Department of Global Health Policy, Graduate School of Medicine, The University of Tokyo, 7-3-1, Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan.
SciREX Centre, National Graduate Institute for Policy Studies, Tokyo, Japan.
BMC Public Health. 2021 Nov 10;21(1):2063. doi: 10.1186/s12889-021-11841-2.
Vaccination is one of the effective ways to develop immunity against potential life-threatening diseases in children in early age. This study is focused on analysing the age-appropriate vaccination coverage at national and subnational levels and identify the factors associated with age-appropriate coverage in Nepal.
460 children aged 12-36 months were included in the study. The data was obtained from Nepal Demographic and Health Survey (NDHS) 2016-17. Age-appropriate coverage of Bacillus Calmette-Guerin vaccine (BCG), oral polio vaccine (OPV) doses 1-3, pentavalent vaccine (PE) doses 1-3, and first dose of measles, mumps, and rubella vaccine (MMR) were estimated using Kaplan Meier method. Multilevel logistic regression with random intercept was used to identify the factors associated with age-appropriate vaccination.
The crude coverage of the vaccines included in the study ranged from 91.5% (95% CI, 88.5-93.7) for PE3 to 97.8% (95.8-98.7) for BCG. Although the crude coverage of all the vaccines was above 90%, the age-appropriate coverage was significantly low, ranging from 41.5% (36.5-46.6) for PE3 to 73.9% (69.2-78.1) for PE1. Furthermore, high disparity in timely vaccination coverage was observed at regional level. Compared to the age-appropriate vaccination coverage in other provinces, Province 2 had the lowest coverage of all, followed by that in Province 6. The timeliness of vaccination was significantly associated with subnational regions i.e., provinces and the season of childbirth.
Although the immunization program in Nepal has achieved the target of 90% crude coverage of all the childhood vaccines, the age-appropriate coverage is significantly low which undermines the effectiveness of the vaccines administered. Thus, along with crude coverage, timeliness of the vaccines administered should be taken into consideration and thoroughly monitored at national and subnational levels. Provincial government should formulate tailored strategies to ensure the timely administration of the childhood vaccines.
接种疫苗是儿童在早期针对潜在危及生命疾病产生免疫力的有效方法之一。本研究专注于分析国家和国家级以下各级适龄儿童疫苗接种覆盖率，并确定尼泊尔与适龄疫苗接种覆盖率相关的因素。
本研究纳入了 2016-17 年尼泊尔全国健康和人口调查（NDHS）中 12-36 月龄的 460 名儿童。采用 Kaplan-Meier 法估计卡介苗（BCG）、口服脊髓灰质炎疫苗（OPV）第 1-3 剂、五联疫苗（PE）第 1-3 剂和麻疹、腮腺炎、风疹联合疫苗（MMR）第 1 剂的适龄接种覆盖率。采用带有随机截距的多水平逻辑回归分析确定与适龄接种相关的因素。
研究中包含的疫苗的粗覆盖率范围从 PE3 的 91.5%（95%CI，88.5-93.7）到 BCG 的 97.8%（95.8-98.7）。尽管所有疫苗的粗覆盖率都在 90%以上，但适龄接种覆盖率明显较低，PE3 的适龄接种覆盖率为 41.5%（36.5-46.6），PE1 的适龄接种覆盖率为 73.9%（69.2-78.1）。此外，在地区层面观察到及时接种疫苗的覆盖率存在很大差异。与其他省份相比，第 2 省的所有疫苗接种率均最低，其次是第 6 省。疫苗接种的及时性与国家以下各级地区即省份和儿童出生季节显著相关。
尽管尼泊尔免疫规划已实现所有儿童疫苗接种粗覆盖率达到 90%的目标，但适龄接种覆盖率明显较低，这削弱了所接种疫苗的效果。因此，除了粗覆盖率外，还应考虑并在国家和国家级以下各级全面监测疫苗接种的及时性。省政府应制定有针对性的策略，确保及时接种儿童疫苗。
