Ali Rozina Feroz, Iftikhar Sundus, Shah Mubarak Taighoon, Dharma Vijay Kumar, Malik Farrukh Raza, Siddiqi Danya Arif, Chandir Subhash
IRD Pakistan, 4th Floor Woodcraft Building, Korangi Creek, Karachi, 75190, Pakistan.
IRD Global, The Great Room, Level 10, One George Street, Singapore, 049145.
J Transp Health. 2024 May;36:101773. doi: 10.1016/j.jth.2024.101773. Epub 2024 Mar 28.
Poor accessibility of immunization services coupled with limited options for transportation and socio-cultural norms that hinder women's mobility are among the key factors contributing to poor immunization coverage in rural areas. We assessed the feasibility and acceptability of establishing a free-of-cost, women-only carpool service for immunization in a rural setting in Pakistan and evaluated its preliminary impact on immunization coverage and timeliness among children.
We conducted a feasibility study in four selected immunization facilities in Shikarpur District, Sindh. A local transport vehicle was hired and branded as an immunization carpool service. Women having un- or under-immunized children aged ≤2 years were invited to visit immunization facilities using carpool vehicles. Information on demographic indicators and service experience was collected. Child immunization details were extracted using the government's provincial electronic immunization registry to estimate immunization coverage and timeliness.
Between January and October 2020, six immunization carpool vehicles provided uninterrupted service and transported 2422 women-child pairs, completing 4691 immunization visits. Majority of women reported that the carpool service improved accessibility (99.6%) by offering group travel (82.9%) and reducing their dependency on family members (93.4%). Preliminary estimates reported an increase in immunization coverage and timeliness across antigens among participating children compared to non-participating children, with significant increase in proportion for BCG coverage (38.1%; p < 0.001, CI: 32.8%, 43.4%) and measles-2 timeliness (18%; p < 0.001, CI: 13.3%, 22.4%).
A women-only immunization carpool service implemented within a rural setting is feasible and highly acceptable. Key factors contributing to the model's success include increased mobility and independence of women, cost-savings, and a culturally and contextually appropriate mechanism of transport embedded within the local setting. Increased accessibility to health services also contributed to improved immunization coverage and timeliness among children.
免疫服务可及性差，再加上交通选择有限以及阻碍女性出行的社会文化规范，是导致农村地区免疫接种覆盖率低的关键因素。我们评估了在巴基斯坦农村地区建立免费的女性专用拼车免疫服务的可行性和可接受性，并评估了其对儿童免疫接种覆盖率和及时性的初步影响。
我们在信德省希卡布尔县的四个选定免疫设施中进行了一项可行性研究。租用了一辆当地运输车辆，并将其打造成免疫拼车服务。邀请有未接种或未完全接种疫苗的2岁及以下儿童的女性乘坐拼车前往免疫设施。收集了人口统计学指标和服务体验信息。使用政府的省级电子免疫登记系统提取儿童免疫接种详细信息，以估计免疫接种覆盖率和及时性。
在2020年1月至10月期间，六辆免疫拼车提供了不间断服务，运送了2422对母婴，完成了4691次免疫接种就诊。大多数女性报告称，拼车服务通过提供集体出行（82.9%）和减少对家庭成员的依赖（93.4%）提高了可及性（99.6%）。初步估计显示，与未参与的儿童相比，参与的儿童在各种抗原的免疫接种覆盖率和及时性方面有所提高，卡介苗覆盖率比例显著增加（38.1%；p<0.001，置信区间：32.8%，43.4%），麻疹-2及时性显著增加（18%；p<0.001，置信区间：13.3%，22.4%）。
在农村地区实施的女性专用免疫拼车服务是可行且高度可接受的。该模式成功的关键因素包括提高了女性的出行能力和独立性、节省了成本，以及在当地环境中嵌入了符合文化和实际情况的交通机制。医疗服务可及性的提高也有助于提高儿童的免疫接种覆盖率和及时性。
