Haenssgen Marco J
Department of International Development, Queen Elizabeth House, University of Oxford, 3 Mansfield Road, Oxford OX1 3AE, UK.
Health Policy Plan. 2017 Jul 1;32(6):800-808. doi: 10.1093/heapol/czx022.
The objective of this article is to analyse and quantify the side effects of the Polio Eradication Initiative on routine immunization performance in India. Past studies have faced methodological challenges in assessing these side effects. This article offers a methodological alternative for health policy analysts. The research uses secondary household survey data from the Indian District-Level Household and Facility Survey (DLHS), focusing on children aged 10-30 months in the Northern Indian states of Uttar Pradesh (n = 34 327) and Bihar (n = 20 525). Covering the years 2002-08, this is the latest large-scale data from India that enables the matching technique used in this article. District-level programme intensity data of the Polio Eradication Initiative in India were reconstructed using publicly available resources. The methodological innovation compared with previous studies consists of matching each child in the DLHS data set with a child-specific value of programme exposure depending on its district of residence, its birth date, and the date of the survey interview. Average and age-specific associations between polio programme exposure and children's full immunization status were assessed using logistic regression, controlling for other determinants of immunization. The regression results show that the link is negative in Uttar Pradesh and positive in Bihar. Age-specific analysis shows that the positive association diminishes for older children in Bihar and that a negative association emerges and becomes increasingly pronounced for older children in Uttar Pradesh. This indicates that heterogeneous results emerge across two neighbouring states with similar programme intensity and suggests that the catch-up of unvaccinated older children may be a channel through which negative effects accrue. The method described in this article, based on an analytical focus on individual-level programme exposure, can therefore help health policy implementers and evaluators to illuminate positive or negative interactions between a health intervention and a health system.
本文旨在分析和量化印度脊髓灰质炎根除计划对常规免疫接种绩效的副作用。以往的研究在评估这些副作用时面临方法上的挑战。本文为卫生政策分析人员提供了一种方法选择。该研究使用了来自印度地区级家庭与设施调查（DLHS）的二手家庭调查数据，重点关注印度北部北方邦（n = 34327）和比哈尔邦（n = 20525）年龄在10至30个月的儿童。涵盖2002年至2008年，这是印度最新的大规模数据，使得本文能够运用匹配技术。印度脊髓灰质炎根除计划的地区级项目强度数据是利用公开可用资源重建的。与以往研究相比，该方法的创新之处在于，根据DLHS数据集中每个儿童的居住地区、出生日期和调查访谈日期，将其与特定的项目暴露值进行匹配。使用逻辑回归评估脊髓灰质炎项目暴露与儿童全程免疫状况之间的平均关联和特定年龄关联，并控制免疫接种的其他决定因素。回归结果显示，在北方邦这种关联为负，而在比哈尔邦为正。特定年龄分析表明，比哈尔邦年龄较大儿童的正相关关系减弱，而北方邦年龄较大儿童出现负相关关系且越来越明显。这表明，在项目强度相似的两个相邻邦出现了不同的结果，这表明未接种疫苗的大龄儿童的追赶接种可能是产生负面影响的一个渠道。因此，本文所描述的基于对个体层面项目暴露进行分析的方法，有助于卫生政策实施者和评估者阐明一项卫生干预措施与卫生系统之间的正负相互作用。
