Public Health, Arsi University, Assela, Ethiopia
School of Public health, College of Health Science, Addis Ababa University, Addis Ababa, Ethiopia.
BMJ Open. 2024 Mar 18;14(3):e079570. doi: 10.1136/bmjopen-2023-079570.
Despite Ethiopia's policy intention to provide recommended vaccination services to underprivileged populations, inequity in polio immunisation persists.
This study examined inequity and trends in polio immunisation and determinant factors among children aged 12-23 months in Ethiopia between 2000 and 2019.
Cross-sectional data from 2000, 2005, 2011, 2016 and 2019 Ethiopian demographic and health surveys were analysed with the updated version of the WHO's Health Equity Assessment Toolkit software. Six standard equity measures: equity gaps, equity ratios, population attributable risk, population attributable fraction, slope index of inequality and relative index of inequality were used. Datasets were analysed and disaggregated by the five equality stratifiers: economic status, education, place of residence, sex of the child and regions. Multilevel logistic regression analysis was used to identify determinant factors.
Polio immunisation coverage was increased from 34.5% (2000) to 60.0% (2019). The wealth index-related inequity, in coverage of polio immunisation between quintiles 5 and 1, was 20 percentage points for most surveys. The population attributable risk and population attributable fraction measure in 2011 indicate that the national polio immunisation coverage in that year could have been improved by nearly 36 and 81 percentage points, respectively, if absolute and relative wealth-driven inequity, respectively, had been avoided. The absolute difference between Addis Ababa and Afar Region was 74 percentage points in 2000 and 60 percentage points in 2019. In multilevel analysis result, individual-level factors like wealth index, maternal education antenatal care and place of delivery showed statistical significance.
Although polio immunisation coverage gradually increased over time, in the 20-year survey periods, still 40% of children remained unvaccinated. Inequities in coverage by wealth, educational status, urban-rural residence and administrative regions persisted. Increasing service coverage and improving equitable access to immunisations services may narrow the existing inequity gaps.
尽管埃塞俄比亚有意向贫困人群提供推荐的疫苗接种服务，但脊灰疫苗接种方面的不平等现象仍然存在。
本研究旨在调查 2000 年至 2019 年期间埃塞俄比亚 12-23 个月儿童脊灰疫苗接种的不平等现象和趋势及其决定因素。
利用世界卫生组织（WHO）卫生公平评估工具包软件的更新版本，对 2000 年、2005 年、2011 年、2016 年和 2019 年埃塞俄比亚人口与健康调查的横断面数据进行了分析。采用了六种标准公平措施：公平差距、公平比、人群归因风险、人群归因分数、不平等斜率指数和相对不平等指数。通过五个平等分层因素：经济地位、教育、居住地、儿童性别和地区对数据集进行了分析和细分。采用多水平逻辑回归分析确定决定因素。
脊灰疫苗接种覆盖率从 2000 年的 34.5%提高到 2019 年的 60.0%。在大多数调查中，五等分 5 到 1 之间与财富指数相关的脊灰疫苗接种覆盖不平等，差距为 20 个百分点。2011 年的人群归因风险和人群归因分数测量表明，如果避免绝对和相对财富驱动的不平等，当年全国脊灰疫苗接种覆盖率可分别提高近 36 和 81 个百分点。2000 年，亚的斯亚贝巴和阿法尔地区之间的绝对差异为 74 个百分点，2019 年为 60 个百分点。在多水平分析结果中，个人层面的因素，如财富指数、产妇教育、产前护理和分娩地点，具有统计学意义。
尽管脊灰疫苗接种覆盖率随着时间的推移逐渐增加，但在 20 年的调查期间，仍有 40%的儿童未接种疫苗。财富、教育程度、城乡居住和行政区域覆盖方面的不平等现象依然存在。增加服务覆盖范围并改善公平获取免疫服务的机会，可能会缩小现有的不平等差距。
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