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Factors associated with routine immunization coverage of children under one year old in Lao People's Democratic
Bounfeng Phoummalaysith1, Eiko Yamamoto2, Anonh Xeuatvongsa3
1Department of Healthcare Administration, Nagoya University Graduate School of Medicine, Nagoya, Japan; National Health Insurance Bureau, Ministry of Health, Vientiane, Lao Democratic People's Republic.
Insights
Routine immunization coverage in Lao PDR is improving but has not reached the national goal. Targeting Bacillus Calmette-Guerin (BCG) vaccine coverage and addressing issues in poor villages are recommended to enhance nationwide immunization rates.
Area of Science:
- Public Health
- Epidemiology
- Global Health
Background:
- Routine vaccination is provided free to children under one year old in Lao PDR, with a national goal of 95% coverage by 2025.
- Factors influencing immunization coverage in Lao PDR were examined, considering both immunization system elements and provincial/district characteristics.
Purpose of the Study:
- To evaluate the association between immunization system factors, provincial/district characteristics, and routine immunization coverage in Lao PDR.
- To identify factors associated with low routine immunization coverage to inform targeted interventions.
Main Methods:
- Analysis of vaccine coverage rates (BCG, DTP-HepB, DTP-HepB-Hib, OPV, MCV1) from 2002-2014 using routine reporting systems.
- Correlation analysis between immunization coverage and provincial/district characteristics (population, density, poverty, high-risk villages) and immunization service factors (health facility access, session types, cold chain).
- Categorization of provinces into low (<80%) and high (≥80%) DTP-HepB-Hib3 coverage groups to identify associated factors.
Main Results:
- Vaccine coverages (BCG, DTP-HepB3, OPV3, MCV1) showed gradual improvement from 2007-2014, reaching 82.2-88.3% in 2014.
- BCG coverage exhibited the least improvement between 2002-2014.
- Low immunization coverage in provinces correlated with a higher proportion of poor villages.
Conclusions:
- Routine immunization coverage in Lao PDR has improved over the past 13 years but has not yet met the national target.
- Improving Bacillus Calmette-Guerin (BCG) vaccine coverage and focusing on interventions in poor villages are recommended strategies to enhance nationwide immunization rates.
Background:
Routine vaccination is administered free of charge to all children under one year old in Lao People's Democratic Republic (Lao PDR) and the national goal is to achieve at least 95% coverage with all vaccines included in the national immunization program by 2025. In this study, factors related to the immunization system and characteristics of provinces and districts in Lao PDR were examined to evaluate the association with routine immunization coverage.
Methods:
Coverage rates for Bacillus Calmette-Guerin (BCG), Diphtheria-Tetanus-Pertussis-Hepatitis B (DTP-HepB), DTP-HepB-Hib (Haemophilus influenzae type B), polio (OPV), and measles (MCV1) vaccines from 2002 to 2014 collected through regular reporting system, were used to identify the immunization coverage trends in Lao PDR. Correlation analysis was performed using immunization coverage, characteristics of provinces or districts (population, population density, and proportion of poor villages and high-risk villages), and factors related to immunization service (including the proportions of the following: villages served by health facility levels, vaccine session types, and presence of well-functioning cold chain equipment). To determine factors associated with low coverage, provinces were categorized based on 80% of DTP-HepB-Hib3 coverage (<80% = low group; ≥80% = high group).
Results:
Coverages of BCG, DTP-HepB3, OPV3 and MCV1 increased gradually from 2007 to 2014 (82.2-88.3% in 2014). However, BCG coverage showed the least improvement from 2002 to 2014. The coverage of each vaccine correlated with the coverage of the other vaccines and DTP-HepB-Hib dropout rate in provinces as well as districts. The provinces with low immunization coverage were correlated with higher proportions of poor villages.
Conclusions:
Routine immunization coverage has been improving in the last 13 years, but the national goal is not yet reached in Lao PDR. The results of this study suggest that BCG coverage and poor villages should be targeted to improve nationwide coverage.