Associations between family planning, healthcare access, and female education and vaccination among under-immunized children

IF 4.5 3区医学 Q2 IMMUNOLOGY

Vaccine Pub Date : 2024-11-24 DOI:10.1016/j.vaccine.2024.126540

Francisco Castillo-Zunino , Kyra A. Hester , Pinar Keskinocak , Dima Nazzal , Hannah K. Smalley , Matthew C. Freeman

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引用次数: 0

Abstract

Background

Increasing childhood vaccination, family planning, healthcare access, and women's empowerment are targets of the Sustainable Development Goals (SDG). Barriers to healthcare access impede vaccination; tackling goals holistically could create larger gains than siloed efforts. We studied Nepal, Senegal, and Zambia to test the association between childhood vaccinations and other SDG indicators to identify clustered deprivations. We quantified how under-immunized children with few – or no – vaccines and their mothers were vulnerable in SDG areas.

Methods

We analyzed Demographic and Health Surveys from Nepal, Senegal, and Zambia. Through ordinal logistic regressions, controlling for household/mother's characteristics, we identified strong predictors of the number of vaccine doses one-year-old children received. Through bootstrapping and optimal propensity scores matching, we compared children with no or few vaccine doses (0–2 doses in early 2000s, or 0–4 in late 2010s) to children who received eight doses (DTP1–3, MVC1, Pol1–3, and BCG vaccines).

Findings

Mothers of children who received eight doses were 14–30 % more likely than mothers of children with few or no doses to have accessed a health facility in the last year (95 % CIs were 16–44 % in Nepal 2001, −5 % to 33 % Nepal 2016, 3–26 % Senegal 2005, 1–31 % Senegal 2019, 9–38 % Zambia 2001–02, 7–36 % Zambia 2018), knew on average 0.7–1.5 more contraceptive methods (0.9–2.0 Nepal 2005, 0.1–1.5 Nepal 2016, 0.6–1.7 Senegal 2005, 0.2–1.7 Senegal 2019, 0.1–1.4 Zambia 2001–02, 0.5–1.4 Zambia 2018), and had 10–22 % higher literacy rates (12–32 % Nepal 2001, −7 % to 36 % Nepal 2016, 10–26 % Senegal 2005, −3 to 22 % Senegal 2019, −4 % to 28 % Zambia 2001–02, 5–36 % Zambia 2018).

Interpretation

Children with few or no vaccine doses and their mothers were behind in access to family planning, healthcare, and education compared to fully vaccinated children and their mothers. Such differences can further impede immunizations; integrated education and health services are needed to improve vaccination outcomes.

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计划生育、医疗保健服务、女性教育与免疫接种不足儿童的疫苗接种之间的关系

背景提高儿童疫苗接种率、计划生育、医疗保健普及率和妇女赋权是可持续发展目标 (SDG) 的具体目标。获得医疗保健服务的障碍阻碍了疫苗接种；与各自为政的努力相比，从整体上实现目标可以取得更大的收益。我们对尼泊尔、塞内加尔和赞比亚进行了研究，以检验儿童疫苗接种与其他可持续发展目标指标之间的关联性，从而确定贫困集群。我们对尼泊尔、塞内加尔和赞比亚的人口与健康调查进行了分析。通过控制家庭/母亲特征的序数逻辑回归，我们确定了一岁儿童接种疫苗剂量的有力预测因素。通过引导和最优倾向得分匹配，我们将未接种疫苗或接种疫苗次数较少（2000 年代初为 0-2 次，2010 年代末为 0-4 次）的儿童与接种了 8 次疫苗（DTP1-3、MVC1、Pol1-3 和卡介苗）的儿童进行了比较。研究结果接种八剂疫苗的儿童的母亲在过去一年中到医疗机构就诊的可能性比接种少剂疫苗或未接种疫苗的儿童的母亲高出 14-30% （尼泊尔 2001 年的 95% CIs 为 16-44%，尼泊尔 2016 年为 -5% 至 33%，塞内加尔 2005 年为 3-26%，塞内加尔 2019 年为 1-31%，赞比亚 2001-02 年为 9-38%，赞比亚 2018 年为 7-36%），平均知道 0.多 0.7-1.5 种避孕方法（尼泊尔 2005 年 0.9-2.0，尼泊尔 2016 年 0.1-1.5，塞内加尔 2005 年 0.6-1.7，塞内加尔 2019 年 0.2-1.7，赞比亚 2001-02 年 0.1-1.4，赞比亚 2018 年 0.5-1.4）。4 赞比亚 2018），识字率高 10-22%（尼泊尔 2001 年 12-32%，尼泊尔 2016 年-7%-36%，塞内加尔 2005 年 10-26%，塞内加尔 2019 年-3-22%，赞比亚 2001-02 年-4%-28%，赞比亚 2018 年 5-36%）。解释接种疫苗剂量少或未接种疫苗的儿童及其母亲在获得计划生育、医疗保健和教育方面落后于完全接种疫苗的儿童及其母亲。这种差异会进一步阻碍免疫接种；需要综合的教育和医疗服务来改善疫苗接种结果。

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来源期刊

Vaccine 医学-免疫学

CiteScore

8.70

自引率

5.50%

发文量

992

审稿时长

131 days

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