Department of Data and Analytics, World Health Organization, Geneve, Switzerland.
Department of Data and Analytics, World Health Organization, Geneve, Switzerland
BMJ Open. 2022 Jul 25;12(7):e061346. doi: 10.1136/bmjopen-2022-061346.
Despite significant progress in childhood vaccination coverage globally, substantial inequality remains. Remote rural populations are recognised as a priority group for immunisation service equity. We aimed to link facility and individual data to examine the relationship between distance to services and immunisation coverage empirically, specifically using a rural population.
Retrospective cross-sectional analysis of facility data from the 2013-2014 Malawi Service Provision Assessment and individual data from the 2015-2016 Malawi Demographic and Health Survey, linking children to facilities within a 5 km radius. We examined associations between proximity to health facilities and vaccination receipt via bivariate comparisons and logistic regression models.
2740 children aged 12-23 months living in rural areas.
Immunisation coverage for the six vaccines included in the Malawi Expanded Programme on Immunization schedule for children under 1 year at time of study, as well as two composite vaccination indicators (receipt of basic vaccines and receipt of all recommended vaccines), zero-dose pentavalent coverage, and pentavalent dropout.
72% (706/977) of facilities offered childhood vaccination services. Among children in rural areas, 61% were proximal to (within 5 km of) a vaccine-providing facility. Proximity to a vaccine-providing health facility was associated with increased likelihood of having received the rotavirus vaccine (93% vs 88%, p=0.004) and measles vaccine (93% vs 89%, p=0.01) in bivariate tests. In adjusted comparisons, how close a child was to a health facility remained meaningfully associated with how likely they were to have received rotavirus vaccine (adjusted OR (AOR) 1.63, 95% CI 1.13 to 2.33) and measles vaccine (AOR 1.62, 95% CI 1.11 to 2.37).
Proximity to health facilities was significantly associated with likelihood of receipt for some, but not all, vaccines. Our findings reiterate the vulnerability of children residing far from static vaccination services; efforts that specifically target remote rural populations living far from health facilities are warranted to ensure equitable vaccination coverage.
尽管全球儿童疫苗接种覆盖率取得了显著进展，但仍存在很大差距。偏远农村人口被认为是免疫服务公平性的优先群体。我们旨在将设施和个人数据联系起来，具体使用农村人口，从实证角度研究服务距离与免疫接种覆盖率之间的关系。
对 2013-2014 年马拉维服务提供情况评估的设施数据和 2015-2016 年马拉维人口与健康调查的个人数据进行回顾性横断面分析，将儿童与 5 公里半径内的设施联系起来。我们通过双变量比较和逻辑回归模型检查了接近卫生设施与疫苗接种接受之间的关联。
2740 名年龄在 12-23 个月之间、居住在农村地区的儿童。
在研究时，1 岁以下儿童的马拉维扩大免疫规划方案包括的六种疫苗的免疫接种率，以及两个复合疫苗指标（基本疫苗接种和所有推荐疫苗接种）、五价疫苗零剂量覆盖率和五价疫苗脱落率。
72%（706/977）的设施提供儿童疫苗接种服务。在农村地区的儿童中，61%的儿童接近（5 公里内）提供疫苗的设施。接近提供疫苗的卫生设施与轮状病毒疫苗（93%比 88%，p=0.004）和麻疹疫苗（93%比 89%，p=0.01）接种率的增加显著相关。在调整后的比较中，儿童与卫生设施的接近程度与他们接种轮状病毒疫苗（调整后的比值比（AOR）1.63，95%置信区间 1.13 至 2.33）和麻疹疫苗（AOR 1.62，95%置信区间 1.11 至 2.37）的可能性仍有显著关联。
接近卫生设施与某些疫苗的接种可能性显著相关，但并非所有疫苗都如此。我们的研究结果再次强调了远离静态疫苗接种服务的儿童的脆弱性；需要针对远离卫生设施的偏远农村人口开展专门工作，以确保公平接种疫苗。
