Determinants of vaccination after the Colombian health system reform.
OBJECTIVE
To assess the effects of individual, household and healthcare system factors on poor children's use of vaccination after the reform of the Colombian health system.


METHODS
A household survey was carried out in a random sample of insured poor population in Bogota, in 1999. The conceptual and analytical framework was based on the Andersen's Behavioral Model of Health Services Utilization. It considers two units of analysis for studying vaccination use and its determinants: the insured poor population, including the children and their families characteristics; and the health care system. Statistical analysis were carried out by chi-square test with 95% confidence intervals, multivariate regression models and Cronbach's alpha coefficient.


RESULTS
The logistic regression analysis showed that vaccination use was related not only to population characteristics such as family size (OR=4.3), living area (OR=1.7), child's age (OR=0.7) and head-of-household's years of schooling (OR=0.5), but also strongly related to health care system features, such as having a regular health provider (OR=6.0) and information on providers' schedules and requirements for obtaining care services (OR=2.1).


CONCLUSIONS
The low vaccination use and the relevant relationships to health care delivery systems characteristics show that there are barriers in the healthcare system, which should be assessed and eliminated. Non-availability of regular healthcare and deficient information to the population are factors that can limit service utilization.
Acosta-Ramírez
Naydú
N
Centro de Proyectos para el Desarrollo, Universidad Javeriana, Bogota, Colombia.
Durán-Arenas
Luis G
LG
Eslava-Rincón
Julia I
JI
Campuzano-Rincón
Julio C
JC
D002675:Child, Preschool; D003105:Colombia; D003430:Cross-Sectional Studies; D005191:Family Characteristics; D005260:Female; D018166:Health Care Reform; D006297:Health Services Accessibility / Q000706:statistics & numerical data*; D006801:Humans; D007223:Infant; D007407:Interviews as Topic; D008297:Male; D011203:Poverty; D012044:Regression Analysis; D012959:Socioeconomic Factors; D014611:Vaccination / Q000706:statistics & numerical data*