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Ellis C, Perraillon M, Lindrooth R, Jacobs M, Hegland K, Grubaugh A, Adams-Mitchell C. Protocol for exploring pathways to equitable outcomes in post-stroke aphasia and dysphagia. PLoS One 2024; 19:e0308963. [PMID: 39331674 PMCID: PMC11433118 DOI: 10.1371/journal.pone.0308963] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2024] [Accepted: 08/04/2024] [Indexed: 09/29/2024] Open
Abstract
INTRODUCTION Longstanding racial disparities in stroke-related outcomes have been well documented. However, the underlying causes of observed disparities have neither been clearly determined nor have strategies to mitigate disparities been developed. Evidence suggests that racial disparities may be partially explained by structural barriers that can arise from implicit and explicit provider biases, institutional practices, public policies, or characteristics of the community where patients reside and recover from their conditions. The objective of this study is to move beyond traditional measures of disparities by identifying the mechanisms that drive these observed disparities in aphasia and dysphagia across the continuum of care. In this study we will follow stroke survivors for 12 months post-discharge, which will allow us to examine the patient, provider, health system, and administrative factors that impact their aphasia and dysphagia recovery. METHODS This study will utilize a 100% sample of Medicare fee-for-service claims data for persons hospitalized for stroke. Patients discharged from acute stroke care will be followed for at least 12 months to measure the timing of post-acute care transition(s) and post-acute care speech-language pathology (SLP) utilization. Functional communication and swallowing outcomes will be measured at initiation, conclusion of post-acute care treatment, and points in-between allowing us to link improvement of functional communication (i.e., aphasia) and swallowing ability (i.e., dysphagia) to aphasia/dysphagia treatments as patients transition through post-acute settings. Then, using regression decomposition methods, we will examine the relationships between race and: (a) where patients receive treatment, (b) the timing of transition between sites of care, and (c) the quality of care received. Decomposition methods will allow us to elucidate the multiple factors that contribute to underlying observed health disparities by quantifying the extent to which differences between the outcomes of two groups are explained by 1) differential endowments or characteristics, such as geographic access, education, risk factors, or insurance coverage; or 2) differences in decision-making, defined as between group differences in outcomes despite equal endowments or unmeasured differences. DISCUSSION We hypothesize that racial disparities in aphasia and dysphagia outcomes will not only result from differences in the quantity and timing of services provided in the post-acute and community settings, but also structural differences at the community level. These findings will provide a more comprehensive understanding of healthcare use and outcomes.
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Affiliation(s)
- Charles Ellis
- Department of Speech Language & Hearing Sciences, University of Florida, Gainesville, FL, United States of America
| | - Marcello Perraillon
- Department of Health Systems, Management & Policy, University of Colorado Anschutz Medical Campus, United States of America
| | - Richard Lindrooth
- Department of Health Systems, Management & Policy, University of Colorado Anschutz Medical Campus, United States of America
| | - Molly Jacobs
- Department of Health Services, Research, Management and Policy, University of Florida, Gainesville, FL, United States of America
| | - Karen Hegland
- Department of Speech Language & Hearing Sciences, University of Florida, Gainesville, FL, United States of America
| | - Anouk Grubaugh
- Department of Psychiatry & Behavioral Sciences, Medical University of South Carolina, United States of America
| | - Candice Adams-Mitchell
- Department of Speech Language & Hearing Sciences, University of Florida, Gainesville, FL, United States of America
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Tesfaye E, Debie A, Sisay F, Tafere TZ. Maternal satisfaction on quality of childhood vaccination services and its associated factors at public health centers in Addis Ababa, Ethiopia. BMC Health Serv Res 2023; 23:1315. [PMID: 38031017 PMCID: PMC10685558 DOI: 10.1186/s12913-023-10174-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Accepted: 10/18/2023] [Indexed: 12/01/2023] Open
Abstract
BACKGROUND Vaccination is one of the most important public health interventions to reduce child mortality and morbidity. In Ethiopia, about 472,000 children die each year by vaccine-preventable diseases. A satisfied mother is assumed to use the services and complies with the service provider for better health care outcomes. However, there was no adequate evidence regarding maternal satisfaction with quality of childhood vaccination services. This study aimed to assess maternal satisfaction on quality of childhood vaccination services and its associated factors at public health centers in Addis Ababa, Ethiopia. METHODS A facility-based cross-sectional study was conducted from 12 July to 12 August 2021 at public health centers in Addis Ababa, Ethiopia. A total of 366 mothers (caretakers) of under one-year-old children participated in the study. A systematic sampling technique with an interviewer-administered questionnaire and inventory checklist were used to collect the data. A binary logistic regression model was fitted. Adjusted Odds Ratio (AOR) with 95% confidence interval (CI) and p-value < 0.05 were used to identify the factors associated with the outcome. RESULTS Nearly two-thirds (61.2%) of mothers (caretakers) were satisfied with the quality of childhood vaccination services. Service providers' greeting [AOR = 1.60; 95%CI: 1.37-1.99] and information about the types of vaccines [AOR = 1.54; 95%CI: 1.32-1.89] were positively associated with maternal satisfaction. On the contrary, long waiting time of mothers (caretakers) to receive services [AOR = 0.29; 95%CI: 0.14-0.62] was negatively associated with services. CONCLUSION The overall maternal satisfaction towards the quality of childhood vaccination services in this study was found to be low. Minimizing waiting time at the health facility, enhancing greetings and providing adequate information regarding childhood vaccination for mothers (caretakers) improved their satisfaction with the services.
