Sunpasitthiprasong Hospital, Ministry of Public Health, Ubon Ratchathani, Thailand.
Influenza Program, Thailand Ministry of Public Health-U.S. Centers for Disease Control and Prevention Collaboration, Nonthaburi, Thailand.
PLoS One. 2021 Jun 25;16(6):e0253561. doi: 10.1371/journal.pone.0253561. eCollection 2021.
Seasonal influenza vaccination uptake among young children in Thailand is low despite national recommendation for vaccination. We implemented a knowledge, attitude/perception, and practice survey to understand determinants of influenza vaccination in children aged six months to two years.
Using a cross-sectional design, we interviewed caregivers of 700 children in seven hospitals using a structured questionnaire to collect information on caregivers' and children's demographic characteristics, and caregivers' knowledge of influenza illness and national vaccine recommendation, attitude/perception toward influenza vaccine, and information sources. We verified children's influenza vaccination status against medical records (vaccinated vs. unvaccinated). Logistic regression was used to examine factors independently associated with children receiving influenza vaccination in the 2018 season using the dataset restricted to only children's parents. Variables associated with vaccination at p-value ≤0.20 were included in subsequent multivariable logistic models. Significant independent determinants of children's influenza vaccination and collinearity of covariates were assessed. The final model was constructed using a stepwise backward elimination approach with variables significant at p-value <0.05 retained in the model.
During August 2018-February 2019, 700 children's caregivers completed the questionnaire; 61 (9%) were caregivers of vaccinated children. Caregivers of the vaccinated children were statistically more likely to have higher education (61% vs. 38%; p-value<0.01) and to know of influenza illness (93% vs. 76%; p-value = 0.03) than those of the unvaccinated group. Factors associated with children receiving influenza vaccination were identifying healthcare providers as a primary source of information about influenza illness for parents (adjusted odds ratio [aOR], 2.8; 95% confidence interval [CI], 1.3-6.0), parents' strongly agreeing with the national recommendation for influenza vaccination in young children (aOR, 2.9; 95% CI, 1.5-5.9), using health insurance provided by the government or parent's employer for children's doctor visits (aOR, 2.6; 95% CI, 1.1-6.6), and the children's history of receiving influenza vaccination in the 2017 season or earlier (aOR, 3.2; 95% CI, 1.4-7.8).
The majority of caregivers of children in this study had knowledge of influenza illness and influenza vaccine. Caregivers reported various sources of information regarding influenza illness and the vaccine, but healthcare providers remained the most trusted source. Children's history of influenza vaccination in prior season(s) was the strongest determinant of children being vaccinated for influenza in the current season.
尽管泰国全国推荐接种季节性流感疫苗，但六个月至两周岁的幼儿接种率仍然较低。我们实施了一项知识、态度/观念和实践调查，以了解影响儿童流感疫苗接种的决定因素。
采用横断面设计，我们使用结构化问卷对 7 家医院的 700 名儿童的照料者进行了访谈，以收集照料者和儿童的人口统计学特征、照料者对流感疾病和国家疫苗推荐的了解、对流感疫苗的态度/观念以及信息来源等信息。我们根据医疗记录（接种组与未接种组）核实了儿童的流感疫苗接种情况。使用仅针对儿童父母的数据集，采用 logistic 回归分析检查与 2018 年流感季节儿童接种疫苗相关的独立因素。将与接种相关的 p 值≤0.20 的变量纳入随后的多变量 logistic 模型。评估儿童流感疫苗接种的显著独立决定因素和协变量的共线性。使用逐步向后消除方法构建最终模型，保留 p 值<0.05 的变量。
2018 年 8 月至 2019 年 2 月期间，700 名儿童的照料者完成了问卷调查；其中 61 名（9%）是接种儿童的照料者。与未接种组相比，接种组儿童的照料者更有可能接受过高等教育（61% vs. 38%；p 值<0.01），且更了解流感疾病（93% vs. 76%；p 值=0.03）。与儿童接种流感疫苗相关的因素包括父母将医疗保健提供者视为获取流感疾病信息的主要来源（调整后的优势比[aOR]，2.8；95%置信区间[CI]，1.3-6.0）、父母强烈同意国家对幼儿接种流感疫苗的建议（aOR，2.9；95% CI，1.5-5.9）、使用政府或父母雇主为儿童提供的医疗保险支付儿童的医生就诊费用（aOR，2.6；95% CI，1.1-6.6）以及儿童在 2017 年或更早接种过流感疫苗（aOR，3.2；95% CI，1.4-7.8）。
在这项研究中，大多数儿童的照料者都了解流感疾病和流感疫苗。照料者报告了有关流感疾病和疫苗的各种信息来源，但医疗保健提供者仍然是最受信任的来源。儿童在前几个季节接种流感疫苗的情况是当前季节接种流感疫苗的最强决定因素。
