Ruela Guilherme de Andrade, Santos Alaneir de Fátima Dos, Macieira César, Girardi Sábado Nicolau, Abreu Daisy Maria Xavier de, Massote Alice Werneck, Araújo Jackson Freire, Machado Antônio Thomaz Gonzaga da Matta
Universidade Federal de Minas Gerais. Faculdade de Medicina. Programa de Pós-Graduação em Saúde Pública. Belo Horizonte, MG, Brasil.
Universidade Federal de Minas Gerais. Faculdade de Medicina. Núcleo de Educação em Saúde Coletiva. Belo Horizonte, MG, Brasil.
Rev Saude Publica. 2025 May 12;59:e12. doi: 10.11606/s1518-8787.2025059006279. eCollection 2025.
To investigate the relationship between vaccination coverage indicators and the structure of primary care for immunization in Brazilian municipalities.
This was a time series ecological study using data from the National Immunization Program Information System (SI-PNI) and the National Program for Improving Primary Care Access and Quality (PMAQ) over three evaluation cycles. A total of 13 variables were assessed, five of which related to the structure of basic health units (BHU) and eight to the availability of immunobiologicals. Analyses of comparisons, associations, and longitudinal models were carried out to assess the influence of these indicators on vaccination coverage levels.
The variables and indicators related to the structure of BHUs, the availability of immunobiologicals in Brazilian municipalities and vaccination coverage showed significant variations over the cycles. BHU structures ranged from fair to good, with lower percentages in Cycle 1 and increases in Cycles 2 and 3 for most of the variables analyzed. The availability of immunobiologicals also improved over the cycles, despite a few exceptions. Indicators of adequate vaccination coverage increased from Cycle 1 to Cycle 2 but decreased in Cycle 3. Improvements in the structure of the BHU and the availability of immunobiologicals were associated with higher adequate vaccination coverage. Keeping the availability of immunobiologicals fixed at good, the chance of having adequate coverage is 86.28% higher for a good structure compared to a poor one.
Changes in the structure of municipal BHUs and in the availability of immunobiologicals over the cycles evaluated were identified and were associated with higher vaccination coverage when they occurred simultaneously (good availability of immunobiologicals and regular or good structure in BHUs). This highlights the importance of the quality of primary care in achieving vaccination coverage targets in Brazilian municipalities.
调查巴西各市疫苗接种覆盖率指标与免疫接种初级保健结构之间的关系。
这是一项时间序列生态学研究，使用了国家免疫规划信息系统（SI-PNI）和国家改善初级保健可及性与质量计划（PMAQ）在三个评估周期的数据。共评估了13个变量，其中5个与基层卫生单位（BHU）的结构有关，8个与免疫生物制品的可及性有关。进行了比较分析、关联分析和纵向模型分析，以评估这些指标对疫苗接种覆盖率水平的影响。
与BHU结构、巴西各市免疫生物制品的可及性和疫苗接种覆盖率相关的变量和指标在各周期中显示出显著差异。BHU结构从中等到良好不等，在第1周期中百分比更低，而在第2和第3周期中，大多数分析变量均有所增加。尽管有一些例外情况，但免疫生物制品的可及性在各周期中也有所改善。充分疫苗接种覆盖率指标从第1周期到第2周期有所增加，但在第3周期有所下降。BHU结构的改善和免疫生物制品的可及性与更高的充分疫苗接种覆盖率相关。将免疫生物制品的可及性固定为良好水平，结构良好的情况下获得充分覆盖率的机会比结构较差的情况高86.28%。
确定了在所评估周期内各市BHU结构和免疫生物制品可及性的变化，并且当它们同时出现时（免疫生物制品可及性良好以及BHU结构正常或良好）与更高的疫苗接种覆盖率相关。这突出了初级保健质量在巴西各市实现疫苗接种覆盖率目标方面的重要性。