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Affiliation(s)
- Eyasu Tesfaye
- Department of Clinical Governance and Quality Management Office, Gandih Memorial Hospital, Addis Ababa, Ethiopia
| | - Ayal Debie
- Department of Health Systems and Policy, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, P.O. Box: 196, Gondar, Ethiopia
| | - Fasil Sisay
- Department of Nursing, Menelik II Medical and Health Science College, Kotebe University of Education, Addis Ababa, Ethiopia
| | - Tesfahun Zemene Tafere
- Department of Health Systems and Policy, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, P.O. Box: 196, Gondar, Ethiopia.
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Gebremedhin S, Shiferie F, Tsegaye DA, Alemayehu WA, Wondie T, Donofrio J, DelPizzo F, Belete K, Biks GA. Oral and Inactivated Polio Vaccine Coverage and Determinants of Coverage Inequality Among the Most At-Risk Populations in Ethiopia. Am J Trop Med Hyg 2023; 109:1148-1156. [PMID: 37748762 PMCID: PMC10622460 DOI: 10.4269/ajtmh.23-0319] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Accepted: 07/08/2023] [Indexed: 09/27/2023] Open
Abstract
Combining oral (OPV) and inactivated (IPV) poliovirus vaccines prevents importation of poliovirus and emergence of circulating vaccine-derived poliovirus. We measured the coverage with IPV and third dose of OPV (OPV-3) and identified determinants of coverage inequality in the most at-risk populations in Ethiopia. A national survey representing 10 partly overlapping underserved populations-pastoralists, conflict-affected areas, urban slums, hard-to-reach settings, developing regions, newly formed regions, internally displaced people (IDPs), refugees, and districts neighboring international and interregional boundaries-was conducted among children 12 to 35 months old (N = 3,646). Socioeconomic inequality was measured using the concentration index (CIX) and decomposed using a regression-based approach. One-third (95% CI: 31.5-34.0%) of the children received OPV-3 and IPV. The dual coverage was below 50% in developing regions (19.2%), pastoralists (22.0%), IDPs (22.3%), districts neighboring international (24.1%) and interregional (33.3%) boundaries, refugees (27.0%), conflict-affected areas (29.3%), newly formed regions (33.5%), and hard-to-reach areas (38.9%). Conversely, coverage was better in urban slums (78%). Children from poorest households, living in villages that do not have health posts, and having limited health facility access had increased odds of not receiving the vaccines. Low paternal education, dissatisfaction with vaccination service, fear of vaccine side effects, living in female-headed households, having employed and less empowered mothers were also risk factors. IPV-OPV3 coverage favored the rich (CIX = -0.161, P < 0.001), and causes of inequality were: inaccessibility of health facilities (13.3%), dissatisfaction with vaccination service (12.8%), and maternal (4.9%) and paternal (4.9%) illiteracy. Polio vaccination coverage in the most at-risk populations in Ethiopia is suboptimal, threatening the polio eradication initiative.
