印度喀拉拉邦高知市城市群儿童疫苗接种覆盖率及相关因素评估。
Assessment of vaccine coverage and associated factors among children in urban agglomerations of Kochi, Kerala, India.
作者信息
Joy Teena M, George Sobha, Paul Nimitha, Renjini B A, Rakesh P S, Sreedevi Aswathy
机构信息
Department of Community Medicine, Amrita Institute of Medical Sciences and Research Centre, Amrita Vishwa Vidyapeetham, Kochi, Kerala, India.
Kaloor Urban Health Centre, Amrita Institute of Medical Sciences and Research Centre, Amrita Vishwa Vidyapeetham, Kochi, Kerala, India.
出版信息
J Family Med Prim Care. 2019 Jan;8(1):91-96. doi: 10.4103/jfmpc.jfmpc_276_18.
CONTEXT
Urban population in India is growing exponentially. The public sector urban health delivery system has so far been limited in its reach and is far from adequate.
AIMS
This study aims to estimate routine immunization coverage and associated factors among children (12-23 months and 60-84 months) in the urban Kochi Metropolitan Area of Kerala.
SETTINGS AND DESIGN
A cross-sectional study was conducted in Kochi Metropolitan area.
MATERIALS AND METHODS
A cluster sampling technique was used to collect data on immunization status from 310 children aged between 12 and 23 months and 308 children aged between 60 and 84 months.
STATISTICAL ANALYSIS
Crude coverage details for each vaccine were estimated using percentages and confidence intervals. Bivariate and multivariate analysis were conducted to identify factors associated with immunization coverage.
RESULTS
Among the children aged 12-23 months, 89% (95% CI 85.5%-92.5%) were fully immunized, 10% were partially immunized, and 1% unimmunized. Less than 10 years of schooling among mothers (OR 2.40, 95% CI 1.20-4.81) and living in a nuclear family (OR 1.72, 95% CI 1.06-3.14) were determinants associated with partial or unimmunization of children as per multivariate analysis. The coverage of individual vaccines was found to decrease after 18 months from 90% to 75% at 4-5 years for Diphtheria Pertussis Tetanus (DPT) booster. Bivariate analysis found lower birth order and belonging to the Muslim religion as significant factors for this decrease.
CONCLUSION
Education of the mother and nuclear families emerged as areas of vulnerability in urban immunization coverage. Inadequate social support and competing priorities with regard to balancing work and home probably lead to delay or forgetfulness in vaccination. Therefore, a locally contextualized comprehensive strategy with strengthening of the primary health system is needed to improve the immunization coverage in urban areas.
背景
印度城市人口呈指数级增长。到目前为止，公共部门的城市卫生服务体系覆盖范围有限，远远不够完善。
目的
本研究旨在估计喀拉拉邦高知都会区城市中12至23个月以及60至84个月儿童的常规免疫接种覆盖率及相关因素。
设置与设计
在高知都会区进行了一项横断面研究。
材料与方法
采用整群抽样技术，收集了310名12至23个月儿童和308名60至84个月儿童的免疫接种状况数据。
统计分析
使用百分比和置信区间估计每种疫苗的粗略覆盖率细节。进行双变量和多变量分析以确定与免疫接种覆盖率相关的因素。
结果
在12至23个月的儿童中，89%（95%置信区间85.5%-92.5%）完全免疫，10%部分免疫，1%未免疫。多变量分析显示，母亲受教育年限少于10年（比值比2.40，95%置信区间1.20-4.81）以及生活在核心家庭（比值比1.72，95%置信区间1.06-3.14）是儿童部分或未免疫的相关决定因素。发现白喉百日咳破伤风（DPT）加强疫苗接种覆盖率在18个月后从90%下降至4至5岁时的75%。双变量分析发现出生顺序较低和属于穆斯林宗教是导致这种下降的重要因素。
结论
母亲的教育程度和核心家庭成为城市免疫接种覆盖率中的薄弱环节。在平衡工作和家庭方面，社会支持不足以及相互竞争的优先事项可能导致疫苗接种延迟或遗忘。因此，需要制定本地化的综合策略并加强初级卫生系统，以提高城市地区的免疫接种覆盖率。
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