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Associations between vaccination clinic factors and DTaP dropout in China: A cross-sectional study
Jiakai Ye1,2, Lei Cao1,2, Yifan Song1,2
1National Immunization Program, Chinese Center for Disease Control and Prevention, Beijing, China.
Insights
Vaccination clinic factors like space, number of tables, staff, and service radius impact DTaP dropout rates. Optimizing these elements can help reduce vaccine dropouts and improve immunization coverage.
Area of Science:
- Public Health
- Immunization Programs
- Healthcare Management
Background:
- Diphtheria, tetanus, and acellular pertussis (DTaP) vaccine dropout is a key indicator of vaccination clinic performance.
- Understanding factors influencing DTaP dropout is crucial for improving childhood immunization rates in China.
Purpose of the Study:
- To examine associations between modifiable vaccination clinic factors and DTaP dropout rates in China.
- To identify specific clinic-level characteristics that can be adjusted to minimize DTaP dropout.
Main Methods:
- A cross-sectional study involving 42,282 clinics in China.
- Utilized clinic-reported factors and vaccination data from national management systems for calendar year 2021.
- Defined low dropout (<5%) and high dropout (≥5%) and employed multivariable logistic regression analysis.
Main Results:
- Clinics with 18%-25% of area for vaccination, 2-5+ vaccination tables, and 4-9+ staff showed significantly lower DTaP dropout rates.
- Service radii of 6-10 km were associated with lower dropout, while radii ≥21 km were associated with higher dropout.
- Four clinic factors (area percentage, number of tables, staff size, service radius) were independently associated with DTaP dropout.
Conclusions:
- Modifiable clinic factors, including physical space allocation, resource availability (tables, staff), and service reach, are independently associated with DTaP dropout.
- Adjusting these clinic-level factors presents an opportunity to minimize DTaP dropout and enhance immunization program effectiveness.
- Findings provide actionable insights for optimizing vaccination clinic operations to improve vaccine completion rates.
Abstract:
Diphtheria, tetanus, and acellular pertussis combined vaccine (DTaP) dropout reflects negatively on the ability of a vaccination clinic to ensure children are fully vaccinated with recommended vaccines. Our study examined associations between modifiable vaccination clinic factors and DTaP dropout in clinics in China. A cross-sectional study of 42,282 clinics used clinic-reported clinic-level factors and clinic-level vaccination data from the National Immunization Information Management System and the Coding Management System during calendar year 2021. We defined low dropout as < 5% and high dropout as ≥ 5%. Multivariable logistic regression analysis showed clinics having 18%-25% of their area devoted to vaccination were more likely to have low dropout rates than clinics with ≤ 17% (OR = 1.09 [95% CI, 1.03-1.16]. Clinics with 2, 3, 4, and ≥ 5 vaccination tables were more likely to have low dropout rates compared with single-table clinics (OR = 1.21 [1.13-1.30]; OR = 1.29 [1.20-1.38]; OR = 1.28 [1.17-1.39]; OR = 1.32 [1.20-1.45]). Clinics with 4-5, 6-8, and ≥ 9 staff were more likely to have low dropout rates compared with clinics with ≤ 3 staff (OR = 1.13 [1.07-1.20]; OR = 1.18 [1.10-1.25]; OR = 1.15 [1.08-1.23]). Compared to clinics with travel-based service radii of ≤ 5 km, clinics with 6-10 km radii were more likely to have low dropout rates (OR = 1.06 [95% CI,1.00-1.12]), and clinics with service radii of ≥ 21 km (OR = 0.90 [95% CI, 0.83-0.98]) were less likely. These four factors were independently associated with DTaP dropout. While considering environmental factors such as population size and level of economic development, these factors can be adjusted to help minimize dropout.
