Effect of the conditional cash transfer program Oportunidades on vaccination coverage in older Mexican people

BMC International Health and Human Rights

Betty Soledad Manrique-Espinoza¹  Aarón Salinas-Rodríguez¹ 

[1]Center for Evaluation Research and Surveys, National Institute of Public Health, Cuernavaca, Morelos, Mexico

关键词: Propensity score matching;    Conditional cash transfer;    Vaccination coverage;    Older people;   

Others  :  855156
DOI  :  10.1186/1472-698X-13-30

 received in 2013-02-08, accepted in 2013-06-28,  发布年份 2013

【 摘 要 】

Background

Immunization is one of the most effective ways of preventing illness, disability and death from infectious diseases for older people. However, worldwide immunization rates are still low, particularly for the most vulnerable groups within the elderly population. The objective of this study was to estimate the effect of the Oportunidades -an incentive-based poverty alleviation program- on vaccination coverage for poor and rural older people in Mexico.

Methods

Cross-sectional study, based on 2007 Oportunidades Evaluation Survey, conducted in low-income households from 741 rural communities (localities with <2,500 inhabitants) of 13 Mexican states. Vaccination coverage was defined according to three individual vaccines: tetanus, influenza and pneumococcal, and for complete vaccination schedule. Propensity score matching and linear probability model were used in order to estimate the Oportunidades effect.

Results

12,146 older people were interviewed, and 7% presented cognitive impairment. Among remaining, 4,628 were matched. Low coverage rates were observed for the vaccines analyzed. For Oportunidades and non-Oportunidades populations were 46% and 41% for influenza, 52% and 45% for pneumococcal disease, and 79% and 71% for tetanus, respectively. Oportunidades effect was significant in increasing the proportion of older people vaccinated: for complete schedule 5.5% (CI_95% 2.8-8.3), for influenza 6.9% (CI_95% 3.8-9.6), for pneumococcal 7.2% (CI_95% 4.3-10.2), and for tetanus 6.6% (CI_95% 4.1-9.2).

Conclusions

The results of this study extend the evidence on the effect that conditional transfer programs exert on health indicators. In particular, Oportunidades increased vaccination rates in the population of older people. There is a need to continue raising vaccination rates, however, particularly for the most vulnerable older people.

