Determinants of vaccination after the Colombian health system reform

Abstract

Descritores Vacinação. Programas de imunização. Acesso aos serviços de saúde.Reforma do setor saúde. Colômbia. Abstract ObjectiveTo assess the effects of individual, household and healthcare system factors on poor children's use of vaccination after the reform of the Colombian health system. Methods A household survey was carried out in a random sample of insured poor population in Bogota, in 1999. The conceptual and analytical framework was based on the Andersen's Behavioral Model of Health Services Utilization. It considers two units of analysis for studying vaccination use and its determinants: the insured poor population, including the children and their families characteristics; and the health care system. Statistical analysis were carried out by chi-square test with 95% confidence intervals, multivariate regression models and Cronbach's alpha coefficient. ResultsThe logistic regression analysis showed that vaccination use was related not only to population characteristics such as family size (OR=4.3), living area (OR=1.7), child's age (OR=0.7) and head-of-household's years of schooling (OR=0.5), but also strongly related to health care system features, such as having a regular health provider (OR=6.0) and information on providers' schedules and requirements for obtaining care services (OR=2.1). ConclusionsThe low vaccination use and the relevant relationships to health care delivery systems characteristics show that there are barriers in the healthcare system, which should be assessed and eliminated. Non-availability of regular healthcare and deficient information to the population are factors that can limit service utilization.

Prevalence and predictors of immunization in a health insurance plan in a developing country

“…In the present study this was examined along with seeking of other health‐care facilities to assess the effect on immunization delay. The present findings support earlier studies whereby the absence of a regular provider was found to be a significant factor associated with vaccination delay 9–11,18 . Furthermore, absence of a regular provider may lead to seeking of other facilities and hence result in underestimation of vaccination rates.…”

“…have stated that ‘children with a regular health‐care provider had greater odds of vaccination use than for those who did not have one’. It was evident in their study as well as the present one that having a regular primary care provider is an important factor predicting compliance; 18 60.8% of children compliant with the vaccination schedule have a primary care provider at UHS ( P = 0.015) and present regularly for health maintenance visits during which vaccination records are reviewed. In the present study this was examined along with seeking of other health‐care facilities to assess the effect on immunization delay.…”

Immunisation-related knowledge, attitudes and practices of mothers in Kinshasa, Democratic Republic of the Congo

“…In Colombia, years of schooling were reported to have a positive effect on the use of vaccination services. 24 Luzolela and Herdt, however, have described the rather positive deviant behaviour of less educated people resembling that of more educated ones in accessing welfare services. 25 Mothers with a family member who had suffered from any EPIpreventable disease were likely to have their children completely immunised.…”

Barreras de acceso a los servicios de salud para mujeres, niños y niñas en América Latina

“…Al respecto, la literatura internacional refuerza la importancia de conocer la relación de la población con los servicios de salud. Por ejemplo, la falta de información de la población (24), la inexperiencia de los padres, la falta de diálogo con los proveedores de salud y la discriminación (25) son factores importantes que afectan la vacunación en América Latina. La literatura internacional también sugiere que la religión (26), las preferencias de los esposos (27) y el temor a efectos secundarios (28) son factores que pueden reducir el uso de los métodos anticonceptivos modernos y uso de la prueba de Papanicolaou (29).…”