Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 North Wolfe Street, Suite E8132, Baltimore, MD, 21205, USA.
BMC Int Health Hum Rights. 2013 May 16;13:25. doi: 10.1186/1472-698X-13-25.
Studies that have looked at the effect of polio eradication efforts in India on routine immunization programs have provided mixed findings. One polio eradication project, funded by US Agency for International Development (USAID) and carried out by the CORE Group Polio Project (CGPP) in the state of Uttar Pradesh of India, has included the strengthening of routine immunization systems as a core part of its polio eradication strategy. This paper explores the performance of routine immunization services in the CGPP intervention areas concurrent with intensive polio eradication activities. The paper also explores determinants of routine immunization performance such as caretaker characteristics and CGPP activities to strengthen routine immunization services.
We conduct secondary data analysis of the latest project household immunization survey in 2011 and compare these findings to reports of past surveys in the CGPP program area and at the Uttar Pradesh state level (as measured by children's receipt of DPT vaccinations). This is done to judge if there is any evidence that routine immunization services are being disrupted. We also model characteristics of survey respondents and respondents' exposure to CGPP, communication activities against their children's receipt of key vaccinations in order to identify determinants of routine immunization coverage.
Routine immunization coverage has increased between the first survey (2005 for state level estimates, 2008 for the CGPP program) and the latest (2011 for both state level and CGPP areas), as measured by children's receipt of DPT vaccination. This increase occurred concurrent with polio eradication efforts intensive enough to result in interruption of transmission. In addition, a mothers' exposure to specific communication materials, her religion and education were associated with whether or not her children receive one or more doses of DPT.
A limitation of the analysis is the absence of a controlled comparison. It is possible routine immunization coverage would have increased even more in the absence of polio eradication efforts. At the same time, however, there is no evidence that routine immunization services were disrupted by polio eradication efforts. Targeted health communications are helpful in improving routine immunization performance. Strategies to address other determinants of routine immunization, such as religion and education, are also needed to maximize coverage.
研究表明，印度消除小儿麻痹症的努力对常规免疫规划的影响喜忧参半。美国国际开发署（USAID）资助、CORE 集团小儿麻痹症项目（CGPP）在印度北方邦实施的一个小儿麻痹症消除项目，将加强常规免疫系统作为其小儿麻痹症消除战略的核心部分。本文探讨了 CGPP 干预地区在强化小儿麻痹症消除活动的同时，常规免疫服务的实施情况。本文还探讨了常规免疫服务表现的决定因素，如看护人的特征和 CGPP 活动，以加强常规免疫服务。
我们对 2011 年最新的项目家庭免疫调查进行了二次数据分析，并将这些发现与 CGPP 项目地区和北方邦州一级过去的调查报告（以儿童接受 DPT 疫苗接种情况衡量）进行了比较。这样做是为了判断常规免疫服务是否受到干扰的证据。我们还对调查对象的特征和调查对象对 CGPP 的接触情况进行了建模，对针对儿童关键疫苗接种的沟通活动进行了建模，以确定常规免疫覆盖率的决定因素。
与第一次调查（2005 年为州一级估计，2008 年为 CGPP 项目）相比，最新的调查（2011 年为州一级和 CGPP 地区）显示，常规免疫覆盖率有所增加，以儿童接受 DPT 疫苗接种情况衡量。这一增长发生在小儿麻痹症消除工作密集到足以导致传播中断的时候。此外，母亲接触特定的沟通材料、宗教和教育程度与她的孩子是否接受一剂或多剂 DPT 疫苗有关。
分析的一个局限性是缺乏对照比较。即使没有小儿麻痹症消除工作，常规免疫接种覆盖率也可能会增加更多。然而，没有证据表明常规免疫服务受到小儿麻痹症消除工作的干扰。有针对性的健康宣传有助于提高常规免疫服务的绩效。还需要采取策略解决常规免疫的其他决定因素，如宗教和教育，以最大限度地提高覆盖率。
