Canavan Maureen E, Sipsma Heather L, Kassie Getnet M, Bradley Elizabeth H
Yale School of Public Health, New Haven, Connecticut, United States of America.
University of Addis Ababa, Addis Ababa, Ethiopia.
PLoS One. 2014 Apr 21;9(4):e95709. doi: 10.1371/journal.pone.0095709. eCollection 2014.
Despite the benefits of childhood vaccinations, vaccination rates in low-income countries (LICs) vary widely. Increasing coverage of vaccines to 90% in the poorest countries over the next 10 years has been estimated to prevent 426 million cases of illness and avert nearly 6.4 million childhood deaths worldwide. Consequently, we sought to provide a comprehensive examination of contemporary vaccination patterns in East Africa and to identify common and country-specific barriers to complete childhood vaccination.
Using data from the Demographic and Health Surveys (DHS) for Burundi, Ethiopia, Kenya, Rwanda, Tanzania, and Uganda, we looked at the prevalence of complete vaccination for polio, measles, Bacillus Calmette-Guérin (BCG) and DTwPHibHep (DTP) as recommended by the WHO among children ages 12 to 23 months. We conducted multivariable logistic regression within each country to estimate associations between complete vaccination status and health care access and sociodemographic variables using backwards stepwise regression.
Vaccination varied significantly by country. In all countries, the majority of children received at least one dose of a WHO recommended vaccine; however, in Ethiopia, Tanzania, and Uganda less than 50% of children received a complete schedule of recommended vaccines. Being delivered in a public or private institution compared with being delivered at home was associated with increased odds of complete vaccination status. Sociodemographic covariates were not consistently associated with complete vaccination status across countries.
Although no consistent set of predictors accounted for complete vaccination status, we observed differences based on region and the location of delivery. These differences point to the need to examine the historical, political, and economic context of each country in order to maximize vaccination coverage. Vaccination against these childhood diseases is a critical step towards reaching the Millennium Development Goal of reducing under-five mortality by two-thirds by 2015 and thus should be a global priority.
尽管儿童疫苗接种有诸多益处，但低收入国家的疫苗接种率差异很大。据估计，在未来10年将最贫穷国家的疫苗接种覆盖率提高到90%，可在全球预防4.26亿病例，并避免近640万儿童死亡。因此，我们试图全面审视东非当代的疫苗接种模式，并确定完成儿童全程疫苗接种的共同障碍和各国特有的障碍。
利用布隆迪、埃塞俄比亚、肯尼亚、卢旺达、坦桑尼亚和乌干达的人口与健康调查（DHS）数据，我们观察了12至23个月大儿童中按照世界卫生组织建议完成脊髓灰质炎、麻疹、卡介苗（BCG）和白百破- Hib -乙肝（DTwPHibHep）疫苗接种的情况。我们在每个国家进行多变量逻辑回归，使用向后逐步回归来估计全程疫苗接种状况与医疗保健可及性及社会人口统计学变量之间的关联。
疫苗接种情况因国家而异。在所有国家，大多数儿童至少接种了一剂世界卫生组织建议的疫苗；然而，在埃塞俄比亚、坦桑尼亚和乌干达，不到50%的儿童完成了建议疫苗的全程接种。与在家分娩相比，在公立或私立机构分娩与全程疫苗接种状况的几率增加有关。社会人口统计学协变量在各国与全程疫苗接种状况的关联并不一致。
尽管没有一组一致的预测因素能解释全程疫苗接种状况，但我们观察到基于地区和分娩地点的差异。这些差异表明需要审视每个国家的历史、政治和经济背景，以最大限度地提高疫苗接种覆盖率。针对这些儿童疾病的疫苗接种是实现到2015年将五岁以下儿童死亡率降低三分之二这一千年发展目标的关键一步，因此应成为全球优先事项。
