Center for Disease Dynamics, Economics & Policy, Washington DC, USA.
The Population Council, 1 Dag Hammarskjold Plaza, New York, NY 10017, USA; Center for Disease Dynamics, Economics & Policy, Washington DC, USA.
Vaccine. 2022 Apr 6;40(16):2388-2398. doi: 10.1016/j.vaccine.2022.03.017. Epub 2022 Mar 16.
Universal coverage of routine childhood vaccines remains a challenge in many low- and middle-income countries (LMICs). In India, vaccination campaigns have increased full immunization coverage among 12-23 month old children from an estimated 62% in 2015-2016 to 76% in 2019-2020. Long-term improvements in coverage will likely require systemic changes to both the supply and demand sides of immunization programs. However, the effect of health system inputs on child vaccination outcomes remains poorly quantified in India. We examined the association between the quality of public health facilities and child vaccination outcomes in rural India using data from the nationally representative Integrated Child Health and Immunization Survey (2015-2016) which covered 1,346 public primary health sub-centers and 44,571 households. We constructed two indices of sub-center quality using multiple correspondence analysis: one related to the general health infrastructure quality and the other measuring vaccine service delivery. Using probit regression, we analyzed the relationship between vaccination outcomes in children under 2 years of age and sub-center quality, controlling for household socioeconomic characteristics. Additionally, we conducted Fairlie decomposition analysis by wealth group - bottom wealth quintile relative to the top four wealth quintiles- to examine factors contributing to gaps in immunization between rich and poor households. Infrastructure quality index was positively associated with completion of seven vaccination outcomes: full immunization, DPT-1 (first dose of diphtheria, pertussis, and tetanus), DPT-2, DPT-3, Bacillus Calmette-Guérin (BCG), hepatitis B (birth dose), and on-time vaccination (OTV). Vaccine service delivery index was positively associated with completion of measles vaccination. The distribution of infrastructure quality contributed to increased gaps in full immunization and OTV between rich and poor households, while greater proximity to vaccination site for poorer households reduced these gaps. Improved quality of health facilities, particularly facilities used by low-income households, may improve vaccination outcomes.
在许多低收入和中等收入国家（LMICs），普及常规儿童疫苗仍然是一个挑战。在印度，疫苗接种运动使 12-23 个月大的儿童完全免疫覆盖率从 2015-2016 年的估计 62%提高到 2019-2020 年的 76%。要实现覆盖范围的长期改善，可能需要对免疫规划的供需双方进行系统性变革。然而，卫生系统投入对儿童疫苗接种结果的影响在印度仍未得到充分量化。我们利用全国代表性的综合儿童健康和免疫调查（2015-2016 年）的数据，研究了印度农村公共卫生设施质量与儿童疫苗接种结果之间的关系，该调查涵盖了 1346 个公共初级保健次级中心和 44571 户家庭。我们使用多元对应分析构建了两个次级中心质量指数：一个与一般卫生基础设施质量有关，另一个衡量疫苗服务提供情况。我们使用概率回归分析，在控制家庭社会经济特征的情况下，分析了 2 岁以下儿童的疫苗接种结果与次级中心质量之间的关系。此外，我们按财富组进行了费尔利分解分析-与前四个财富五分位数相比，最底层财富五分位数-以检查贫富家庭之间免疫差距的贡献因素。基础设施质量指数与完成以下七个疫苗接种结果呈正相关：完全免疫、DPT-1（白喉、百日咳和破伤风的第一剂）、DPT-2、DPT-3、卡介苗（BCG）、乙型肝炎（出生剂量）和按时接种疫苗（OTV）。疫苗服务提供指数与麻疹疫苗接种完成呈正相关。基础设施质量的分布导致富人和穷人家庭之间完全免疫和 OTV 的差距加大，而较贫困家庭靠近疫苗接种点则缩小了这些差距。改善卫生设施的质量，特别是改善低收入家庭使用的卫生设施，可能会提高疫苗接种效果。