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Affiliation(s)
| | | | | | | | - Tamiru Wondie
- Project HOPE, Ethiopia Country Office, Addis Ababa, Ethiopia
| | - Jen Donofrio
- Bill & Melinda Gates Foundation, Seattle, Washington
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Asresie MB, Dagnew GW, Bekele YA. Changes in immunization coverage and contributing factors among children aged 12-23 months from 2000 to 2019, Ethiopia: Multivariate decomposition analysis. PLoS One 2023; 18:e0291499. [PMID: 37703252 PMCID: PMC10499235 DOI: 10.1371/journal.pone.0291499] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Accepted: 08/30/2023] [Indexed: 09/15/2023] Open
Abstract
BACKGROUND Immunization has been promoted as a global strategy aimed at improving child survival. The World Health Organization strives to make immunization services available to everyone, everywhere to save over 50 million lives by 2030. Monitoring the change and identifying the factors contributing to the change in immunization coverage over time and across the nations is imperative for continuing global success in increasing immunization coverage. In this study, we examined the changes and factors that contributed to the change in full immunization coverage over time in Ethiopia (2000 to 2019). METHODS We analyzed data on children aged 12-23 months, extracted from the 2000 and 2019 Ethiopian Demographic and Health Survey (EDHS) datasets. A total of 3,072 weighted samples (2,076 in 2000 and 966 in 2019) were included in the analysis. A multivariate decomposition analysis technique was used to determine change and identify factors that contributed to the change over time. Statistical significance was defined at a 95% confidence interval with a p-value of less than 0.05. RESULTS There was a 29.56% (95% CI: 24.84, 34.28) change in full immunization coverage between the two surveys. It increased from 14.62% (95% CI: 12.43, 17.11) in 2000 to 44.18% (95% CI: 37.19, 51.41) in 2019. The decomposition analysis showed that about 75% of explained change was attributed to the differences in the composition of explanatory variables (the endowment effect). Particularly, women aged 35-49 years (-2.11%), those who attended four or more antenatal care visits (17.06%), individual who had postnatal care visits (16.90%), households with two or more under-five children (2.50%), and those with a history of child mortality (17.80%) were significantly attributed to the change. The rest, 25% of the explained change was attributed to the difference in the effects of explanatory variables (coefficient). The change in the coefficient for women who had experienced child death (-20.40%) was statistically significant to the change in full immunization coverage over time. CONCLUSION The finding of this study revealed that there was a statistically significant change in full immunization coverage over time. The majority of the change was attributed to the differences in the composition of explanatory variables such as antenatal care and postnatal care visits, age of the mother, and number of living children in the household. Therefore, strengthening maternal health services utilization may enhance immunization coverage in Ethiopia. Furthermore, the difference in coefficient of mothers with a history of child death had a substantial counteracting effect on the change, emphasizing the importance of raising awareness and delivering vaccine education to them and the larger community.
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Affiliation(s)
- Melash Belachew Asresie
- Department of Reproductive Health and Population Studies, School of Public Health, College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia
| | - Gizachew Worku Dagnew
- Department of Reproductive Health and Population Studies, School of Public Health, College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia
| | - Yibeltal Alemu Bekele
- Department of Reproductive Health and Population Studies, School of Public Health, College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia
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Asresie MB, Fekadu GA, Dagnew GW. Urban-rural disparities in immunization coverage among children aged 12-23 months in Ethiopia: multivariate decomposition analysis. BMC Health Serv Res 2023; 23:969. [PMID: 37679707 PMCID: PMC10485935 DOI: 10.1186/s12913-023-09940-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2022] [Accepted: 08/20/2023] [Indexed: 09/09/2023] Open
Abstract
