加纳 1993-2014 年一岁儿童完全免疫覆盖率的不平等现象。
Inequalities in the prevalence of full immunization coverage among one-year-olds in Ghana, 1993-2014.
机构信息
Department of Population and Health, University of Cape Coast, Cape Coast, Ghana.
School of Public Health, Faculty of Health, University of Technology Sydney, Australia.
出版信息
Vaccine. 2022 Jun 9;40(26):3614-3620. doi: 10.1016/j.vaccine.2022.04.081. Epub 2022 May 14.
BACKGROUND
We examined the inequalities in the prevalence of full immunization coverage among one-year-olds in Ghana using nationally representative data from the 1993-2014 Ghana Demographic and Health Surveys (GDHSs).
METHODS
Using the World Health Organization's (WHO) Health Equity Assessment Toolkit (HEAT) software, data from the 1993-2014 GDHSs were analyzed. We disaggregated full immunization by five equity stratifiers: wealth quintile, education, sex, residence, and region. Second, we measured the inequality through summary measures, namely Difference, Population Attributable Risk, Ratio, and Population Attributable Fraction. Statistical significance was pegged at 95% Uncertainty Interval.
RESULTS
From 1993 to 2014, full immunization was higher among children born to mothers of the richest wealth index compared with those born to mothers of the poorest wealth index. Children with highly educated mothers dominated in full immunization coverage from 1993 (86.67%; UI = 70.38, 94.68] to 2014 (79.90%; UI = 73.94, 84.78). Within the same period, children of women without education recorded the least prevalence. Full immunization coverage was high among urban children in 1993 (71.07%; UI = 63.20, 77.84) but favoured rural children in 2008 (80.09%; UI = 74.30, 84.84) and 2014 (79.50%; UI = 74.00, 84.09) compared to urban children. More females were fully immunized in 1993 (56.68%; UI = 50.32, 62.82). In 2003, 2008 and 2014, Volta region (82.29%; UI = 70.32, 90.11), Brong Ahafo (93.94%; UI = 82.00, 98.14) and Upper East (95.27%; UI = 87.35, 98.32) regions dominated in full immunization coverage respectively.
CONCLUSION
The inequality estimates revealed significant socio-economic inequality in full immunization coverage between 1993 and 2014 in Ghana. Similarly, urban children and children of women with secondary or higher education were predominantly fully immunized. To accelerate full immunization, policy makers should consider these disparities in the implementation of policies on childhood immunization in Ghana.
背景
本研究使用来自 1993-2014 年加纳人口与健康调查（GDHS）的全国代表性数据，考察了加纳一岁儿童完全免疫覆盖率方面的不平等现象。
方法
利用世界卫生组织（WHO）的卫生公平评估工具包（HEAT）软件，对 1993-2014 年 GDHS 数据进行了分析。我们通过五个公平分层变量（财富五分位数、教育、性别、居住地和地区）对完全免疫进行了细分。其次，我们使用了综合指标来衡量不平等程度，包括差异、人群归因风险、比值和人群归因分数。统计显著性以 95%不确定区间（UI）表示。
结果
1993 年至 2014 年期间，出生于最富有财富指数母亲的儿童与出生于最贫穷财富指数母亲的儿童相比，完全免疫接种率更高。1993 年（86.67%；UI=70.38，94.68]）至 2014 年（79.90%；UI=73.94，84.78]），受教育程度较高的母亲的子女在完全免疫接种方面占主导地位。在此期间，未受过教育的母亲所生子女的完全免疫接种率最低。1993 年，城市儿童的完全免疫接种率较高（71.07%；UI=63.20，77.84），但 2008 年（80.09%；UI=74.30，84.84）和 2014 年（79.50%；UI=74.00，84.09）农村儿童的完全免疫接种率更高。1993 年，更多女性得到完全免疫接种（56.68%；UI=50.32，62.82）。2003 年、2008 年和 2014 年，沃尔特地区（82.29%；UI=70.32，90.11）、布隆阿哈福地区（93.94%；UI=82.00，98.14）和上东部地区（95.27%；UI=87.35，98.32）在完全免疫接种覆盖率方面分别占据主导地位。
结论
1993 年至 2014 年期间，加纳的完全免疫覆盖率存在显著的社会经济不平等现象。同样，城市儿童和受过中等或高等教育的母亲的子女主要得到了完全免疫接种。为了加速完全免疫接种，决策者在实施加纳儿童免疫政策时应考虑到这些差异。
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