Incomplete childhood immunization with new and old vaccines and associated factors: BRISA birth cohort, São Luís, Maranhão State, Northeast Brazil

Silva, Francelena de Sousa; Barbosa, Yonna Costa; Batalha, Mônica Araújo; Ribeiro, Marizélia Rodrigues Costa; Simões, Vanda Maria Ferreira; Branco, Maria dos Remédios Freitas Carvalho; Thomaz, Érika Bárbara Abreu Fonseca; Queiroz, Rejane Christine de Sousa; Araújo, Waleska Regina Machado; Silva, Antônio Augusto Moura da

Acessibilidade / Reportar erro

Brasil

Cadernos de Saúde Pública

Español English

Brasil

Español English

sumário « anterior atual seguinte »

Sumário

ARTICLE • Cad. Saúde Pública 34 (3) • 2018 • https://doi.org/10.1590/0102-311X00041717 copy

Incomplete childhood immunization with new and old vaccines and associated factors: BRISA birth cohort, São Luís, Maranhão State, Northeast Brazil

Authorship SCIMAGO INSTITUTIONS RANKINGS

This study estimated the percentages of incomplete immunization with new vaccines and old vaccines and associated factors in children 13 to 35 months of age belonging to a birth cohort in São Luís, the capital of Maranhão State, Brazil. The sample was probabilistic, with 3,076 children born in 2010. Information on vaccination was obtained from the Child’s Health Card. The new vaccines, namely those introduced in 2010, were meningococcal C and 10-valent pneumococcal, and the old vaccines, or those already on the childhood immunization schedule, were BCG, hepatitis B, human rotavirus, polio, tetravalent (diphtheria, tetanus, pertussis, Haemophilus influenzae b), yellow fever, and triple viral (measles, mumps, rubella). The study used hierarchical modeling and Poisson regression with robust variance. Prevalence ratios (PR) and 95% confidence intervals (95%CI) were calculated. Incomplete immunization was higher with new vaccines (51.1%) than with old vaccines (33.2%). Children 25 to 35 months of age (PR = 1.27; 95%CI: 1.14-1.41) and those in economic classes D/E (PR = 1.20; 95%CI: 1.06-1.35) were only significantly associated with new vaccines; low maternal schooling (PR = 1.58; 95%CI: 1.21-2.06), unavailability of outpatient and/or hospital care for the child (PR = 1.20; 95%CI: 1.04-1.38), and unavailability of the vaccine in health services (PR: 1.28; 95%CI: 1.12-1.46) were only associated with old vaccines. Immunization strategies should consider the vulnerability of older preschool-age children and those belonging to classes D and E, especially when new vaccines are introduced, as well as children of mothers with low schooling. Strategies should also address problems with the availability of health services and vaccines.

