东开普农村地区的免疫接种覆盖率——我们是否掌握了初级保健的基本要点？一项纵向前瞻性队列研究的结果
Immunisation coverage in the rural Eastern Cape - are we getting the basics of primary care right? Results from a longitudinal prospective cohort study.
作者信息
Le Roux K, Akin-Olugbade O, Katzen L S, Laurenzi C, Mercer N, Tomlinson M, Rotheram-Borus M J
机构信息
Visiting research scholar, Center for Health and Wellbeing, Woodrow Wilson School, Princeton University, New Jersey, USA; Primary Healthcare Directorate, University of Cape Town, South Africa; Zithulele Hospital, Eastern Cape, South Africa.
出版信息
S Afr Med J. 2016 Dec 21;107(1):52-55. doi: 10.7196/SAMJ.2016.v107.i1.11242.
BACKGROUND
Immunisations are one of the most cost-effective public health interventions available and South Africa (SA) has implemented a comprehensive immunisation schedule. However, there is disagreement about the level of immunisation coverage in the country and few studies document the immunisation coverage in rural areas.
OBJECTIVE
To examine the successful and timely delivery of immunisations to children during the first 2 years of life in a deeply rural part of the Eastern Cape Province of SA.
METHODS
From January to April 2013, a cohort of sequential births (N=470) in the area surrounding Zithulele Hospital in the OR Tambo District of the Eastern Cape was recruited and followed up at home at 3, 6, 9, 12 and 24 months post birth, up to May 2015. Immunisation coverage was determined using Road-to-Health cards.
RESULTS
The percentages of children with all immunisations up to date at the time of interview were: 48.6% at 3 months, 73.3% at 6 months, 83.9% at 9 months, 73.3% at 12 months and 73.2% at 24 months. Incomplete immunisations were attributed to stock-outs (56%), lack of awareness of the immunisation schedule or of missed immunisations by the mother (16%) and lack of clinic attendance by the mother (19%). Of the mothers who had visited the clinic for baby immunisations, 49.8% had to make multiple visits because of stock-outs. Measles coverage (of at least one dose) was 85.2% at 1 year and 96.3% by 2 years, but 20.6% of babies had not received a second measles dose (due at 18 months) by 2 years. Immunisations were often given late, particularly the 14-week immunisations.
CONCLUSIONS
Immunisation rates in the rural Eastern Cape are well below government targets and indicate inadequate provision of basic primary care. Stock-outs of basic childhood immunisations are common and are, according to mothers, the main reason for their children's immunisations not being up to date. There is still much work to be done to ensure that the basics of disease prevention are being delivered at rural clinics in the Eastern Cape, despite attempts to re-engineer primary healthcare in SA.
背景
免疫接种是现有的最具成本效益的公共卫生干预措施之一，南非（SA）已实施了全面的免疫接种计划。然而，对于该国的免疫接种覆盖率水平存在分歧，很少有研究记录农村地区的免疫接种覆盖率。
目的
考察在南非东开普省一个偏远农村地区，2岁以下儿童免疫接种是否成功且及时。
方法
2013年1月至4月，招募了东开普省奥·坦博区齐图莱勒医院周边地区的一系列连续出生的婴儿（N = 470），并在其出生后3、6、9、12和24个月进行家访随访，直至2015年5月。使用儿童健康记录卡确定免疫接种覆盖率。
结果
在访谈时，完成所有免疫接种的儿童百分比分别为：3个月时为48.6%，6个月时为73.3%，9个月时为83.9%，12个月时为73.3%，24个月时为73.2%。未完成免疫接种归因于疫苗缺货（56%）、母亲对免疫接种计划或错过的免疫接种缺乏认识（16%）以及母亲未前往诊所就诊（19%）。在因婴儿免疫接种前往诊所的母亲中，49.8%因疫苗缺货不得不多次前往。1岁时麻疹疫苗接种覆盖率（至少一剂）为85.2%，2岁时为96.3%，但到2岁时，20.6%的婴儿未接种第二剂麻疹疫苗（应在18个月接种）。免疫接种经常延迟进行，尤其是14周龄时的免疫接种。
结论
东开普省农村地区的免疫接种率远低于政府目标，表明基本初级保健服务不足。基本儿童免疫疫苗缺货情况常见，据母亲们说，这是她们孩子免疫接种未达标的主要原因。尽管南非试图对初级医疗保健进行重新规划，但要确保东开普省农村诊所提供疾病预防的基本服务，仍有许多工作要做。
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