1 University of California at San Francisco, CA, USA.
2 University of Texas at Dallas, Richardson, TX, USA.
Asia Pac J Public Health. 2019 Jan;31(1):51-60. doi: 10.1177/1010539518813604. Epub 2018 Nov 30.
In Bangladesh, policy discourse has mostly focused on regional inequities in health, including child immunization coverage. Knowledge of local geographical and contextual factors within regions, however, becomes pertinent in efforts to address these inequities. We used the Bangladesh Demographic and Health Survey 2011 to examine factors that influence intraregional differences in vaccination coverage using a multilevel analysis. We found that in spite of the provision of health facilities at each level of administrative governance, only distance to the Upazilla Health Complex was a consistent predictor for each dose of vaccine, highlighting the remote locations of the communities that remain underserved. Our analysis demonstrates the value of subregional analyses that identify the characteristics of communities that are vulnerable to incomplete immunization coverage. Unless specific policy actions are taken to increase coverage in these remote areas, geographic inequities are likely to persist within regions, and desired targets will not be achieved.
在孟加拉国，政策讨论主要集中在卫生方面的区域不平等问题，包括儿童免疫接种覆盖率。然而，了解区域内的当地地理和背景因素对于解决这些不平等问题至关重要。我们使用 2011 年孟加拉国人口与健康调查数据，采用多水平分析方法研究了影响疫苗接种覆盖率区域内差异的因素。我们发现，尽管在每个行政治理级别都提供了卫生设施，但只有到 Upazilla 健康中心的距离是每个剂量疫苗的一致预测因素，突出了服务不足的社区所处的偏远位置。我们的分析表明，进行分区分析具有价值，可以确定容易出现免疫接种不完全的社区的特征。除非采取具体的政策行动来增加这些偏远地区的覆盖率，否则区域内的地理不平等可能会持续存在，并且无法实现预期目标。