BACKGROUND Immunization is one of the most cost-effective public health interventions for improving children's health and survival. In Ethiopia, low immunization coverage and disparity across residences are major public health problems. However, the factors that contributed to the urban-rural disparity have not been thoroughly investigated. Therefore, the objective of this study was to examine the change and contributing factors in full immunization coverage across geographic locations (urban-rural) in Ethiopia. METHODS We analyzed data on children aged 12 to 23 months obtained from the 2019 mini-Ethiopian demographic and health survey. A total of 996 weighted samples (299 in urban and 697 in rural areas) were included in the analysis. A multivariate decomposition analysis technique was used to determine the disparity and identify factors that contribute to the disparity across geographical locations. Statistical significance was defined at a 95% confidence interval with a p-value of less than 0.05. RESULTS The percentage of children aged 12-23 months who received full immunization increased from 36.84% (95% CI:31.59, 42.41) in rural areas to 64.59% (95% CI:47.10, 78.89) in urban areas. The decomposition analysis showed that the observed urban-rural disparity was attributed to a change in the effect of population characteristics (coefficient) across residences. Specifically, receiving 1-3 (β = 0.0895, 95% CI: 0.0241, 0.1550) and 4 or more (β = 0.1212, 95% CI: 0.0224, 0.2199) antenatal care visits, delivering at a health facility (β = 0.1350, 95% CI: 0.0227, 0.2472), and the source of information about immunization status from vaccination cards (β = 0.2666, 95% CI:0.1763, 0.3569) significantly contributed to the widening urban-rural disparity. On the other hand, being of high wealth status (β=-0.141, 95% CI: -0.1945, -0.0876), receiving postnatal care (β=-0.0697, 95% CI: -0.1344, -0.0051), and having four or more living children (β=-0.1774, 95% CI: -0.2971, -0.0577) significantly contributed to narrowing the urban-rural disparity. CONCLUSIONS There was a significant urban-rural disparity in immunization coverage in Ethiopia, with urban children more likely to complete immunization. The change in the composition of population characteristics was not significant for the observed disparity. The observed disparity in full immunization coverage was mainly driven by the coefficients related to maternal healthcare utilization, household wealth status, the number of living children, and the source of immunization information. Therefore, strengthening maternal health services utilization, encouraging mothers to maintain their children's immunization records, and addressing economic inequality, particularly in rural areas, may narrow the urban-rural disparity and enhance immunization coverage nationwide.
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Affiliation(s)
- Melash Belachew Asresie
- Department of Reproductive Health and Population Studies, School of Public Health, College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia.
| | - Gedefaw Abeje Fekadu
- Department of Reproductive Health and Population Studies, School of Public Health, College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia
| | - Gizachew Worku Dagnew
- Department of Reproductive Health and Population Studies, School of Public Health, College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia
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Dhalaria P, Kapur S, Singh AK, Priyadarshini P, Dutta M, Arora H, Taneja G. Exploring the Pattern of Immunization Dropout among Children in India: A District-Level Comparative Analysis. Vaccines (Basel) 2023; 11:vaccines11040836. [PMID: 37112748 PMCID: PMC10143302 DOI: 10.3390/vaccines11040836] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Revised: 03/27/2023] [Accepted: 04/03/2023] [Indexed: 04/29/2023] Open
Abstract
The dropout rate is one of the determinants of immunization coverage and program performance, program continuity, and follow-up. The dropout rate refers to the proportion of vaccine recipients who did not finish their vaccination schedules, and it is determined by comparing the number of infants who started the schedule to the number who completed it. It is the rate difference between the first and final dosage or the rate difference between the first vaccination and the last vaccine dropout; thus, it denotes that the first recommended dose of vaccine was received, but that the subsequently recommended dose was missed. In India, immunization coverage has shown significant improvements over the last two decades, but full immunization coverage has remained stagnant at 76.5%, of which 19.9% are partially immunized, and 3.6% are children who have been left out. In India, the Universal Immunization Programme (UIP) is challenged with cases related to dropout in immunization. Although immunization coverage in India is improving, the program is challenged by vaccination dropouts. This study provides an analysis of the determinants of vaccination dropout in India using data from two rounds of the National Family Health Survey. The finding shows that the mother's age, education, family wealth, antenatal care visit, and place of delivery were some of the variables that significantly contributed to reducing the dropout rate of immunization among children. The findings of this paper show that the dropout rate has reduced over a certain period of time. The overall improvement in the rates of dropout and increase in full immunization coverage could be attributed to various policy measures taken in the last decade in India, which brought structural changes with a positive impact on full immunization coverage and its components.
