Kuan-Mahecha Maria A, Rahman Sabrina, Martínez-Rivera Paola, Lamb Molly M, Asturias Edwin J
University Francisco Marroquin School of Medicine, Guatemala City, Guatemala.
Department of Epidemiology, Colorado School of Public Health, Aurora, CO, USA.
Vaccine. 2023 May 5;41(19):3099-3105. doi: 10.1016/j.vaccine.2023.03.064. Epub 2023 Apr 13.
The objectives of this study were to evaluate parental confidence and attitudes towards immunization in urban Guatemala between private versus public health systems and their impact on vaccination timeliness in their children.
A cross-sectional survey was conducted in parents 6-18-month-old children who attended well-child outpatient clinics from two health systems (public employee-based insurance and private health care) in Guatemala City from November 2017 through August 2018. Parental demographics, household characteristics, food insecurity, vaccine hesitancy using the WHO SAGE Vaccine Hesitancy Scale, and information on parental use of social media platforms and vaccine information sources were collected.
Five hundred-three parents were surveyed, most of them mothers. Only 9 parents reported they had previously refused a vaccine for their child: 8 (3.2 %) from private clinics and 1 (0.4 %) from the public clinic (p = 0.02). Significantly more children attending private clinics (226, 90.4 %) were shown to have a delay in any of their vaccines scheduled for the first 2 years of life compared to those in the public clinic (169, 66.8 %; p < 0.01). Children of parents having a college degree (84.5 vs 70.1 %; p < 0.001), earning more than US$ 1,000 per month (81.5 vs 70.7 %; p < 0.001), and having a computer at home (81.4 vs 70.2; p = 0.007) were more likely to have any delays in the scheduled vaccines. Parents seeking care at private clinics were 1.14 times more at risk of delaying a vaccine compared to those at the public clinic, adjusted for other covariates (p = 0.03, 95 % CI: 1.01, 1.28).
In Guatemala, children receiving immunizations at private clinics were significantly more likely than those attending public clinics to be delayed in their immunization schedule and to remain more days without the recommended protection, especially for third doses of the primary vaccine series.
本研究的目的是评估危地马拉城市地区私立与公立卫生系统中父母对免疫接种的信心和态度，以及它们对子女疫苗接种及时性的影响。
2017年11月至2018年8月，对危地马拉城两个卫生系统（基于公职人员保险的公立系统和私立医疗系统）中6至18个月大儿童的家长进行了一项横断面调查。收集了家长的人口统计学信息、家庭特征、粮食不安全状况、使用世界卫生组织全球疫苗安全咨询委员会（WHO SAGE）疫苗犹豫量表评估的疫苗犹豫情况，以及家长使用社交媒体平台和疫苗信息来源的信息。
共调查了503名家长，其中大多数是母亲。只有9名家长报告他们之前曾拒绝为孩子接种疫苗：8名（3.2%）来自私立诊所，1名（0.4%）来自公立诊所（p = 0.02）。与公立诊所的儿童（169名，66.8%）相比，私立诊所就诊的儿童（226名，90.4%）在生命的前两年中任何计划接种的疫苗出现延迟的情况显著更多（p < 0.01）。父母拥有大学学历（84.5%对70.1%；p < 0.001）、月收入超过1000美元（81.5%对70.7%；p < 0.001）以及家中有电脑（81.4%对70.2%；p = 0.007）的儿童，其计划接种的疫苗更有可能出现延迟。在调整其他协变量后，在私立诊所就诊的家长延迟接种疫苗的风险是在公立诊所就诊家长的1.14倍（p = 0.03，95%可信区间：1.01，1.28）。
在危地马拉，在私立诊所接种疫苗的儿童比在公立诊所接种疫苗的儿童更有可能延迟免疫接种计划，并且在更长时间内得不到推荐的保护，尤其是对于初级疫苗系列的第三剂。