Keywords:
Immunization Coverage; Immunization Programs; Child Health

Variables	n (N = 3,076)	% *
Distal level - socioeconomic and demographic charateristics
Mother’s age (n = 3,076)
Adult	2,537	82.6
Adolescent	539	17.4
Mother’s skin color (n = 3,037)
White	539	17.3
Brown	2,089	69.3
Black	409	13.4
Economic class ** (n = 3,076)
A/B	564	16.5
C	1,783	59.8
D/E	729	23.7
Who is head of family (n = 3,058)
Interviewee’s spouse/partner	1,846	61.0
Interviewee’s mother/father	537	17.4
Other	397	12.9
Interviewee	278	8.7
Mother’s schooling in years (n = 3,043)
≥ 12	419	12.3
9-11	2,244	75.5
5-8	310	9.9
0-4	70	2.3
Number of activities by mother *** (n = 3,076)
0	96	3.0
1	1,798	58.3
2	1,062	34.8
3	120	3.9
Number of child’s siblings living in the household (n = 3,076)
0	1,517	49.9
1	991	32.2
2-3	493	15.6
> 3	75	2.3
Child’s age, in months, when enrolled in Bolsa Família Program (n = 2,957)
Not enrolled	2,148	72.1
Familiy enrolled before child was born	359	12.3
0-6	113	3.9
7-12	169	5.9
> 12	168	5.8
Child’s age in months (n = 3,076)
13-18	2,061	67.7
19-24	713	22.8
25-35	302	9.5
Child’s sex (n = 3,076)
Male	1,572	51.3
Female	1,504	48.7
Intermediate level - maternal characteristics
Behavioral
Smokes (n = 3,048)
No	2,904	95.5
Yes	144	4.5
Alchool consumption (n = 3,048)
No	2,396	78.8
Yes	652	21.2
Planned pregnancy (n = 3,073)
No	974	31.9
Yes	2,099	68.1
Conjugal status (n = 3,076)
Married	656	20.6
Common-law marriage	1,826	60.2
Without partner	594	19.2
Reproductive history
Preterm and/or low birth weight (n = 2,687)
No	2,258	84.3
Preterm	220	8.0
Low birth weight	86	3.1
Preterm and low birth weight	123	4.6
New pregnancy in firts year after birth of index child (n = 3,050)
No	2,789	91.7
Yes	261	8.3
Proximal level - use of health services
Prenatal care
Trimester of firts prenatal visit (n = 2,983)
1^st	2,097	70.9
2^nd	833	27.4
3^rd	53	1.7
Number of prenatal visits (n = 2,957)
≥ 6	1,968	69.5
< 6	989	30.5
Place of prenatal care (n = 3,038)
Private sector	489	13.1
Public sector	2,549	86.9
Care in FHS
Enrolled in FHS (n = 3,073)
Yes	583	19.1
No	2,490	80.9
Visit by CHW during pregnancy (n = 3,074)
Yes	970	32.5
No	2,104	67.5
Care in FHS during pregnancy (n = 3,073)
Yes	352	11.5
No	2,721	88.5
Healthcare and availability of vaccine
Child has private health plan (n = 3,076)
Yes	821	25.8
No	2,255	74.2
Use of outpatient, inpatient, and immunization services by child (n = 3,076)
Yes	2,185	71.2
No, for other reasons	418	13.6
No, for lack of vaccine	473	15.2
Outcomes for individual vaccines - incomplete immunization ^#
BCG	17	0.5
Polio	135	4.2
Hepatitis B	178	5.8
Tetravalent	251	7.9
Yellow fever	310	9.5
Triple viral	341	10.6
Human rotavirus	591	18.8
Meningococcal C	1,012	32.2
10-valent pneumococcal	1,537	48.9
Immunization schedule, old vaccines ^##	1,045	33.2
Immunization schedule, new vaccines ^###	1,605	51.1

