Socioeconomic inequalities are still a barrier to full child vaccine coverage in the Brazilian Amazon: a cross-sectional study in Assis Brasil, Acre, Brazil

International Journal for Equity in Health

Mônica da Silva-Nunes¹  Claudia Torres Codeço²  Alanderson Alves Ramalho¹  Cristieli Sérgio de Menezes Oliveira¹  Antonio Camargo Martins¹  Saulo Augusto Silva Mantovani¹  Humberto Oliart-Guzmán¹  Athos Muniz Braña¹  Breno Matos Delfino¹  Thasciany Moraes Pereira¹  Fernando Luiz Cunha Castelo Branco¹ 

[1] Universidade Federal do Acre, BR 363 km 04, Rio Branco, 69919-769, Acre, Brazil;Scientific Computing Program, Oswaldo Cruz Foundation, Avenida Brasil, Rio de Janeiro, 4365, RJ, Brazil

关键词: Amazon;    Child;    Coverage;    Vaccine;   

Others  :  1146237
DOI  :  10.1186/s12939-014-0118-y

 received in 2014-06-10, accepted in 2014-11-17,  发布年份 2014

【 摘 要 】

Introduction

Vaccines are very important to reduce morbidity and mortality by preventable infectious diseases, especially during childhood. Optimal coverage is not always achieved, for several reasons. Here we assessed vaccine coverage for the first 12 months of age in children between 12 and 59 months old, residing in the urban area of a small Amazonian city, and factors associated with incomplete vaccination.

Methods

A census was performed in the urban area of Assis Brasil, in the Brazilian Amazon, in January 2010, with mothers of 282 children aged 12 to 59 months old, using structured interviews and data from vaccination cards. Mixed logistic regression was used to determine factors associated with incomplete vaccination schemes.

Results

Only 82.6% of all children had a completed the basic vaccine scheme for the first year of life. Vaccine coverage ranged from 52.7% coverage (oral rotavirus vaccine) to 99.7% coverage (for Bacille Calmette-Guérin). The major deficiencies occurred in doses administered after the first six months of life. Incomplete vaccination was associated with not having enough income to buy a house (aOR = 2.12, 95% CI 1.06-4.21), low maternal schooling (aOR = 2.60, 95% CI 1.28 – 5.29) , and time of residence of the child in the urban area of the city (aOR = 0.73, 95% CI 0.55 – 0.95).

Conclusions

This study showed that vaccine coverage in the first twelve months of life in Assis Brasil is similar to other areas in the Amazon and it is below the coverage postulated by the Brazilian Ministry of Health. Low vaccine coverage was associated with socioeconomic inequities that still prevail in the Brazilian Amazon. Short and long-term strategies must be taken to update child vaccines and increase vaccine coverage in the Amazon.

