Fielding School of Public Health, University of California, Los Angeles, Department of Epidemiology, Los Angeles, CA 90095, United States.
Fielding School of Public Health, University of California, Los Angeles, Department of Epidemiology, Los Angeles, CA 90095, United States.
Vaccine. 2018 Jan 25;36(4):587-593. doi: 10.1016/j.vaccine.2017.11.049. Epub 2017 Dec 14.
Measles is a significant contributor to child mortality in the Democratic Republic of the Congo (DRC), despite routine immunization programs and supplementary immunization activities (SIA). Further, national immunization coverage levels may hide disparities among certain groups of children, making effective measles control even more challenging. This study describes measles vaccination coverage and reporting methods and identifies predictors of vaccination among children participating in the 2013-2014 DRC Demographic and Health Survey (DHS).
We examined vaccination coverage of 6947 children aged 6-59 months. A multivariate logistic regression model was used to identify predictors of vaccination among children reporting vaccination via dated card in order to identify least reached children. We also assessed spatial distribution of vaccination report type by rural versus urban residence.
Urban children with educated mothers were more likely to be vaccinated (OR = 4.1, 95% CI: 1.6, 10.7) versus children of mothers with no education, as were children in wealthier rural families (OR = 2.9, 95% CI: 1.9, 4.4). At the provincial level, urban areas more frequently reported vaccination via dated card than rural areas.
Results indicate that, while the overall coverage level of 70% is too low, socioeconomic and geographic disparities also exist which could make some children even less likely to be vaccinated. Dated records of measles vaccination must be increased, and groups of children with the greatest need should be targeted. As access to routine vaccination services is limited in DRC, identifying and targeting under-reached children should be a strategic means of increasing country-wide effective measles control.
尽管开展了常规免疫规划和补充免疫活动（SIA），但麻疹仍是刚果民主共和国（DRC）儿童死亡的主要原因之一。此外，国家免疫覆盖率可能掩盖了某些儿童群体之间的差异，使得有效控制麻疹更加具有挑战性。本研究描述了麻疹疫苗接种覆盖率和报告方法，并确定了参与 2013-2014 年刚果民主共和国人口与健康调查（DHS）的儿童接种疫苗的预测因素。
我们检查了 6947 名 6-59 个月龄儿童的疫苗接种覆盖率。使用多变量逻辑回归模型，根据接种日期卡报告接种情况的儿童，确定接种疫苗的预测因素，以便确定未覆盖的儿童。我们还评估了按城乡居住地点报告的接种报告类型的空间分布。
与母亲未受过教育的儿童相比，母亲受过教育的城市儿童更有可能接种疫苗（OR=4.1，95%CI：1.6，10.7），农村家庭中较富裕的儿童也是如此（OR=2.9，95%CI：1.9，4.4）。在省级层面，城市地区比农村地区更频繁地通过接种日期卡报告接种情况。
结果表明，尽管总体覆盖率 70%太低，但也存在社会经济和地理差异，这可能使一些儿童更不可能接种疫苗。必须增加麻疹疫苗接种的日期记录，并且应针对最需要的儿童群体。由于刚果民主共和国常规疫苗接种服务的获取受到限制，确定和针对未覆盖的儿童应成为提高全国有效麻疹控制的战略手段。