Variables	Incomplete immunization with new vaccines *
	Unadjusted			Adjusted **
	% ***	PR (95%CI) ***	p-value ***	PR (95%CI) ***	p-value ***
Distal level - socioeconomic and demographic charateristics
Mother’s age			0.162		0.002
Adult	50.5	1.00		1.00
Adolescent	53.8	1.06 (0.97-1.16)		1.15 (1.05-1.27)
Mother’s skin color			0.620
White	50.0	1.00
Brown	51.6	1.03 (0.93-1.13)
Black	49.2	0.98 (0.86-1.12)
Economic class ^#			< 0.001		0.004
A/B	45.8	1.00		1.00
C	50.1	1.09 (0.98-1.21)		1.04 (0.97-1.20)
D/E	57.2	1.24 (1.11-1.39)		1.20 (1.06-1.35)
Who is head of family			0.591
Interviewee’s spouse/partner	50.1	1.00
Interviewee’s mother/father	51.9	1.03 (0.94-1.14)
Other	51.3	1.02 (0.91-1.14)
Interviewee	54.2	1.08 (0.95-1.22)
Mother’s schooling in years			< 0.001
≥ 12	42.2	1.00
9-11	51.2	1.21 (1.06-1.37)
5-8	56.9	1.34 (1.15-1.57)
0-4	67.9	1.60 (1.31-1.97)
Number of activities by mother ^##			0.085
0	58.1	1.00
1	52.5	0.90 (0.75-1.08)
2	48.4	0.83 (0.68-1.00)
3	47.6	0.82 (0.62-1.06)
Number of child’s siblings living in the household			< 0.001		< 0.001
0	44.6	1.00		1.00
1	56.0	1.25 (1.15-1.36)		1.29 (1.19-1.40)
2-3	60.0	1.34 (1.22-1.48)		1.33 (1.24-1.52)
> 3	61.4	1.37 (1.12-1.68)		1.36 (1.11-1.67)
Child’s age, in months, when enrolled in Bolsa Família Program			0.043
Not enrolled	50.1	1.00
Familiy enrolled before child was born	55.1	1.10 (0.99-1.22)
0-6	42.5	0.84 (0.67-1.06)
7-12	49.1	0.98 (0.83-1.15)
> 12	58.2	1.16 (1.01-1.33)
Child’s age in months			< 0.001		< 0.001
13-18	48.8	1.00		1.00
19-24	53.2	1.09 (0.99-1.18)		1.07 (0.98-1.17)
25-35	61.9	1.26 (1.14-1.40)		1.26 (1.14-1.39)
Child’s sex			0.851
Male	51.2	1.00
Female	50.9	1.00 (0.93-1.08)
Intermediate level - maternal characteristics
Behavioral
Smokes			< 0.001		0.003
No	50.3	1.00		1.00
Yes	64.2	1.27 (1.11-1.46)		1.22 (1.07-1.40)
Alchool consumption			0.722
No	50.7	1.00
Yes	51.5	1.01 (0.93-1.10)
Planned pregnancy			0.002		0.028
No	46.7	1.00		1.00
Yes	53.2	1.13 (1.05-1.23)		1.09 (1.00-1.18)
Conjugal status			0.019
Married	45.8	1.00
Common-law marriage	52.5	1.14 (1.04-1.26)
Without partner	52.1	1.13 (1.01-1.28)
Reproductive history
Preterm and/or low birth weight			0.641
No	50.5	1.00
Preterm	51.8	1.02 (0.89-1.17)
Low birth weight	47.3	0.92 (0.74-1.18)
Preterm and low birth weight	45.1	0.89 (0.72-1.09)
New pregnancy in firts year after birth of index child			0.001		0.009
No	50.1	1.00		1.00
Yes	59.9	1.19 (1.07-1.33)		1.16 (1.03-1.29)
Proximal level - use of health services
Prenatal care
Trimester of firts prenatal visit			< 0.001		0.002
1^st	49.7	1.00		1.00
2^nd	52.7	1.06 (0.97-1.14)		0.93 (0.85-1.01)
3^rd	74.3	1.49 (1.26-1.76)		1.27 (1.07-1.52)
Number of prenatal visits			< 0.001		0.001
≥ 6	47.3	1.00		1.00
< 6	58.4	1.22 (1.13-1.31)		1.15 (1.06-1.25)
Place of prenatal care			< 0.001
Private sector	42.5	1.00
Public sector	52.3	1.23 (1.10-1.39)
Care in FHS
Enrolled in FHS			0.814
Yes	51.5	1.00
No	50.9	0.98 (0.90-1.08)
Visit by CHW during pregnancy			0.051
Yes	53.6	1.00
No	49.8	0.92 (0.86-1.00)
Care in FHS during pregnancy			0.023
Yes	56.6	1.00
No	50.2	0.88 (0.80-0.98)
Healthcare and availability of vaccine
Child has private health plan			< 0.001
Yes	43.3	1.00
No	53.7	1.24 (1.13-1.35)
Use of outpatient, inpatient, and immunization services by child			0.001
Yes	50.0	1.00
No, for other reasons	58.2	1.16 (1.05-1.27)
No, for lack of vaccine	49.4	0.98 (0.88-1.09)