【 授权许可】

   
2013 Salinas-Rodríguez and Manrique-Espinoza; licensee BioMed Central Ltd.

【 图 表 】

【 参考文献 】

• [1]Bentley DW: Immunizations in the elderly. Bul NY Acad Med 1987, 63:533-551.
• [2]Bader MS: Immunization for the Elderly. Am J Med Sci 2007, 334:481-486.
• [3]Sistema Nacional de Información en Salud. http://www.sinais.salud.gob.mx/basesdedatos/index.html webcite
• [4]Zimmerman RK, Santibanez TA, Fine MJ, Janosky JE, Nowalk MP, Bardella IJ, Raymund M, Wilson SA: Barriers and facilitators of pneumococcal vaccination among the elderly. Vaccine 2003, 21:1510-1517.
• [5]Endrich MM, Blank PR, Szucs TD: Influenza vaccination uptake and socioeconomic determinants in 11 European countries. Vaccine 2009, 27:4018-4024.
• [6]Blank PR, Matthias SM, Szucs TD: Influenza vaccination coverage rates in five European countries during season 2006/07 and trends over six consecutive seasons. BMC Publ Health 2008, 8:272. BioMed Central Full Text
• [7]Gaughran F, Walwyn R, Lambkin-Williams R, Whelan P, Chatterton K, Oxford J, Macdonald A: Flu: effect of vaccine in elderly care home residents: a randomized trial. J Am Geriatr Soc 2007, 55:1912-1920.
• [8]Lemaitre M, Meret T, Rothan-Tondeur M, Belmin J, Lejonc JL, Luquel L, Piette F, Salom M, Verny M, Vetel JM, Veyssier P, Carrat F: Effect of influenza vaccination of nursing home staff on mortality of residents: a cluster-randomized trial. J Am Geriatr Soc 2009, 57:1580-1586.
• [9]Shapiro ED, Clemens JD: A controlled evaluation of the protective efficacy of pneumococcal vaccine for patients at high risk of serious pneumococcal infections. Ann Intern Med 1984, 101:325-330.
• [10]Butler JC, Breiman RF, Campbell JF, Lipman HB, Broome CV, Facklam RR: Pneumococcal polysaccharide vaccine efficacy: an evaluation of current recommendations. JAMA 1993, 270:1826-1831.
• [11]Farr BM, Johnston BL, Cobb DK, Fisch MJ, Germanson TP, Adal KA, Anglim AM: Preventing pneumococcal bacteremia in patients at risk: results of a matched case–control study. Arch Intern Med 1995, 155:2336-2340.
• [12]Shapiro ED, Berg AT, Austrian R, Schroeder D, Parcells V, Margolis A, Adair RK, Clemens JD: The protective efficacy of polyvalent pneumococcal polysaccharide vaccine. N Engl J Med 1991, 325:1453-1460.
• [13]McElhaney JE: Influenza vaccine responses in older adults. Ageing Res Rev 2011, 10:379-388.
• [14]Lang PO, Govind S, Mitchell WA, Siegrist CA, Aspinall R: Vaccine effectiveness in older individuals: what has been learned from the influenza-vaccine experience. Ageing Res Rev 2011, 10:389-395.
• [15]Monto AS, Ansaldi F, Aspinall R, McElhaney JE, Montaño LF, Nichol KL, Puig-Barberá J, Stephenson I: Influenza control in the 21st century: Optimizing protection of older adults. Vaccine 2009, 27:5043-5053.
• [16]Deans GD, Stiver HG, McElhaney JE: Influenza vaccines provide diminished protection but are cost-saving in older adults. J Intern Med 2010, 267:220-227.
• [17]World Health Organization: Influenza vaccines. WHO position paper. Wkly Epidemiol Rec 2002, 77:230-234.
• [18]Holm MV, Blank PR, Szucs TD: Trends in influenza vaccination coverage rates in Germany over five seasons from 2001 to 2006. BMC Infect Dis 2007, 7:144. BioMed Central Full Text
• [19]Müller D, Szucs TD: Influenza vaccination coverage rates in 5 European countries: a population-based cross-sectional analysis of the seasons 02/03, 03/04 and 04/05. Infection 2007, 35:308-319.
• [20]de Janvry A, Sadoulet E: Making conditional cash transfer programs more efficient: designing for maximum effect of the conditionality. World Bank Econ Rev 2006, 20:1-29.
• [21]Rawlings LB, Rubio GM: Evaluating the impact of conditional cash transfer programs: lessons from Latin America. World Bank Res Obs 2005, 20:29-55.
• [22]Heinrich CJ: Demand and supply-side determinants of conditional cash transfer program effectiveness. World Dev 2007, 35:121-143.
• [23]Skoufias E, Davis B, Behrman JR: An Evaluation of the Selection of Beneficiary Households in the Education, Health, and Nutrition Program (PROGRESA) of Mexico. Final Report, International Food Policy Research Institute; 1999. http://oportunidades.gob.mx:8010/es/wersd53465sdg1/docs/2000/ifpri_2000_skoufias_target.pdf webcite
• [24]Agreement whereby the Operational Rules of the Oportunidades Human Development Program are issued for Fiscal Year 2007. http://www.oportunidades.gob.mx/Portal/work/sites/Web/resources/ArchivoContent/715/Reglas_de_Operacion_Oportunidades_2007_LINKS_MAYO_9.pdf webcite
• [25]Official Mexican Norm NOM-036-SSA2-2002. Disease Prevention and Control. Administration of vaccines, toxoids, immune saline solutions, antitoxins and immunoglobulin in humans. http://www.salud.gob.mx/unidades/cdi/nom/036ssa202.html webcite
• [26]Folstein MF, Folstein SE, McHugh PR: "Mini-mental state". A practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res 1975, 2:189-198.
• [27]Kohlhammer Y, Schnoor M, Schwartz M, Raspe H, Schäfer T: Determinants of influenza and pneumococcal vaccination in elderly people: a systematic review. Public Health 2007, 121:742-751.
• [28]Opstelten W, Hak E, Verheij TJ, van Essen GA: Introducing a Pneumococcal Vaccine to an Existing Influenza Immunization Program: Vaccination Rates and Predictors of Noncompliance. Am J Med 2001, 111:474-479.
• [29]Johnson DR, Nichol KL, Lipczynski K: Barriers to adult immunization. Am J Med 2008, 121:S28-S35.
• [30]Davis JW, Fujimoto RY, Chan H, Juarez DT: Factors affecting the influenza vaccination of high risk adults in Hawai'i. Hawaii Med J 2009, 68:50-54.