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Affiliation(s)
- Pritu Dhalaria
- Immunization Technical Support Unit, Ministry of Health & Family Welfare, New Delhi 110070, India
| | | | - Ajeet Kumar Singh
- Immunization Technical Support Unit, Ministry of Health & Family Welfare, New Delhi 110070, India
| | - Pretty Priyadarshini
- Immunization Technical Support Unit, Ministry of Health & Family Welfare, New Delhi 110070, India
| | - Mili Dutta
- Immunization Technical Support Unit, Ministry of Health & Family Welfare, New Delhi 110070, India
| | | | - Gunjan Taneja
- Bill & Melinda Gates Foundation, New Delhi 110067, India
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Simegn W, Diress M, Gela YY, Belay DG, Ayelign Kibret A, Chilot D, Sinamaw D, Abdu Seid M, Andualem AA, Anmut Bitew D, Eshetu HB, Mohammed Seid A. Childhood vaccination practices and associated factors among mothers/caregivers in Debre Tabor town, Northwest Ethiopia: A cross-sectional study. Front Pediatr 2023; 11:1070722. [PMID: 36793335 PMCID: PMC9922988 DOI: 10.3389/fped.2023.1070722] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2022] [Accepted: 01/02/2023] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND Incomplete immunization and non-immunization increase the risk of disease and death among children. This study aims to assess childhood vaccination practices and associated factors among mothers and caregivers in Debre Tabor town, Amhara region, Ethiopia. METHODS A community-based cross-sectional study design was conducted between February 30 and April 30, 2022. The study participants were proportionally allocated to all six kebeles found in the town. A systematic random sampling technique was used to select the study participants. The collected data were checked and coded and then entered into EpiData Version 3.1 and exported into SPSS Version 26. The results were organized using frequency tables, graphs, and charts, and bivariate and multivariable logistic regression were used to test the association of covariates with childhood vaccination practices. RESULT Approximately 422 study mothers and caregivers participated in the study, with a response rate of 100%. The mean age was 30.63 years (11.74), which ranged from 18 to 58 years. More than half of the study participants (56.4%) expressed fears about the side effects of vaccination. A majority (78.4%) of the study participants availed of counseling services about vaccination, and 71.1% of them received regular antenatal care. This study found that approximately 280 [66.4%, 95% confidence interval (CI): 61.8-70.6] mothers/caregivers had a history of good childhood vaccination practices. The factors of the fear of side effects [adjusted odds ratio (AOR) = 3.34; 95% CI: 1.72-6.49], no workload (AOR = 6.08; 95% CI: 1.74-21.22), medium workload (AOR = 4.80; 95% CI: 1.57-14.71), being a mother of child/children (AOR = 2.55; 95% CI: 1.27-5.13), positive attitude (AOR = 2.25; 95% CI: 1.32-3.82), and sound knowledge (AOR = 3.88; 95% CI: 2.26-6.68) were significantly associated with childhood vaccination practices. CONCLUSION More than half of the study participants had a history of good childhood vaccination practices. However, the rate of such practices was low among mothers and caregivers. The fear of side effects, workload, motherhood, attitude, and knowledge were all factors associated with childhood vaccination practices. Awareness creation and a consideration of the workload of mothers would be helpful in dispelling fears and increasing the rate of good practices among mothers and caregivers.
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Affiliation(s)
- Wudneh Simegn
- Department of Social and Administrative Pharmacy, School of Pharmacy, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Mengistie Diress
- Department of Human Physiology, School of Medicine, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Yibeltal Yismaw Gela
- Department of Human Physiology, School of Medicine, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Daniel Gashaneh Belay
- Department of Human Anatomy, School of Medicine, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia.,Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Anteneh Ayelign Kibret
- Department of Human Anatomy, School of Medicine, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Dagmawi Chilot
- Department of Human Physiology, School of Medicine, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia.,Center for Innovative Drug Development and Therapeutic Trials for Africa (CDT-Africa), Addis Ababa University, College of Health Sciences, Addis Ababa, Ethiopia
| | - Deresse Sinamaw
- Department of Biomedical Science, Debre Markos University, Debre Markos, Ethiopia
| | - Mohammed Abdu Seid
- Unit of Human Physiology, Department of Biomedical Science, College of Health Sciences, Debre Tabor University, Debre tabor, Ethiopia
| | | | - Desalegn Anmut Bitew
- Department of Reproductive Health, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Habitu Birhan Eshetu
- Department of Health Promotion and Health Behavior, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Abdulwase Mohammed Seid
- Department of Clinical Pharmacy, School of Pharmacy, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
