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Childhood vaccines in Uganda and Zambia: Determinants and barriers to vaccine coverage

机译：乌干达和赞比亚的儿童疫苗：疫苗覆盖的决定因素和障碍

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BackgroundImproving childhood vaccine coverage is a priority for global health, but challenging in low and middle-income countries. Although previous research has sought to measure determinants of vaccination, most has limitations. We measure determinants using a clearly-defined hypothetical model, multi-faceted data, and modeling strategy that makes full use of the hypothesis and data.MethodsWe use linked, cross-sectional survey data from households, health facilities, patients and health offices in Uganda and Zambia, and Bayesian Structural Equation Modeling to quantify the proportion of variance in childhood vaccination that is explained by key determinants, controlling for known confounding.ResultsWe find evidence that the leading determinant of vaccination is different for different outcomes. For three doses of pentavalent vaccine, intent to vaccinate (on the part of the mother) is the leading driver, but for one dose of the vaccine, community access is a larger factor. For pneumococcal conjugate vaccine, health facility readiness is the leading driver. Considering specifically-modifiable determinants, improvements in cost, facility catchment populations and staffing would be expected to lead to the largest increase in coverage according to the model.ConclusionsThis analysis measures vaccination determinants using improved methods over most existing research. It provides evidence that determinants should be approached in the context of relevant outcomes, and evidence of specific determinants that could have the greatest impact in these two countries, if targeted. Future studies should seek to improve our analytic framework, apply it in different settings, and utilize stronger study designs. Programs that focus on a particular determinant should use these results to select an outcome that is appropriate to measure their effectiveness. Vaccination programs in these countries should use our findings to better target interventions and continue progress against vaccine preventable diseases.
机译：背景下，儿童疫苗覆盖率是全球健康的优先事项，但在低收入和中等收入国家挑战。虽然以前的研究试图测量疫苗接种的决定因素，但大多数都有局限性。我们测量使用明确定义的假设模型，多面数据和建模策略来衡量决定因素，这些策略充分利用了乌干达家庭，卫生设施，患者和乌干达患者和健康办公室的联系，横断面调查数据和赞比亚和贝叶斯结构方程建模量量化了受关键决定因素解释的儿童疫苗接种的差异比例，控制着众所周知的混淆。方法发现疫苗接种的主要决定因素对于不同的结果不同。对于三个剂量的五价疫苗，意图接种疫苗（在母亲的部分）是领先的驾驶员，但对于一剂疫苗，社区进入是一个更大的因素。对于肺炎球菌缀合物疫苗，卫生设施准备是领先的司机。考虑到明确可修改的决定因素，预计将导致根据模型的覆盖范围的最大增加的成本，设施集水集群和人员的改进.Conclusionsthis分析，使用改进方法在大多数现有研究中使用改进方法来测量疫苗接种决定簇。它提供了证据，即应在相关结果的背景下接近决定因素，如果有针对性，这两个国家的特定决定因素的证据都是最大的决定因素的证据。未来的研究应该寻求改善我们的分析框架，将其应用于不同的设置，并利用更强大的研究设计。关注特定决定因素的程序应使用这些结果选择适合衡量其有效性的结果。这些国家的疫苗接种计划应使用我们的研究结果来更好的目标干预措施，并继续对疫苗可预防疾病的进展。

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