Kim Young Eun
Development Research Group and EAPCE Research Center, World Bank, Kuala Lumpur, Malaysia
BMJ Open. 2021 Apr 14;11(4):e045070. doi: 10.1136/bmjopen-2020-045070.
Childhood vaccination coverage in Nagaland has lagged almost all states in India for more than two decades. This study aims to find drivers and barriers of childhood vaccination in Nagaland from the perspective of demand, supply and local health governance.
A cross-sectional study was designed using a survey conducted by the Directorate of Health and Family in 2015.
Households, community-based health centres and health committees were surveyed.
285 children aged under 2 years with vaccination cards and data on households, health centres and health committees were included.
Variables indicating whether a child received each of bacillus calmette-guérin (BCG), diphtheria-tetanus-pertussis (DTP3), oral polio (OPV3) and measles vaccination and all of them were outcome variables. Associated factors were identified using multilevel logistic regressions.
Antenatal care at least three times was significantly associated with BCG, DTP3, OPV3 and full vaccination with adjusted ORs ranging from 2.4 (95% CI 1.1 to 5.1) to 3.3 (1.1 to 9.9). The availability of bus to health centre was slightly significant for BCG and OPV3 with the adjusted ORs of 2.0 (0.9 to 4.5) and 2.1 (0.9 to 4.8), respectively. Health committees' budget provision to health centres was significant for OPV3 and full vaccination with the respective adjusted ORs of 15.7 (1.0 to 234.1) and 15.9 (1.2 to 214.7), the wide 95% CIs of which were driven by a small sample size. Health committees' review of expenditure of health centres was significant for measles and full vaccination with the adjusted ORs of 4.0 (1.4 to 11.4) and 5.2 (1.4 to 19.4), respectively.
This study suggests that enhancing the utilisation of antenatal care and providing reliable transportation between villages and health centres are required to improve childhood vaccination coverage. Also, the significant association of budget administration of health committees suggests that supporting local health committees for effective financial management is important.
二十多年来，那加兰邦的儿童疫苗接种覆盖率几乎落后于印度所有邦。本研究旨在从需求、供应和地方卫生治理的角度找出那加兰邦儿童疫苗接种的驱动因素和障碍。
采用卫生与家庭事务局2015年进行的一项调查设计了一项横断面研究。
对家庭、社区卫生中心和卫生委员会进行了调查。
纳入了285名2岁以下持有疫苗接种卡的儿童以及有关家庭、卫生中心和卫生委员会的数据。
至少三次产前检查与卡介苗（BCG）、白喉-破伤风-百日咳（DTP3）、口服脊髓灰质炎疫苗（OPV3）接种及全程接种显著相关，调整后的比值比在2.4（95%置信区间1.1至5.1）至3.3（1.1至9.9）之间。前往卫生中心的公共汽车可用性对卡介苗和口服脊髓灰质炎疫苗接种有轻微显著影响，调整后的比值比分别为2.0（0.9至4.5）和2.1（0.9至4.8）。卫生委员会向卫生中心提供的预算对口服脊髓灰质炎疫苗接种和全程接种有显著影响，各自调整后的比值比为15.7（1.0至234.1）和15.9（1.2至214.7），其95%置信区间较宽是由样本量小导致的。卫生委员会对卫生中心支出的审查对麻疹接种和全程接种有显著影响，调整后的比值比分别为4.0（1.4至11.4）和5.2（1.4至19.4）。
本研究表明，需要加强产前检查的利用，并在村庄和卫生中心之间提供可靠的交通，以提高儿童疫苗接种覆盖率。此外，卫生委员会预算管理的显著关联表明，支持地方卫生委员会进行有效的财务管理很重要。
