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Factors influencing the routine immunization status of children aged 2-3 years in China
Lei Cao1, Jing-Shan Zheng1, Ling-Sheng Cao1
1National Immunization Program, Chinese Center for Disease Control and Prevention, Beijing, China.
Insights
Routine childhood immunization in China is significantly impacted by sociodemographic and provider factors. Targeted interventions for high-risk groups and improved accessibility of services are crucial for enhancing immunization coverage.
Area of Science:
- Public Health
- Pediatrics
- Epidemiology
Background:
- Routine childhood immunization is vital for preventing infectious diseases.
- Understanding factors influencing immunization coverage is essential for public health strategies.
- China's Expanded Program on Immunization aims to improve child health outcomes.
Purpose of the Study:
- To identify sociodemographic and provider-associated factors affecting full immunization status in Chinese children aged 2-3 years.
- To provide evidence for targeted strategies to improve routine childhood immunization coverage.
- To inform resource allocation for China's Expanded Program on Immunization.
Main Methods:
- Analysis of data from 45,095 children aged 2-3 years from the 2013 National Immunization Coverage Survey.
- Utilized univariate and multiple logistic regression analyses to identify significant factors.
- Examined sociodemographic variables (e.g., gender, ethnicity, parental education) and provider-associated factors (e.g., vaccination location, reminders, travel time).
Main Results:
- Full immunization rate was 93.1%.
- Factors increasing odds of incomplete immunization included male gender, minority ethnicity, lower paternal education, home births, immigration from adjacent counties, urban-rural fringe/mountainous living areas, home vaccine administration, lack of household reminders, and longer travel time to providers (>40 minutes).
- Two-year-old children were less likely to be fully immunized compared to 3-year-olds.
Conclusions:
- Sociodemographic and provider-associated factors significantly impact routine childhood immunization rates in China.
- Accessible immunization services and effective reminders are critical for improving coverage.
- Targeted interventions for identified high-risk groups are necessary to reduce immunization disparities.
Objectives:
To examine the factors associated with the routine immunization status of children aged 2-3 years in China for gaining a better understanding of the Expanded Program on Immunization and to provide evidence for formulating specific strategies to guide the allocation of health resources.
Methods:
We analyzed data from 45095 children aged 2-3 years in the 2013 National Immunization Coverage Survey to identify the sociodemographic and provider-associated factors affecting the full immunization status of children. Univariate and multiple logistic regression analyses were performed.
Results:
The immunization rate for children aged 2-3 years ranged from 95.9% (diphtheria and tetanus toxoid with pertussis vaccine, 4th dose) to 99.5% (Japanese encephalitis vaccine, 1st dose) and was 93.1% for full immunization. In terms of sociodemographic factors, male children [adjusted OR (AOR): 1.115; 95% confidence interval(CI):1.016-1.222], minority children (AOR: 1.632; 95% CI: 1.457-1.828), children of fathers with less than high school education (AOR: 1.577; 95% CI: 1.195-2.081), those born at home (AOR: 4.655; 95% CI: 3.771-5.746), those who immigrated from an adjacent county (AOR: 2.006; 95% CI: 1.581-2.546), and those living in urban-rural fringe areas (AOR: 1.807; 95% CI: 1.475-2.214) or mountainous areas (AOR: 1.615; 95% CI: 1.437-1.814) had significantly increased odds of not being fully immunized. In terms of provider-associated factors, administration of vaccines at home (AOR: 2.311; 95% CI: 1.316-4.059), household reminders (AOR: 2.292; 95% CI: 1.884-2.789), and travel time to vaccination providers of >40 minutes (AOR: 1.622; 95% CI: 1.309-2.010) were negatively associated with immunization rates. In addition, compared to 3-year-old years, 2-year-old children (AOR: 1.201; 95% CI: 1.094-1.318) were less likely to be fully immunized.
Conclusions:
All included factors except maternal education level and distance from home to vaccination providers significantly affected immunization rates. Appropriate reminders and accessibility of immunization services played key roles in improving the immunization status. More attention to high-risk groups identified in this study may reduce the disparities in routine childhood immunization in China.
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