【 授权许可】

   
2014 Branco et al.; licensee BioMed Central Ltd.

【 参考文献 】

• [1]de Moraes JC, Barata RCB, Ribeiro MCSA, de Castro PC: Cobertura vacinal no primeiro ano de vida em quatro cidades do Estado de São Paulo, Brasil. Rev Panam Salud Publica 2000, 8:332-341.
• [2][http://bvsms.saude.gov.br/bvs/publicacoes/funasa/manu_normas_vac.pdf] webcite Brasil. Ministério da Saúde: Manual de Normas de Vacinação. 3ª ed. Brasília: Fundação Nacional de Saúde; 2001 []
• [3]Silveira ASA, da Silva BMF, Peres EC, Meneghin P: Controle de vacinação de crianças matriculadas em escolas municipais da cidade de São Paulo. Rev esc enferm USP 2007, 41:299-305.
• [4][http://bvsms.saude.gov.br/bvs/publicacoes/cd03_10.pdf] webcite Brasil. Ministério da Saúde: Programa Nacional de Imunizações: PNI 25 anos. Brasília: Fundação Nacional de Saúde; 1998. [.
• [5]Pôrto A, Ponte CF: Vacinas e campanhas: as imagens de uma história a ser contada. Hist Cienc Saude Manguinhos 2003, 10(2):725-742.
• [6]Barata RB, Ribeiro MC, de Moraes JC, Flannery B: Socioeconomic inequalities and vaccination coverage: results of an immunisation coverage survey in 27 Brazilian capitals, 2007–2008. J Epidemiol Community Health 2011, 66:934-941.
• [7][http:/ / bvsms.saude.gov.br/ bvs/ publicacoes/ funasa/ salavac_treinando_completo.pdf] webcite Brasil. Ministério da Saúde: Capacitação de pessoal em sala de vacinação - manual do treinando. In Organizado pela Coordenação do Programa Nacional de Imunizações. 2ª ed. Brasília: Fundação Nacional de Saúde; 2001 []
• [8]Sanou A, Simboro S, Kouyaté B, Dugas M, Bibeau JGG: Assessment of factors associated with complete immunization coverage in children aged 12–23 months: a cross-sectional study in Nouna district, Burkina Faso. BMC Int Health Hum Rights 2009, 9 Suppl 1:S10. doi:10.1186/1472-698X-9-S1-S10 BioMed Central Full Text
• [9]Mutua MK, Kimani-Murage E, Ettarh RR: Childhood vaccination in informal urban settlements in Nairobi, Kenya: Who gets vaccinated? BMC Public Health 2011, 11:6. doi:10.1186/1471-2458-11-6 BioMed Central Full Text
• [10]Hemat S, Takano T, Kizuki M, Mashal T: Health-care provision factors associated with child immunization coverage in a city centre and a rural area in Kabul, Afghanistan. Vaccine 2009, 27:2823-2829. doi:10.1016/j.vaccine.2009.02.097
• [11]Ramalho AA, Mantovani SA, Delfino BM, Pereira TM, Martins AC, Oliart-Guzmán H, Brãna AM, Branco FL, Campos RG, Guimarães AS, Araújo TS, Oliveira CS, Codeço CT, Muniz PT, da Silva-Nunes M: Nutritional status of children under 5 years of age in the Brazilian Western Amazon before and after the Interoceanic highway paving: a population-based study. BMC Public Health 2013, 13:1098. doi:10.1186/1471-2458-13-1098 BioMed Central Full Text
• [12][http:/ / www.ibge.gov.br/ home/ estatistica/ populacao/ censo2010/ tabelas_pdf/ total_populacao_acre.pdf] webcite Instituto Brasileiro de Geografia e Estatística: Resultados parciais do Estado do Acre no Censo 2010., []
• [13][http:/ / www.prefeitura.sp.gov.br/ cidade/ secretarias/ upload/ informe_rotavirus2_1254747927.pdf] webcite Brasil. Ministério da Saúde: Doença Diarréica por Rotavírus: Vigilância Epidemiológica e Prevenção pela Vacina Oral de Rotavírus Humano - VORH. Brasília: Secretaria de Vigilância em Saúde; 2005 []
• [14]da Silva-Nunes M1, Codeço CT, Malafronte RS, da Silva NS, Juncansen C, Muniz PT, Ferreira MU: Malaria on the Amazonian frontier: transmission dynamics, risk factors, spatial distribution, and prospects for control. Am J Trop Med Hyg 2008, 79:624-635.
• [15]Filmer D, Pritchett LH: Estimating wealth effects without expenditure data - or tears: an application to educational enrollments in states of India. Demography 2001, 38:115-132.
• [16]Jolliffe IT: Choosing a subset of principal componente variables. In Principal Component Analysis. Edited by Jolliffe IT. Springer, New York; 1986:111-149.
• [17]Yokokura AVCP, da Silva AAM, Bernardes ACF, Filho FL, Alves MTSSB, Cabra NAL, Alves RFLB: Cobertura vacinal em crianças de 12 a 23 meses de idade: estudo exploratório tipo Survey. Rev Eletr Enf 2009, 11:360-372.
• [18]Luhm KR, Cardoso MRA, Waldman EA: Cobertura vacinal em menores de dois anos a partir de registro informatizado de imunização em Curitiba, PR. Rev Saude Publica 2011, 45:90-98.
• [19]Ramos CF, da Paixão JGM, Donza FCS, da Silva AMP, Caçador DF, Dias VDV, Sodré EFLM: Cumprimento do calendário de vacinação de crianças em uma unidade de saúde da família. Rev Pan-Amaz Saude 2010, 1:55-60.
• [20]Sharma R, Desai VK, Kavishvar A: Assessment of immunization status in the slums of surat by 15 clusters multi indicators cluster survey technique. Indian J Community Med 2009, 34:152-155.