Variables	Incomplete immunization with old vaccines *
	Undajusted			Adjusted **
	% ***	PR (95%CI) ***	p-value ***	PR (95%CI) ***	p-value ***
Distal level - socioeconomic and demographic charateristics
Mother’s age			0.115		0.001
Adult	32.6	1.00		1.00
Adolescent	36.2	1.10 (0.97-1.26)		1.26 (1.10-1.45)
Mother’s skin color			0.427
White	30.9	1.00
Brown	33.6	1.08 (0.94-1.25)
Black	34.7	1.12 (0.92-1.35)
Economic class ^#			0.019
A/B	29.0	1.00
C	33.0	1.13 (0.97-1.32)
D/E	36.7	1.26 (1.07-1.49)
Who is head of family			0.177
Interviewee’s spouse/partner	32.5	1.00
Interviewee’s mother/father	35.4	1.09 (0.95-1.25)
Other	30.6	0.94 (0.79-1.11)
Interviewee	37.5	1.15 (0.97-1.37)
Mother’s schooling in years			< 0.001		< 0.001
≥ 12	29.4	1.00		1.00
9-11	31.9	1.08 (0.91-1.29)		0.99 (0.83-1.18)
5-8	42.9	1.46 (1.18-1.79)		1.20 (0.96-1.49)
0-4	54.7	1.86 (1.42-2.44)		1.58 (1.21-2.06)
Number of activities by mother ^##			0.864
0	36.9	1.00
1	32.8	0.89 (0.67-1.18)
2	33.5	0.90 (0.68-1.21)
3	34.1	0.92 (0.63-1.34)
Number of child’s siblings living in the household			< 0.001		< 0.001
0	28.1	1.00		1.00
1	35.8	1.27 (1.13-1.44)		1.32 (1.17-1.49)
2-3	41.9	1.49 (1.31-1.72)		1.55 (1.34-1.80)
> 3	52.7	1.87 (1.47-2.40)		1.81 (1.41-2.33)
Child’s age, in months, when enrolled in Bolsa Família Program			0.052
Not enrolled	31.9	1.00
Familiy enrolled before child was born	33.7	1.05 (0.89-1.23)
0-6	38.8	1.21 (0.94-1.55)
7-12	29.2	0.91 (0.71-1.16)
> 12	41.3	1.29 (1.06-1.57)
Child’s age in months			0.552
13-18	33.5	1.00
19-24	31.7	0.94 (0.83-1.07)
25-35	35.1	1.04 (0.88-1.24)
Child’s sex			0.927
Male	33.2	1.00
Female	33.3	0.99 (0.89-1.10)
Intermediate level - maternal characteristics
Behavioral
Smokes			< 0.001		< 0.001
No	32.3	1.00		1.00
Yes	52.3	1.61 (1.35-1.92)		1.52 (1.28-1.82)
Alchool consumption			0.012
No	32.1	1.00
Yes	37.4	1.16 (1.03-1.31)
Planned pregnancy			< 0.001		0.009
No	28.5	1.00		1.00
Yes	35.5	1.24 (1.10-1.40)		1.18 (1.05-1.31)
Conjugal status			0.022
Married	28.7	1.00
Common-law marriage	33.9	1.18 (1.02-1.36)
Without partner	35.7	1.25 (1.06-1.48)
Reproductive history
Preterm and/or low birth weight			0.283
No	32.9	1.00
Preterm	36.8	1.11 (0.92-1.34)
Low birth weight	24.9	0.75 (0.51-1.10)
Preterm and low birth weight	35.5	1.07 (0.83-1.38)
New pregnancy in firts year after birth of index child			0.010		0.009
No	32.6	1.00		1.00
Yes	40.4	1.23 (1.05-1.45)		1.22 (1.04-1.43)
Proximal level - use of health services
Prenatal care
Trimester of firts prenatal visit			< 0.001		0.038
1^st	30.4	1.00		1.00
2^nd	39.2	1.28 (1.15-1.43)		1.08 (0.96-1.22)
3^rd	53.5	1.75 (1.34-2.29)		1.40 (1.06-1.86)
Number of prenatal visits			< 0.001		< 0.001
≥ 6	29.5	1.00		1.00
< 6	41.8	1.41 (1.27-1.56)		1.25 (1.11-1.40)
Place of prenatal care			0.078
Private sector	29.4	1.00
Public sector	33.8	1.14 (0.98-1.34)
Care in FHS
Enrolled in FHS			0.576
Yes	32.2	1.00
No	33.5	1.03 (0.90-1.18)
Visit by CHW during pregnancy			0.042
Yes	35.8	1.00
No	32.1	0.89 (0.80-0.99)
Care in FHS during pregnancy			0.050
Yes	37.9	1.00
No	32.6	0.86 (0.74-1.00)
Healthcare and availability of vaccine
Child has private health plan			< 0.001
Yes	26.8	1.00
No	35.5	1.32 (1.15-1.50)
Use of outpatient, inpatient, and immunization services by child			< 0.001		< 0.001
Yes	30.3	1.00		1.00
No, for other reasons	40.3	1.33 (1.16-1.52)		1.20 (1.04-1.38)
No, for lack of vaccine	40.8	1.34 (1.18-1.53)		1.28 (1.12-1.46)

Escola Nacional de Saúde Pública Sergio Arouca, Fundação Oswaldo Cruz Rua Leopoldo Bulhões, 1480 , 21041-210 Rio de Janeiro RJ Brazil, Tel.:+55 21 2598-2511, Fax: +55 21 2598-2737 / +55 21 2598-2514 - Rio de Janeiro - RJ - Brazil
E-mail: cadernos@ensp.fiocruz.br

Acompanhe os números deste periódico no seu leitor de RSS

[1] * Correspondence F. S. Silva Programa de Pós-graduação em Saúde Coletiva, Departamento de Saúde Pública, Universidade Federal do Maranhão. Rua Barão de Itapary 155, São Luís, MA 65020-070, Brasil. francelenasilva@gmail.com