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    The impact of community-based outreach immunisation services on immunisation coverage with GIS network accessibility analysis in peri-urban areas, Zambia


    Sasaki, Satoshi and Igarashi, Kumiko and Fujino, Yasuyuki and Comber, Alexis and Brunsdon, Chris and Muleya, Clala Mbwili and Suzuki, Hiroshi (2010) The impact of community-based outreach immunisation services on immunisation coverage with GIS network accessibility analysis in peri-urban areas, Zambia. Journal of Epidemiology and Community Health, 65 (12). pp. 1171-1178. ISSN 1470-2738

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    Abstract

    determinant for health outcome. Objectives To examine the association between immunisation coverage and distance to an immunisation service as well as socio-demographic and economic factors before and after the introduction of outreach immunisation services, and to identify optimal locations for outreach immunisation service points in a peri-urban area in Zambia. Methods Repeated cross-sectional surveys were conducted for two groups of children born between 1999 and 2001, and between 2003 and 2005.The association between immunisation coverage for DPT3 and measles, and access distance, child sex, female headed households, and monthly household income were assessed using logistic regression analysis. Optimal locations for outreach service points were identified using GIS network analysis and genetic algorithms. Results Before the introduction of outreach services, longer distances to the service points were associated with lower DPT3 and measles immunisation coverage (OR¼0.24, 95% CI 0.10 to 0.56, p<0.01 for DPT3; and OR¼0.38, 95% CI 0.17 to 0.83, p<0.05 for measles). However, access distances were not an impediment to immunisation coverage once the outreach services were introduced. The average distance to immunisation services could be decreased from 232.3 to 168.4 metres if the current 12 outreach service points were repositioned at optimal locations. Conclusion Access distance to immunisation services was a critical determinant of immunisation coverage in a peri-urban area. Intervention via outreach services played an important role in averting the risk of missing out on immunisation. Optimal location analysis has the potential to contribute to efficient decision making regarding the delivery of immunisation services.

    Item Type: Article
    Keywords: community-based outreach; immunisation services; immunisation coverage; GIS network accessibility analysis in peri-urban; areas; Zambia;
    Academic Unit: Faculty of Science and Engineering > Research Institutes > National Centre for Geocomputation, NCG
    Item ID: 5864
    Identification Number: https://doi.org/10.1136/jech.2009.104190
    Depositing User: Prof. Chris Brunsdon
    Date Deposited: 19 Feb 2015 09:57
    Journal or Publication Title: Journal of Epidemiology and Community Health
    Publisher: BMJ Publishing Group
    Refereed: Yes
    URI:

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