• [31]High KP: Overcoming barriers to adult immunization. J Am Osteopath Assoc 2009, 109:S25-S28.
• [32]Nowalk MP, Zimmerman RK, Tabbarah M, Raymund M, Jewell IK: Determinants of adult vaccination at inner-city health centers: a descriptive study. BMC Fam Pract 2006, 7:2. BioMed Central Full Text
• [33]CONAPO: Índices de Marginación. 2005. http://www.conapo.gob.mx/es/CONAPO/Indices_de_marginacion_2005_ webcite
• [34]Abadie A, Imbens G: Large sample properties of matching estimators for average treatment effects. Econometrica 2006, 74:235-267.
• [35]Becker S, Ichino A: The estimation of average treatment effects based on propensity scores. Stata J 2002, 2:358-377.
• [36]Leuven E, Sianesi B: Psmatch2: Stata module to perform full Mahalanobis and propensity score matching, common support graphing, and covariate imbalance testing. http://ideas.repec.org/c/boc/bocode/s432001.html webcite
• [37]Rosenbaum P, Rubin D: The central role of the propensity score in observational studies for causal effects. Biometrika 1983, 70:41-55.
• [38]Dehejia RH, Wahba S: Causal effects in nonexperimental studies: re-evaluating the evaluation of training programs. J Am Stat Assoc 1999, 94:1053-1062.
• [39]Dehejia RH, Wahba S: Propensity score-matching methods for nonexperimental causal studies. Rev Econ Stat 2002, 84:151-161.
• [40]Diaz JJ, Handa S: An assessment of propensity score matching as a nonexperimental impact estimator: evidence from Mexico’s PROGRESA program. J Hum Resour 2006, 61:319-345.
• [41]Agresti A: Categorical Data Analysis. New Jersey: Wiley; 2002.
• [42]White HA: Heteroskedasticity-Consistent Covariance Matrix Estimator and a Direct Test for Heteroskedasticity. Econometrica 1980, 48:817-838.
• [43]R Development Core Team: R: A language and environment for statistical computing. Vienna, Austria: R Foundation for Statistical Computing; 2012. http://www.R-project.org/ webcite
• [44]StataCorp: Stata Statistical Software: Release 12. College Station, TX: StataCorp LP; 2011.
• [45]Gaarder M, Glassman A, Todd J: Conditional cash transfers and health: unpacking the causal chain. Journal of Development Effectiveness 2010, 2:6-50.
• [46]Lagarde M, Haines A, Palmer N: The impact of conditional cash transfers on health outcomes and use of health services in low and middle income countries. Cochrane Database Syst Rev 2009., 4CD008137
• [47]Attanasio O, Gómez LC, Heredia P, Vera-Hernandez M: The short term impact of a conditional cash subsidy on child health and nutrition in Colombia. http://www.ifs.org.uk/publications/3503 webcite
• [48]Morris SS, Flores R, Olinto P, Medina JM: Monetary incentives in primary health care and effects on use and coverage of preventive health care interventions in rural Honduras: cluster randomised trial. Lancet 2004, 364:2030-2037.
• [49]Barham T, Maluccio J: Eradicating Disease: The Effect of Conditional Cash Transfers on Vaccination Coverage in Nicaragua. J Health Econ 2009, 38:611-621.
• [50]Barham T, Brenzel L, Maluccio JÁ: Beyond 80 %: Are There New Ways of Increasing Vaccination Coverage – Evaluation of CCT Programs in Mexico and Nicaragua. Health, Nutrition and Population Discussion Paper. Washington D.C: World Bank; 2007.
• [51]National Health Program 2007–2012. For health in Mexico: Constructing alliances for improving health. (Por un México sano: construyendo alianzas para una mejor salud). http://www.geriatria.salud.gob.mx/descargas/programa_nacional_salud.pdf webcite
• [52]Sosa-Rubí SG, Walker D, Serván E, Bautista-Arredondo S: Learning effect of a conditional cash transfer programme on poor rural women’s selection of delivery care in Mexico. Health Policy Plan 2011, 26:496-507.
• [53]Lagarde M, Haines A, Palmer N: Conditional cash transfers for improving uptake of health interventions in low- and middle-income countries: a systematic review. JAMA 2007, 298:1900-1910.
• [54]Fernald LCH, Gertler PG, Neufeld LM: Role of cash in conditional cash transfer programmes for child health, growth, and development: an analysis of Mexico's Oportunidades. Lancet 2008, 371:828-837.
• [55]Kenji S: Conditional cash transfer: a magic bullet for health? Lancet 2008, 371:789-791.
• [56]World Health Organization: Active ageing. A policy framework. Paper presented at the Second United Nations Assembly on Aging, Madrid, España, April 2002http://whqlibdoc.who.int/hq/2002/WHO_NMH_NPH_02.8.pdf webcite
• [57]Mac Donald R, Baken L, Nelson A, Nichol KL: Validation of Self-Report of Influenza and Pneumococcal Vaccination Status in Elderly Outpatients. Am J Prev Med 1996, 16:173-177.
• [58]Skull SA, Andrews RM, Byrnes GB, Kelly HA, Nolan TM, Brown GV, Campbell DA: Validity of self-reported influenza and pneumococcal vaccination status among a cohort of hospitalized elderly inpatients. Vaccine 2007, 25:4774-4783.
• [59]Bayas JM, Izquierdo C, Ruiz L, Sintes X, Sousa D, Celorrio JM, Varona W, Carratalá J, Nebot M, Batalla J, Sugrañes S, Manzur A, Terren A, García C, Clemente E, Rivera S, Justo I, Arévalo A, Salleras L, Domínguez A: Validity of self-reported pneumococcal vaccination status in the elderly in Spain. Vaccine 2009, 27:4560-4564.
• [60]Health at a Glance 2011: OECD Indicators. http://www.oecd.org/els/health-systems/49105858.pdf webcite
• [61]Jefferson T, Rivetti D, Rivveti A, Rudin M, Di pietrantonj C, Demicheli V: Efficacy and effectiveness of influenza vaccines in elderly people: a systematic review. Lancet 2005, 366:1165-1174.