Kanmiki Edmund Wedam, Mamun Abdullah A, Phillips James F, O'Flaherty Martin
Institute for Social Science Research, The University of Queensland, Indooroopilly, QLD, 4068, Australia.
Poche Centre for Indigenous Health, Faculty of Health and Behavioural Sciences, The University of Queensland, Brisbane, Australia.
Res Health Serv Reg. 2023 Dec 5;2(1):18. doi: 10.1007/s43999-023-00032-8.
Child healthcare services such as diphtheria-tetanus-pertussis (DPT3) vaccination are known to reduce childhood mortality and morbidity. However, inequalities in access to these services in developing countries continue to constrain global efforts aimed at improving child health. This study examines the impact and equity effect of a community-based primary healthcare programme known as the Ghana Essential Health Intervention Programme (GEHIP) on improving the uptake of childhood DPT3 immunisation coverage in a remote rural region of Ghana.
Using baseline and end-line household survey data collected from mothers, the effect of GEHIP's community-based healthcare programme on DPT3 immunisation coverage is evaluated using difference-in-differences multivariate logistic regression models. Household wealth index and maternal educational attainment were used as equity measures.
At end-line, both intervention and comparison districts recorded increases in DPT3 immunisation coverage although intervention districts had a relatively higher coverage than comparison districts (90% versus 88%). While children resident in intervention areas had slightly higher rates than children resident in comparison areas, regression results show that this difference was not statistically significant (DiD = 0.038, p-value = 0.102). There were also no significant equity disparities in the coverage of DPT3 vaccination for both household wealth index and maternal educational attainment.
DPT3 vaccination coverage in both study arms met the global vaccine action plan targets. However, because estimated effects are not significantly higher among treatment area children than among comparison districts counterparts, no equity/inequity effects of the community-based healthcare programme on DPT 3 coverage is evident.
白喉-破伤风-百日咳（DPT3）疫苗接种等儿童医疗服务可降低儿童死亡率和发病率。然而，发展中国家在获取这些服务方面存在的不平等状况，继续制约着旨在改善儿童健康的全球努力。本研究考察了一项名为加纳基本健康干预计划（GEHIP）的社区初级医疗保健计划，对加纳一个偏远农村地区提高儿童DPT3免疫接种覆盖率的影响及公平效应。
利用从母亲那里收集的基线和终线家庭调查数据，采用双重差分多元逻辑回归模型，评估GEHIP社区医疗保健计划对DPT3免疫接种覆盖率的影响。家庭财富指数和母亲教育程度被用作公平性衡量指标。
在终线时，干预区和对照区的DPT3免疫接种覆盖率均有所提高，不过干预区的覆盖率相对高于对照区（90%对88%）。虽然居住在干预区的儿童接种率略高于居住在对照区的儿童，但回归结果显示，这种差异无统计学意义（双重差分=0.038，p值=0.102）。在DPT3疫苗接种覆盖率方面，家庭财富指数和母亲教育程度也不存在显著的公平差距。
两个研究组的DPT3疫苗接种覆盖率均达到了全球疫苗行动计划的目标。然而，由于治疗区儿童的估计效果并不显著高于对照区的儿童，基于社区的医疗保健计划对DPT3覆盖率不存在公平/不公平效应。
