Childhood Immunization and Access to Health Care

Devkota, Satis; Panda, Bibhudutta

doi:10.1177/1010539515626268

Cited by 21 publications

(26 citation statements)

References 24 publications

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“…Univariate analysis indicated a pronounced decline in coverage of immunisation with increased travel time to health facilities for travel times of greater than an hour. Longer travel time also correlate with other factors such as increased transport costs which may also play a major role in decreased service utilization [ 15 , 19 ]. There was a significant effect on both fully immunised status and DPT3 coverage up to more than two-hours.…”

Section: Discussionmentioning

confidence: 99%

“…Multiple contacts with health facilities are required to achieve full immunisation status [ 17 ]. However, long distances and increased travel times (spatial accessibility) remains a major barrier to expanding immunisation coverage in many SSA countries [ 15 , 18 , 19 ]. This is more pronounced in the rural areas, where most of the unvaccinated children live and where services are limited [ 20 , 21 ] and in informal settlement that are densely populated and often affected by significant traffic delays [ 22 , 23 ].…”

Section: Introductionmentioning

confidence: 99%

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Spatial access inequities and childhood immunisation uptake in Kenya

et al. 2020

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Background Poor access to immunisation services remains a major barrier to achieving equity and expanding vaccination coverage in many sub-Saharan African countries. In Kenya, the extent to which spatial access affects immunisation coverage is not well understood. The aim of this study was to quantify spatial accessibility to immunising health facilities and determine its influence on immunisation uptake in Kenya while controlling for potential confounders. Methods Spatial databases of immunising facilities, road network, land use and elevation were used within a cost friction algorithim to estimate the travel time to immunising health facilities. Two travel scenarios were evaluated; (1) Walking only and (2) Optimistic scenario combining walking and motorized transport. Mean travel time to health facilities and proportions of the total population living within 1-h to the nearest immunising health facility were computed. Data from a nationally representative cross-sectional survey (KDHS 2014), was used to estimate the effect of mean travel time at survey cluster units for both fully immunised status and third dose of diphtheria-tetanus-pertussis (DPT3) vaccine using multi-level logistic regression models. Results Nationally, the mean travel time to immunising health facilities was 63 and 40 min using the walking and the optimistic travel scenarios respectively. Seventy five percent of the total population were within one-hour of walking to an immunising health facility while 93% were within one-hour considering the optimistic scenario. There were substantial variations across the country with 62%(29/47) and 34%(16/47) of the counties with < 90% of the population within one-hour from an immunising health facility using scenarios 1 and 2 respectively. Travel times > 1-h were significantly associated with low immunisation coverage in the univariate analysis for both fully immunised status and DPT3 vaccine. Children living more than 2-h were significantly less likely to be fully immunised [AOR:0.56(0.33–0.94) and receive DPT3 [AOR:0.51(0.21–0.92) after controlling for household wealth, mother’s highest education level, parity and urban/rural residence. Conclusion Travel time to immunising health facilities is a barrier to uptake of childhood vaccines in regions with suboptimal accessibility (> 2-h). Strategies that address access barriers in the hardest to reach communities are needed to enhance equitable access to immunisation services in Kenya.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Spatial access inequities and childhood immunisation uptake in Kenya

et al. 2020

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“…This is because the geographical area that mainly composes of the mountains and hills which require considerable travel time and travel costs. This condition where the increase in costs of travel may significantly reduce the immunization success rate (Devkota & Panda, 2016).…”

Section: The Relationship Between Access Variable and The Advanced Pementioning

confidence: 99%

The Analysis of Factors that Related to Advanced Pentavalent Immunization Status in Sinjai Regency

