BACKGROUND:Vaccines are highly effective at preventing infectious diseases in children, and prevention is especially important in resource-limited countries where treatment is difficult to access. In Honduras, the World Health Organization (WHO) reports very high immunization rates in children. To determine whether or not these estimates accurately depict the immunization coverage in non-urban regions of the country, we compared the WHO data to immunization rates obtained from a local database tool and community health center records in rural Intibucá, Honduras. METHODS:We used data from two sources to comprehensively evaluate immunization rates in the area: 1) census data from a local database and 2) immunization data collected at health centers. We compared these rates using logistic regression, and we compared them to publicly available WHO-reported estimates using confidence interval inclusion. RESULTS:We found that mean immunization rates for each vaccine were high (range 84.4 to 98.8 percent), but rates recorded at the health centers were significantly higher than those reported from the census data (p ≤ 0.001). Combining the results from both databases, the mean rates of four out of five vaccines were less than WHO-reported rates (p <0.05). Overall immunization rates were significantly different between townships (p=0.03). The rates by individual vaccine were similar across townships (p >0.05), except for diphtheria/tetanus/pertussis vaccine (p=0.02) and oral polio vaccine (p <0.01). CONCLUSIONS:Immunization rates in Honduras were high across data sources, though most of the rates recorded in rural Honduras were less than WHO-reported rates. Despite geographical difficulties and barriers to access, the local database and Honduran community health workers have developed a thorough system for ensuring that children receive their immunizations on time. The successful integration of community health workers and a database within the Honduran decentralized health system may serve as a model for other immunization programs in resource-limited countries where health care is less accessible.

译文

背景:疫苗在预防儿童传染病方面非常有效,在资源匮乏且难以获得治疗的国家,预防尤为重要。在洪都拉斯,世界卫生组织(世卫组织)报告说,儿童的免疫接种率很高。为了确定这些估计值是否准确描述了该国非城市地区的免疫覆盖率,我们将WHO数据与从洪都拉斯农村Intibucá的本地数据库工具和社区卫生中心记录获得的免疫率进行了比较。
方法:我们使用来自两个来源的数据来全面评估该地区的免疫率:1)来自本地数据库的普查数据,以及2)在卫生中心收集的免疫数据。我们使用logistic回归比较了这些比率,并使用置信区间包含将它们与WHO公开报告的估计数进行了比较。
结果:我们发现每种疫苗的平均免疫率很高(范围为84.4%到98.8%),但是在卫生中心记录的疫苗接种率明显高于人口普查数据报告的疫苗接种率(p≤0.001)。结合两个数据库的结果,五种疫苗中有四种的平均发生率低于WHO报告的发生率(p <0.05)。各个乡镇的总体免疫接种率显着不同(p = 0.03)。除白喉/破伤风/百日咳疫苗(p = 0.02)和脊髓灰质炎疫苗(p <0.01)外,各个乡镇的疫苗接种率相似(p> 0.05)。
结论:尽管在洪都拉斯农村地区记录的大多数发病率低于世界卫生组织报告的发病率,但洪都拉斯的免疫接种率很高。尽管存在地理困难和获取障碍,但当地数据库和洪都拉斯社区卫生工作者已经建立了完善的系统,以确保儿童按时接受免疫接种。社区卫生工作者和洪都拉斯权力下放卫生系统内数据库的成功整合可能会成为资源有限的国家(卫生保健较难获得)中其他免疫计划的模型。

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