• [21][http://ais.paho.org/phip/viz/im_coveragebyvaccine.asp] webcite Pan American Health Organization: Vaccination coverage by vaccine.[]
• [22]Salvador PTCO, de Almeida TJ, Alves KYA, Dantas CN: A rotavirose e a vacina oral de rotavírus humano no cenário Brasileiro: revisão integrativa da literatura. Ciênc saúde coletiva 2011, 16:567-574.
• [23]Bosch-Capblanch X, Banerjee K, Burton A: Unvaccinated children in years of increasing coverage: how many and who are they? evidence from 96 low-and middle-income countries.Trop Med Int Health 2012, 17:697–710. doi:10.1111/j.1365-3156.2012.02989.x.
• [24][http://who.int/immunization/newsroom/global_immunization_data_july_2014.pdf] webcite WHO: Global immunization coverage in 2013., []
• [25]Konstantyner T, Taddei JAAC, Rodrigues LC: Risk factors for incomplete vaccination in children less than 18 months of age attending the nurseries of day-care centres in Sao Paulo, Brazil. Vaccine 2011, 29:9298-9302. doi:10.1016/j.vaccine.2011.10.020
• [26]Queiroz LLC, Monteiro SG, Mochel EG, Veras MASM, de Sousa FGM, Bezerra MLM, Chein MBC: Cobertura vacinal do esquema básico para o primeiro ano de vida nas capitais do Nordeste brasileiro. Cad Saude Publica 2013, 29:294-302.
• [27]Ueda M, Kondo N, Takada M, Hashimoto H: Maternal work conditions, socioeconomic and educational status, and vaccination of children: a community-based household survey in Japan. Prev Med 2014, 66:17-21. doi:10.1016/j.ypmed.2014.05.018
• [28]da Silva AAM, Gomes UA, Tonial SR, da Silva RA: Cobertura vacinal e fatores de risco associados à não- vacinação em localidade urbana do Nordeste brasileiro. Rev Saude Publica 1999, 33:147-156.
• [29]Rahman M, Islam MA, Mahalanabis D: Mother’s knowledge about vaccine preventable diseases and immunization coverage of a population with high rate of illiteracy. J Trop Pediatr 1995, 41:376-381.
• [30]Cutts Felicity T, Soares A, Jecque AV, Cliff J, Kortbeek S, Colombo S: The use of evaluation to improve the expanded programme on immunization in Mozambique. Bull World Health Organ 1990, 68:199-208.
• [31]Szwarcwald CL, ValenteII JG: Avaliação da cobertura de vacinação em Teresina - Piauí (Brasil - 1983). Cad Saude Publica 1985, 1:41-49.
• [32]Yokokura AVCP, da Silva AAM, Bernardes ACF, Filho FL, Alves MTSSB, Cabra NAL, Alves RFLB: Cobertura vacinal e fatores associados ao esquema vacinal básico incompleto aos 12 meses de idade, São Luís, Maranhão, Brasil, 2006. Cad Saude Publica 2013, 29:522-534.
• [33]de Miranda AS, Scheibel IM, Tavares MRG, Takeda SMP: Avaliação da cobertura vacinal do esquema básico para o primeiro ano de vida. Rev Saude Publica 1995, 29:208-214.
• [34]Barros FC, Matijasevich A, Requejo JH, Giugliani E, Maranhão AG, Monteiro CA, Barros AJ, Bustreo F, Merialdi M, Victora CG: Recent trends in maternal, newborn, and child health in Brazil: progress toward millennium development goals 4 and 5. Am J Public Health 2010, 100:1877-1889.
• [35]Cleland JG, Van Ginneken JK: Maternal education and child survival in developing countries: the search for pathways of influence. Soc Sci Med 1988, 27:1357-1368.
• [36]Mathew JL: Inequity in childhood immunization in India: a systematic review. Indian Pediatr 2012, 49:203-223.
• [37]Hu Y, Li Q, Chen E, Chen Y, Qi X: Determinants of childhood immunization uptake among socio-economically disadvantaged migrants in East China. Int J Environ Res Public Health 2013, 10:2845-2856. doi:10.3390/ijerph10072845
• [38]Nankabirwa V, Tylleskär T, Tumwine JK, Sommerfelt H: Promise-ebf Study Group. maternal education is associated with vaccination status of infants less than 6 months in Eastern Uganda: a cohort study. BMC Pediatr 2010, 10:92. doi:10.1186/1471-2431-10-92 BioMed Central Full Text
• [39]Muhsen K, Abed El-Hai R, Amit-Aharon A, Nehama H, Gondia M, Davidovitch N, Goren S, Cohen D: Risk factors of underutilization of childhood immunizations in ultraorthodox Jewish communities in Israel despite high access to health care services. Vaccine 2012, 30:2109-2115. doi:10.1016/j.vaccine.2012.01.044
• [40]Logullo P, de Carvalho HB, Saconi R, Massad E: Factors affecting compliance with the measles vaccination schedule in a Brazilian city. Sao Paulo Med J 2008, 126:166-171.
• [41]Santos SR, Cunha AJLA, Gamba CM, Machado FG, Filho JMML, Moreira NLM: Avaliação da assistência à saúde da mulher e da criança em localidade urbana da região Sudeste do Brasil. Rev Saude Publica 2000, 34:266-271.
• [42]Victora CG, Aquino EM, do Carmo Leal M, Monteiro CA, Barros FC, Szwarcwald CL: Maternal and child health in Brazil: progress and challenges. Lancet 2011, 377:1863-1876.
• [43][http://tabnet.datasus.gov.br/cgi/idb2012/c01b.htm] webcite Datasus: Número de óbitos infantis (menores de 1 ano) por 1.000 nascidos vivos, Brasil, 2000–2011. 2012, []