Dwinata

Ahmad

Arsyad

2019

JBE

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Background: Basic pentavalent immunization coverage in Sinjai Regency in 2017 has reached the target, but the advanced pentavalent immunization rate is still low (52.90%). This condition leads to make a huge gap in toddlers’ immunization status. Purpose: This study aims to determine the factors associated with advanced pentavalent immunization status in the work area of Kampala Health Service Center (PUSKESMAS), Sinjai Regency. Methods: The cross-sectional study was used in this study. The mothers who have the children aged 18-36 months were used as population. About 145 samples were obtained by using simple random sampling technique. The two-way data collection technique, namely primary data obtained through questionnaires and secondary data obtained from the evaluation data of pentavalent immunization at Kampala Health Service Center, Sinjai Regency. Furthermore, chi-square was used for data analysis. Results: Generally, the respondents were 25-29 years old in average (26.90%) and had a high school/ equivalent education degree (53.80%). The respondents’ occupation are mostly housewives (83, 40%). Moreover, the toddlers were 24-29 months-old (46.90%) in average. This study showed that the majority of respondents did not take advanced pentavalent immunization (61.38%). Factors affecting the immunization status of the pentavalent were maternal knowledge (p = 0.03), family support (p= <0.01), and the role of health workers (p= <0.01). Surprisingly, the maternal attitude (p=0.57) and access to immunization services (p=0.17) were not related to advanced pentavalent immunization status. Conclusion: There was a relationship between maternal knowledge, family support, and the role of health workers with advanced pentavalent immunization status

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“…Spatial access to a health facility, especially in sub-Saharan Africa (SSA) countries, is a signi cant determinant of DTP3 vaccination coverage as the vaccine is mainly administered during routine immunisation schedules at health facilities [11][12][13]. Studies have shown that rural areas [14,15] and densely populated informal settlements [16,17] are most affected by poor access to healthcare services.…”

Section: Introductionmentioning

confidence: 99%

Pentavalent vaccination in rural Kenya: coverage and geographical accessibility to health facilities using data from a community demographic and health surveillance system in Kilifi County.

Ogero

Orwa²,

Agoi³

et al. 2020

Preprint

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Background There is substantial evidence that immunization is one of the most significant and cost-effective pillars of preventive and promotive health interventions. Effective childhood immunization coverage is thus essential in stemming persistent childhood illnesses. The main indicator of performance of the immunisation programme is the third dose of diphtheria-tetanus-pertussis (DTP3) vaccine for children, because it mirrors the completeness of a child’s immunisation schedule. Spatial access to a health facility, especially in SSA countries, is a significant determinant of DTP3 vaccination coverage as the vaccine is mainly administered during routine immunisation schedules at health facilities. Rural areas and densely populated informal settlements are most affected by poor access to healthcare services. We therefore sought to determine vaccination coverage of DTP3, estimate the travel time to health facilities offering immunisation services, and explore of its effect on immunisation coverage in one of the predominantly rural counties in the coast of Kenya.Methods Coordinates of health facilities, information on land cover, digital elevation model, and road network were used to compute spatial accessibility to immunising health facilities for eligible children within Kaloleni-Rabai Community Health Demographic Surveillance System (HDSS). To explore the effect of the travel-time on DTP3 coverage, we fitted a hierarchical multivariable model adjusting for other apriori identified confounding factors. Results Spatial access to health facilities that offer immunization services significantly affected DTP3 coverage with travel times of more than one hour to a health facility significantly associated with reduced odds of receiving DTP3 vaccine (AOR= 0.84 (95% CI 0.74 – 0.94).Conclusion Increased travel time is a significant barrier to the uptake of facility-delivered immunizations in this rural community. To improve immunisation coverage, local health authorities and policy makers in remote settings can use high resolution maps to identify areas where distance and travel time may impede achievement of high immunizations coverage and identify appropriate interventions. These could include improving the road network, establishing new health centres and/or stepping up health outreach activities that include vaccinations in hard to reach areas within the county.

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Childhood Immunization and Access to Health Care

Cited by 21 publications

References 24 publications

Spatial access inequities and childhood immunisation uptake in Kenya

Spatial access inequities and childhood immunisation uptake in Kenya

The Analysis of Factors that Related to Advanced Pentavalent Immunization Status in Sinjai Regency

Pentavalent vaccination in rural Kenya: coverage and geographical accessibility to health facilities using data from a community demographic and health surveillance system in Kilifi County.

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