儿童疫苗及时接种的不公平现象：来自撒哈拉以南非洲的证据。

Inequities in On-Time Childhood Vaccination: Evidence From Sub-Saharan Africa.

机构信息

African Population and Health Research Center, Nairobi, Kenya.

出版信息

Am J Prev Med. 2021 Jan;60(1 Suppl 1):S11-S23. doi: 10.1016/j.amepre.2020.10.002. Epub 2020 Nov 13.

DOI:10.1016/j.amepre.2020.10.002

PMID:33191062

Abstract

INTRODUCTION

Vaccination coverage has improved in the past decade, but inequalities persist: the poorest, least educated, and rural communities are left behind. Programming has focused on increasing coverage and reaching the hardest-to-reach children, but vaccination timeliness is equally important because delays leave children vulnerable to infections. This study examines the levels and inequities of on-time vaccination in the Sub-Saharan African region.

METHODS

The most recent Demographic and Health Surveys or Multiple Indicator Clusters Surveys since 2000 from Sub-Saharan Africa were used to assess on-time vaccination and inequalities by household wealth, maternal education, and place of residence. Inequalities were quantified using slope index of inequality and concentration index.

RESULTS

The analysis included 153,632 children aged 12-36 months from 40 Sub-Saharan Africa countries. Median on-time vaccination coverage was <50% in all the 4 subregions. Differences in on-time vaccination were observed by place of residence in the Southern (20.8 percentage points, 95% CI=0.8, 40.8), West (17.5 percentage points, 95% CI=5.1, 29.9), and Eastern (20.9 percentage points, 95% CI=6.5, 35.2) regions. Wealth-related inequities were observed in the Southern (22.6 percentage points, 95% CI=4.0, 41.2), Western (30.6 percentage points, 95% CI=19.1, 42.1), and Eastern (26.1 percentage points, 95% CI=8.2, 44.0) regions. Significant education-related differences in on-time vaccination were observed in the Western (20.7 percentage points, 95% CI=10.9, 30.5) and Eastern (21.2 percentage points, 95% CI=7.0, 35.4) regions.

CONCLUSIONS

On-time vaccination coverage was low in all subregions and nearly all countries. Inequalities in on-time immunization by household wealth, place of residence, and education existed in most countries. Concrete strategies to improve levels of timeliness are needed.

SUPPLEMENT INFORMATION

This article is part of a supplement entitled Global Vaccination Equity, which is sponsored by the Global Institute for Vaccine Equity at the University of Michigan School of Public Health.

摘要

简介

在过去的十年中，疫苗接种覆盖率有所提高，但不平等现象仍然存在：最贫穷、受教育程度最低和农村社区仍然落后。规划工作的重点是提高覆盖率并覆盖最难覆盖的儿童，但疫苗接种及时性同样重要，因为延迟会使儿童容易受到感染。本研究检查了撒哈拉以南非洲地区按时接种疫苗的水平和不平等现象。

方法

使用自 2000 年以来撒哈拉以南非洲地区最新的人口与健康调查或多指标类集调查，评估家庭财富、产妇教育和居住地对按时接种疫苗的影响。使用斜率不平等指数和集中指数来量化不平等现象。

结果

分析包括来自撒哈拉以南非洲 40 个国家的 153632 名 12-36 个月大的儿童。所有 4 个次区域的按时疫苗接种覆盖率中位数均低于 50%。在南部（20.8 个百分点，95%CI=0.8，40.8）、西部（17.5 个百分点，95%CI=5.1，29.9）和东部（20.9 个百分点，95%CI=6.5，35.2）地区，按时接种疫苗存在差异。在南部（22.6 个百分点，95%CI=4.0，41.2）、西部（30.6 个百分点，95%CI=19.1，42.1）和东部（26.1 个百分点，95%CI=8.2，44.0）地区，观察到与财富相关的不平等现象。在西部（20.7 个百分点，95%CI=10.9，30.5）和东部（21.2 个百分点，95%CI=7.0，35.4）地区，按时接种疫苗存在显著的教育相关差异。