童则出现了显著增加（p < 0.001）。在所有三个时期，家中户主受教育程度低的儿童都不太可能完成免疫接种（p < 0.01）。
1990 年存在的公平性，在 1996 年更加明显，但在 2005 年却出现了倒退，因此，尽管在国家层面上免疫接种覆盖率没有改变，但在亚组层面上，与不断变化的背景和改革相关的差异显著。为了解决免疫接种方面的亚组差异，建议采取以治理和卫生系统为重点的战略，以覆盖所有人群和最贫困人群。
