Trends in vaccination coverage and equity in the Democratic Republic of the Congo from 2017 to 2023.

IF 3.5
Vaccine Pub Date : 2025-08-30 Epub Date: 2025-08-15 DOI:10.1016/j.vaccine.2025.127609
Elise Lankiewicz, Junias Kabele Ngoy Mpemba, Paul Samson Lusamba Dikassa, Viviane Mayala Masiala, Benito Kazenza Maykondo, Trad Hatton, Saira Nawaz, Wolfgang Munar, Catherine Arsenault
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引用次数: 0

Abstract

Introduction: Several routine immunization (RI) strengthening efforts have been implemented in the Democratic Republic of the Congo (DRC) in the last decade. However, there has been no assessment of national or provincial-level trends in inequalities in RI coverage since the implementation of these programs. In this analysis, we aimed to describe trends in childhood vaccination coverage and inequalities from 2017 to 2023 at the national and provincial levels and to compare these trends among groups of provinces where two initiatives have been in place: the Mashako plan and a provincial level public-private partnership using a memorandum of understanding (MOU) approach.

Materials and methods: We used population-based surveys including the Multiple Indicator Cluster Survey (MICS) - Palu 2017-2018 survey and four annual vaccination coverage surveys conducted from 2020 through 2023. We described vaccination coverage (three doses of pentavalent vaccine (Penta3) and at least one dose of a measles containing vaccine (MCV1)) and assessed relative and absolute inequalities in vaccination coverage by maternal education and household wealth at each time point. Analyses were conducted at the national level and within two groups of provinces: those initially included in the Mashako plan in 2018 and those initially included in the MOU approach. Inequality estimates were pooled across province groups using a random effects DerSimonian and Laird estimator for meta-analysis.

Results: From 2017 to 2023, national Penta3 coverage increased by 9.9 percentage points (47.7 % to 57.6 %) while MCV1 declined by 6.7 percentage points (58.9 % to 52.2 %). As of 2023, substantial wealth and education-related inequalities in childhood vaccination coverage remained: at the national level, children from wealthier households were 2.23 times more likely to receive Penta3 compared to children from poorest households (95 % Confidence Interval (CI) 2.16-2.31). Between 2017 and 2023, absolute and relative wealth-related inequalities appear to have declined, but differences were not statistically significant. Education-related inequalities have improved less than wealth-related inequalities. Though differences were often not statistically significant, reductions in inequalities were generally larger in provinces initially included in the Mashako plan and the MOU approach than in provinces not initially included in either initiative. Initial improvements in coverage and inequality between 2017 and 2020-2021 have largely stagnated at the national and sub-national levels in 2022 and 2023.

Discussion: Efforts remain needed to reach RI coverage and equity targets in the DRC. Routine monitoring of inequalities in RI coverage should be performed regularly to track progress. A more explicit equity focus in RI strengthening initiatives in the DRC may be necessary to accelerate progress in reducing existing inequalities.

2017年至2023年刚果民主共和国疫苗接种覆盖率和公平性趋势。
在过去十年中,刚果民主共和国(DRC)实施了几项常规免疫(RI)加强工作。然而,自实施这些计划以来,一直没有对国际扶轮覆盖不平等的国家或省级趋势进行评估。在本分析中,我们旨在描述2017年至2023年国家和省级儿童疫苗接种覆盖率和不平等的趋势,并在实施了两项举措的省份群体之间比较这些趋势:Mashako计划和使用谅解备忘录(MOU)方法的省级公私伙伴关系。材料和方法:我们采用基于人群的调查,包括多指标类集调查(MICS) - Palu 2017-2018调查和四次年度疫苗接种覆盖率调查,从2020年到2023年进行。我们描述了疫苗接种覆盖率(三剂五价疫苗(Penta3)和至少一剂含麻疹疫苗(MCV1)),并评估了在每个时间点,孕产妇教育和家庭财富在疫苗接种覆盖率方面的相对和绝对不平等。在国家层面和两组省份内进行了分析:2018年最初纳入Mashako计划的省份和最初纳入谅解备忘录方法的省份。使用随机效应DerSimonian和Laird估计器进行meta分析,汇总了各省组的不平等估计。结果:2017年至2023年,全国Penta3覆盖率上升9.9个百分点(47.7%至57.6%),而MCV1覆盖率下降6.7个百分点(58.9%至52.2%)。截至2023年,与财富和教育相关的儿童疫苗接种覆盖率不平等仍然存在:在国家一级,来自较富裕家庭的儿童获得Penta3的可能性是最贫困家庭儿童的2.23倍(95%置信区间(CI) 2.16-2.31)。从2017年到2023年,与财富相关的绝对和相对不平等似乎有所下降,但差异在统计上并不显著。与教育相关的不平等比与财富相关的不平等改善得更少。虽然差异通常在统计上并不显著,但最初纳入Mashako计划和谅解备忘录方法的省份,其不平等现象的减少幅度通常大于最初未纳入这两项倡议的省份。2017年至2020-2021年期间,覆盖率和不平等方面的初步改善在2022年和2023年基本停滞在国家和地方层面。讨论:仍需努力在刚果民主共和国实现国际扶轮覆盖率和公平目标。应定期对国际扶轮覆盖率的不平等情况进行例行监测,以跟踪进展情况。为了加快减少现有不平等的进展,可能有必要在加强刚果民主共和国国际合作倡议中更明确地注重公平。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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