Kahn J G, Mokdad A H, Deming M S, Roungou J B, Boby A M, Excler J L, Waldman R J
Institute for Health Policy Studies, University of California, San Francisco, 94109, USA.
Bull World Health Organ. 1995;73(1):47-55.
Quantified in the study are the extent of missed opportunities for immunization and the potential increases in vaccination coverage and timeliness that could be achieved by using all health centre visits to administer childhood vaccinations in the Central African Republic. The data were collected during a national vaccination coverage survey of 642 children aged 12-23 months from three areas: rural, urban, and the capital, Bangui. Dates of all vaccination visits and other health centre visits were obtained from combined vaccination/health cards. Nationwide, 70% of all opportunities for valid measles vaccination were missed. Of these, 28% occurred at visits when at least one vaccine was given, while 72% occurred at other health centre visits. If there had been no missed opportunities to administer all vaccinations due when at least one vaccine was given, the coverage would have increased from 53% to 67% for the diphtheria-pertussis-tetanus series, from 54% to 70% for measles, and from 34% to 59% for all antigens. If there had been no missed opportunities at any visit, the corresponding increases would have been to 70%, 76%, and 65%. For measles, 46% of the potential increase depends on recognizing that an earlier dose of the vaccine was invalid and on revaccinating. Days-at-risk for measles (after the age of 270 days) would have been reduced by a mean of 74 days per subject with a health card had no opportunities been missed. The method used serves as a valuable adjunct to evaluations of missed opportunities based on exit interviews at health facilities.(ABSTRACT TRUNCATED AT 250 WORDS)
该研究量化了中非共和国在免疫接种方面错失机会的程度，以及通过利用所有健康中心就诊机会来进行儿童疫苗接种所能实现的疫苗接种覆盖率和及时性的潜在提升。数据收集于一项针对来自农村、城市和首都班吉三个地区的642名12至23个月大儿童的全国疫苗接种覆盖率调查。所有疫苗接种就诊和其他健康中心就诊的日期均从疫苗接种/健康联合卡中获取。在全国范围内，70%的有效麻疹疫苗接种机会被错失。其中，28%发生在至少接种一剂疫苗的就诊时，而72%发生在其他健康中心就诊时。如果在至少接种一剂疫苗时不存在接种所有疫苗的错失机会，白喉-百日咳-破伤风系列疫苗的接种覆盖率将从53%提高到67%，麻疹疫苗接种覆盖率将从54%提高到70%，所有抗原的接种覆盖率将从34%提高到59%。如果在任何就诊时都不存在错失机会，相应的提高将分别达到70%、76%和65%。对于麻疹，46%的潜在提高取决于识别早期一剂疫苗无效并进行补种。如果没有错失机会，持有健康卡的每个受试者的麻疹风险天数（270天龄后）平均将减少74天。所使用的方法是基于医疗机构出口访谈对错失机会进行评估的宝贵辅助手段。（摘要截短于250字）