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Al-Kassab-Córdova A, Silva-Perez C, Maguiña JL. Spatial distribution, determinants and trends of full vaccination coverage in children aged 12-59 months in Peru: A subanalysis of the Peruvian Demographic and Health Survey. BMJ Open 2022; 12:e050211. [PMID: 36368757 PMCID: PMC9660560 DOI: 10.1136/bmjopen-2021-050211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE To assess the spatial distribution, trends and determinants of crude full vaccination coverage (FVC) in children aged 12-59 months between 2010 and 2019 in Peru. DESIGN, SETTING AND ANALYSIS A cross-sectional study based on the secondary data analysis of the 2010 and 2019 Peruvian Demographic and Health Surveys (DHSs) was conducted. Logit based multivariate decomposition analysis was employed to identify factors contributing to differences in FVC between 2010 and 2019. The spatial distribution of FVC in 2019 was evaluated through spatial autocorrelation (Global Moran's I), ordinary kriging interpolation (Gaussian process regression) and Bernoulli-based purely spatial scan statistic. OUTCOME MEASURE FVC, as crude coverage, was defined as having completely received BCG; three doses of diphtheria, pertussis, and tetanus, and polio vaccines; and measles vaccine by 12 months of age. PARTICIPANTS A total of 5 751 and 14 144 children aged 12-59 months from 2010 and 2019 DHSs, respectively, were included. RESULTS FVC increased from 53.62% (95% CI 51.75% to 55.49%) in 2010 to 75.86% (95% CI 74.84% to 76.85%) in 2019. Most of the increase (70.39%) was attributable to differences in coefficients effects. Family size, visit of health workers in the last 12 months, age of the mother at first delivery, place of delivery and antenatal care follow-up were all significantly associated with the increase. The trend of FVC was non-linear and increased by 2.22% annually between 2010 and 2019. FVC distribution was heterogeneous at intradepartmental and interdepartmental level. Seven high-risk clusters of incomplete coverage were identified. CONCLUSIONS Although FVC has increased in Peru, it still remains below the recommended threshold. The increase of FVC was mainly attributed to the change in the effects of the characteristics of the population. There was high heterogeneity across Peruvian regions with the presence of high-risk clusters. Interventions must be redirected to reduce these geographical disparities.
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Affiliation(s)
- Ali Al-Kassab-Córdova
- Facultad de Ciencias de la Salud, Universidad Peruana de Ciencias Aplicadas, Lima, Peru
| | - Claudia Silva-Perez
- Facultad de Ciencias de la Salud, Universidad Peruana de Ciencias Aplicadas, Lima, Peru
| | - Jorge L Maguiña
- Facultad de Ciencias de la Salud, Universidad Peruana de Ciencias Aplicadas, Lima, Peru
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陈 廷, 李 剑, 杨 洋. [Social Determinants Affecting Changes in Mental Health of Rural-Urban Migrant Population in Chengdu: An Oaxaca-Blinder Decomposition Analysis]. SICHUAN DA XUE XUE BAO. YI XUE BAN = JOURNAL OF SICHUAN UNIVERSITY. MEDICAL SCIENCE EDITION 2022; 53:656-662. [PMID: 35871737 PMCID: PMC10409457 DOI: 10.12182/20220760303] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 10/09/2021] [Accepted: 06/16/2022] [Indexed: 06/15/2023]
Abstract
Objective To investigate the social determinants that influenced the changes in the mental health of the rural-urban migrant population in Chengdu. Methods Using data from two cross-sectional surveys, one conducted in 2009 and another, in 2018, of the rural-urban migrant population in Chengdu, we analyzed the social determinants of mental health affecting the rural-urban migrant population in Chengdu by multiple linear regression, and analyzed the contribution of changes in social determinants to the disparity in mental health over a decade using the Oaxaca-Blinder decomposition analysis. Results This study included 3091 cases of rural-urban migrants in Chengdu, with 965 (31.22%) covered in the survey year of 2009 and 2126 (68.78%) covered in 2018. Multiple linear regression models were established with mental component summary (MCS) as the dependent variable, the social determinants of health as the independent variables, and gender, age, and survey year as covariates. The findings showed that being married ( β=2.33, P<0.001), drinking 1-2 times per week ( β=-1.42, P<0.05), illness within four weeks ( β=-2.57, P<0.001), and hospitalization in the past year ( β=-1.82, P<0.05), wage arrears ( β=-1.67, P<0.05), job satisfaction ( β=1.25, P<0.001), monthly housing costs (housing costs below monthly income: β=-1.55, P=0.001; housing costs above monthly income: β=-4.59, P=0.001) and housing condition ( β=0.23, P<0.05) had significant impact on the MCS of the rural-urban migrant population. The results of the Oaxaca-Blinder decomposition method showed that the MCS disparity between the two surveys was -4.7660 points. With 2018 as the base year, the explainable parts accounted for 15.80%. Being married, decrease in the prevalence of illnesses within four weeks, and increased job satisfaction formed positive contribution to the improvement of the mental health, and increase in the proportion of monthly housing expenses formed negative contribution. Conclusion Between 2009 and 2018, the mental health of the rural-urban migrant population in Chengdu showed improvement, and changes in marital status, illness within four weeks, job satisfaction, and monthly housing costs contributed to improvements in mental health during the period. Future intervention measures to promote the mental health of the floating population can be developed with the perspective of improving the social determinants of health in mind.
