Yuqing Zhou1, Yi Xing2, Xiaofeng Liang1, Chenyan Yue1, Xu Zhu3, David Hipgrave4. 1. National Immunization Program, Chinese Centre for Disease Control and Prevention, Beijing, People's Republic of China. 2. Peking University Health Science Centre, Beijing, People's Republic of China. 3. UNICEF China Country Office, Beijing, People's Republic of China. 4. UNICEF Headquarters, New York, New York, USA.
Abstract
OBJECTIVE: To evaluate interventions to improve routine vaccination coverage and caregiver knowledge in China's remote west, where routine immunisation is relatively weak. DESIGN: Prospective pre-post (2006-2010) evaluation in project counties; retrospective comparison based on 2004 administrative data at baseline and surveyed post-intervention (2010) data in selected non-project counties. SETTING: Four project counties and one non-project county in each of four provinces. PARTICIPANTS: 3390 children in project counties at baseline, and 3299 in project and 830 in non-project counties post-intervention; and 3279 caregivers at baseline, and 3389 in project and 830 in non-project counties post-intervention. INTERVENTION: Multicomponent inexpensive knowledge-strengthening and service-strengthening and innovative, multisectoral engagement. DATA COLLECTION: Standard 30-cluster household surveys of vaccine coverage and caregiver interviews pre-intervention and post-intervention in each project county. Similar surveys in one non-project county selected by local authorities in each province post-intervention. Administrative data on vaccination coverage in non-project counties at baseline. PRIMARY OUTCOME MEASURES: Changes in vaccine coverage between baseline and project completion (2010); comparative caregiver knowledge in all counties in 2010. ANALYSIS: Crude (χ(2)) analysis of changes and differences in vaccination coverage and related knowledge. Multiple logistic regression to assess associations with timely coverage. RESULTS: Timely coverage of four routine vaccines increased by 21% (p<0.001) and hepatitis B (HepB) birth dose by 35% (p<0.001) over baseline in project counties. Comparison with non-project counties revealed secular improvement in most provinces, except new vaccine coverage was mostly higher in project counties. Ethnicity, province, birthplace, vaccination site, dual-parental out-migration and parental knowledge had significant associations with coverage. Knowledge increased for all variables but one in project counties (highest p<0.05) and was substantially higher than in non-project counties (p<0.01). CONCLUSIONS: Comprehensive but inexpensive strategies improved vaccination coverage and caretaker knowledge in western China. Establishing multisectoral leadership, involving the education sector and including immunisation in public-sector performance standards, are affordable and effective interventions. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/
OBJECTIVE: To evaluate interventions to improve routine vaccination coverage and caregiver knowledge in China's remote west, where routine immunisation is relatively weak. DESIGN: Prospective pre-post (2006-2010) evaluation in project counties; retrospective comparison based on 2004 administrative data at baseline and surveyed post-intervention (2010) data in selected non-project counties. SETTING: Four project counties and one non-project county in each of four provinces. PARTICIPANTS: 3390 children in project counties at baseline, and 3299 in project and 830 in non-project counties post-intervention; and 3279 caregivers at baseline, and 3389 in project and 830 in non-project counties post-intervention. INTERVENTION: Multicomponent inexpensive knowledge-strengthening and service-strengthening and innovative, multisectoral engagement. DATA COLLECTION: Standard 30-cluster household surveys of vaccine coverage and caregiver interviews pre-intervention and post-intervention in each project county. Similar surveys in one non-project county selected by local authorities in each province post-intervention. Administrative data on vaccination coverage in non-project counties at baseline. PRIMARY OUTCOME MEASURES: Changes in vaccine coverage between baseline and project completion (2010); comparative caregiver knowledge in all counties in 2010. ANALYSIS: Crude (χ(2)) analysis of changes and differences in vaccination coverage and related knowledge. Multiple logistic regression to assess associations with timely coverage. RESULTS: Timely coverage of four routine vaccines increased by 21% (p<0.001) and hepatitis B (HepB) birth dose by 35% (p<0.001) over baseline in project counties. Comparison with non-project counties revealed secular improvement in most provinces, except new vaccine coverage was mostly higher in project counties. Ethnicity, province, birthplace, vaccination site, dual-parental out-migration and parental knowledge had significant associations with coverage. Knowledge increased for all variables but one in project counties (highest p<0.05) and was substantially higher than in non-project counties (p<0.01). CONCLUSIONS: Comprehensive but inexpensive strategies improved vaccination coverage and caretaker knowledge in western China. Establishing multisectoral leadership, involving the education sector and including immunisation in public-sector performance standards, are affordable and effective interventions. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/
Authors: Qun Meng; Ling Xu; Yaoguang Zhang; Juncheng Qian; Min Cai; Ying Xin; Jun Gao; Ke Xu; J Ties Boerma; Sarah L Barber Journal: Lancet Date: 2012-03-03 Impact factor: 79.321
Authors: Li Liu; Hope L Johnson; Simon Cousens; Jamie Perin; Susana Scott; Joy E Lawn; Igor Rudan; Harry Campbell; Richard Cibulskis; Mengying Li; Colin Mathers; Robert E Black Journal: Lancet Date: 2012-05-11 Impact factor: 79.321