Vaccine coverage with hepatitis B and other vaccines in the Colombian Amazon: do health worker knowledge and perception influence coverage?
We conducted a vaccination coverage survey in the Colombian Amazon, an area highly endemic for hepatitis B (HB), where HB vaccine was introduced in 1992. The aim was to measure vaccine coverage and factors influencing it, especially those related to health
A total of 3573 children younger than 11 years were randomly selected from four populations. Vaccination status was ascertained through the vaccination card and a questionnaire on socio-demographic factors was applied to children's caretakers. Health
workers (HW) in charge of vaccination in rural and urban areas were interviewed regarding knowledge and practices in vaccination. Individual and HW characteristics were related to individual vaccination using logistic regression. Results
Overall cumulated vaccination coverage
was high for polio (96%, 95% CI: 94–98), measles (94%, 95% CI: 92.8–95.2), BCG (91%, 95% CI: 90–93), DPT (90%, 95% CI: 88–92) and HB (88%, 95% CI: 86–90). However, <50% of children completed the primary course of vaccination in the first year of life. Individual
factors improving the likelihood of being either fully or HB vaccinated were: age > 1 year, living in Leticia, being affiliated to the social security, and living in a house with a roof made of tiles rather than palm tree leaf. Among the variables related to HWs, poor
knowledge of vaccine contraindications predicted a lower chance of being fully or HB vaccinated in the population served by them, even after controlling for individual variables. Conclusions
The HB control program in Colombia has achieved good coverage in one of the most endemic
areas of the country. However, barriers to vaccination arise from inequities in the distribution of health insurance and inadequate HW knowledge.
Document Type: Research Article
Instituto Nacional de Salud de Colombia, Universidad Nacional de Colombia, Bogotá, Colombia
Secretaria de Salud del Amazonas, Leticia, Amazonas, Colombia
Institute of Public Health and Primary Care, University of Cambridge, Cambridge, UK
London School of Hygiene and Tropical Medicine, London, UK
Publication date: April 1, 2005