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Affiliation(s)
- 廷婷 陈
- 四川大学华西公共卫生学院/四川大学华西第四医院 健康行为与社会医学系 (成都 610041)Department of Health Behavior and Social Medicine, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu 610041, China
| | - 剑波 李
- 四川大学华西公共卫生学院/四川大学华西第四医院 健康行为与社会医学系 (成都 610041)Department of Health Behavior and Social Medicine, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu 610041, China
- 江苏省苏州市吴中区卫生健康委员会 医政管理与基层卫生科 (苏州 215104)Department of Medical Administration and Primary Health Care, Wuzhong District Health Commission, Suzhou, Jiangsu Province, Suzhou 215104, China
| | - 洋 杨
- 四川大学华西公共卫生学院/四川大学华西第四医院 健康行为与社会医学系 (成都 610041)Department of Health Behavior and Social Medicine, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu 610041, China
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Fenta SM, Fenta HM. Individual and community-level determinants of childhood vaccination in Ethiopia. Arch Public Health 2021; 79:53. [PMID: 33879269 PMCID: PMC8059167 DOI: 10.1186/s13690-021-00581-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Accepted: 04/13/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Vaccines are one of our most important tools for preventing outbreaks and keeping the world safe. Most unvaccinated children live in the poorest countries including Ethiopia. Therefore, this study aimed to identify the determinants of vaccination coverage among children aged12-23 months in Ethiopia. METHODS A cross-sectional secondary data were obtained from the 2016 Ethiopian Demographic and Health Survey data (EDHS). A total of 1929 children were included. A Multilevel Proportional Odds Model was used to identify the individual and community-level factors associated with child vaccination. RESULT Among 1, 929 children, only 48.6% (95% CI: 46.3 to 50.8%) were fully vaccinated while 37.8% (95% CI: 35.7 to 40.1%) were partially vaccinated.. The multilevel ordinal logistic regression model reveled that housewife mother (AOR =1.522, 95%CI: 1.139, 2.034), institutional delivery (AOR =2.345, 95%CI: 1.766, 3.114),four or above antenatal care visits (AOR = 2.657; 95% CI: 1.906, 3.704), children of mothers with secondary or higher education (AOR = 2.008; 95% CI: 1.209, 3.334),Children whose fathers primary education (AOR = 1.596; 95% CI: 1.215, 2.096), from the rich households (AOR = 1.679; 95% CI: 1.233, 2.287) were significantly associated with childhood vaccination. CONCLUSION Child vaccination coverage in Ethiopia remains low. Therefore, there is a need to increase child vaccination coverage by promoting institutional delivery and prenatal care visits, as well as maternal tetanus immunization. Besides, public initiatives needed to improve child vaccination coverage, women's and husband's education, poor women, and further advancement of health care services for poor women, housewife women, women living in remote areas should be made to maintain further improvements in child vaccination. Furthermore, policies and programs aimed at addressing cluster variations in child vaccination need to be formulated and their implementation must be strongly pursued.
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Affiliation(s)
- Setegn Muche Fenta
- Department of Statistics, Faculty of Natural and Computational Sciences, Debre Tabor University, Debre Tabor, Ethiopia.
| | - Haile Mekonnen Fenta
- Department of Statistics, College of Science, Bahir Dar University, Bahir Dar, Ethiopia
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