| 1. BackgroundThe expanded program of immunization(EPI) was established in Zhejiang province since 1978. The service network of EPI was well developed and the incidence of most of the vaccine preventable diseases(VPDs) declined to the lowest level in history. Since the fast socio-economic development, Zhejiang has attracted more and more migrant people and migrant children from rural areas of other province. As the poorer awareness of health and living condition and the deficiency of the original immunization service model, the coverage rate of EPI vaccines was lower for migrant children. That also became a key issue to improve the quality of EPI service.Yiwu city is located in east China and has a total area of 1105.5 Km2 and is the biggest small commodity trade and vibrant free markets worldwide. Yiwu has 13 towns with a population of 2.13 million residents, of which 65% are migrant. Yiwu has 13 immunization clinics and 83 full-job Vaccine Personnel. The most of immunization clinics of Yiwu open every day or week. According to the recent two vaccination coverage investigations of migrant children aged< 7yrs in Yiwu, we found that the coverage of first measles containing vaccine for migrant children was lower than that for resident children and the coverage of other EPI vaccines was less than 90%. Since 2011, Yiwu participant the "study on manage strategy and model of EPI service for migrant children", which was launched by China’s ministry of health and United Nations Children’s Fund.This study aimed to assess the socio-demographic characteristics of migrant children and their caregivers, explore the risk factors of vaccination coverage and evaluate the effect of the interventions of EPI service conducted in Yiwu.2. Material and Method2.1 Resources of data2.1.1 Routine surveillance dataThe immunization records of migrant children was queried from the immunization information system of Zhejiang province, which was established in 2005. The population data of Yiwu was collected from the local public security bureau.2.1.2 Quantity investigation dataTwo round of investigation on coverage rates of EPI vaccine and impact factors among migrant children was conducted in Sep 2011 and June 2014. The content of these survey included the demographic characteristics of migrant children and their caregivers, coverage of EPI vaccines, Knowledge, attitude and practice of EPI, the demands, utilization and satisfaction of immunization service of migrant people.2.2 Study population"Migrants" in our study refer to people living in an area without f temporary household registration card issued by public security bureau of their current living areas. Migrant children aged 1-4 years and their caregivers who had lived in the surveyed areas continuously for 3 month or more at the time they were interviewed were selected as study subjects.2.3 InterventionsIntervention included making supportive policy, improving management, staff training, health education and improving the quality of vaccination service.2.4 Data collection and statistical analysisThe routine surveillance data were analyzed by Microsoft Excel 2010. Questionnaires were coded unified, inputting into computers to build database by Epidata 3.1 software.Use descriptive analysis to quantitative survey data, and χ2 test to comparisons of categorical data and rates, logistics regression to explore impact factors of coverage rates, by SPSS 13.0 software, P< 0.05 was statistically significant difference. The analysis indexes included odds ratio and its 95% confident interval (CI). We compared some variables on EPI and immunization coverage to evaluate the effect of the interventions:(1) the proportion of migrant children who have immunization cards and were registered in immunization information system; (2) the coverage of EPI vaccines and the proportion of full immunized children; (3) the coverage of non-EPI vaccines; (4)the knowledge, attitude and practice of immunization among migrant children’s caregivers;(5) the utilization of immunization service of migrant children; (6) the satisfaction of immunization service among migrant children’s caregivers. We chose the demographic characteristics, the knowledge, attitude and practice of immunization, the utilization and satisfaction of immunization service of migrant children as independent variables, explored the risk factors of coverage rates of EPI or non-EPI vaccines.3. Results3.1 The variety of EPI index before and after interventionsCompared with the survey conduct before interventions, the registered proportion in immunization information system rise from 90.9% to 95.6%; the proportion of full immunized children aged 1-4 years rise from 71.5% to 88.6% and that for children aged 2-4years rise 42.2% to 80%; a three doses of Hib schedule was covered only 0.4% of migrant children aged 1-4 years, and also the coverage of the fourth dose of Hib was 5.8% among migrant children aged 2-4 years. The coverage of VarV was 74.5%; the correct rates of five out of seven variables on knowledge of EPI were above 90%, the correct rates of seven out of eight variables on attitude of EPI were above 90%, and the correct rate of four variables on practice of EPI was>90%; The proportion of migrant children who received an immunization notification within 3 months after its immigration was up by 47.8% compared with that before interventions; The proportion of using text message or telephone for immunization notification rise from<10% to 85.2%,36.9%, respectively; The proportion of migrant people who thought the environment or order well in immunization clinics was up by 50%,57.1% compared with those before interventions, respectively; After intervention, the proportion of migrant people who thought the vaccine personnel’ manner or skill well, and got the same service as local children was up by 45.9%,68.4%,58.5%, respectively.3.2 Impact factors for coverage of EPI vaccines and non-EPI vaccines for migrant childrenThe education level of caregivers, living duration, adoption advice from friends, time interval from immigration to receiving the immunization notification, reservation for next vaccination, distance of the house to immunization clinics and the manner of vaccine personnel were associated with full immunized of children aged 1-4 years. Age of caregivers, working time per day, household register status, education level, birth place of children, living duration, priority when time conflict, time interval from immigration to receiving the immunization notification, waiting time for immunization were associated with full immunized of children aged 2-4 years.The age of caregivers, siblings, living duration, household register status, family income per month, the price of non-EPI vaccines, awareness of health education on immunization, distance of the house to immunization clinics and the manner of vaccine personnel were associated with the coverage of non-EPI vaccines.4. ConclusionThrough implementing a package of intervention including making supportive policy, improving management, staff training, health education and improving the quality of vaccination service, according to specific conditions of Yiwu, the coverage rates of EPI vaccines and the register rates among migrant children were significantly improved. The knowledge, attitude and practice towards immunization and utilization and satisfaction of immunization service among migrant people also improved compared with the baseline survey before implementing interventions. It implicated that these interventions were effective and efficiency, and these intervention could be spread to other areas with a dense migrant population. |
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