Impact of conflict on infant immunisation coverage in Afghanistan: a countrywide study 2000-2003.
BACKGROUND
Infant immunisation is an effective public health intervention to reduce the morbidity and mortality of vaccine preventable diseases. However, some developing countries fail to achieve desirable vaccination coverage; Afghanistan is one such country. The present study was performed to evaluate the progress and variation in infant immunisation coverage by district and region in Afghanistan and to assess the impact of conflict and resource availability on immunisation coverage.


RESULTS
This study analysed reports of infant immunisation from 331 districts across 7 regions of Afghanistan between 2000 and 2003. Geographic information system (GIS) analysis was used to visualise the distribution of immunisation coverage in districts and to identify geographic inequalities in the process of improvement of infant immunisation coverage. The number of districts reporting immunisation coverage increased substantially during the four years of the study. Progress in Bacillus Calmette-Guerin (BCG) immunisation coverage was observed in all 7 regions, although satisfactory coverage of 80% remained unequally distributed. Progress in the third dose of Diphtheria-Pertussis-Tetanus (DPT3) immunisation differed among regions, in addition to the unequal distribution of immunisation coverage in 2000. The results of multivariate logistic regression analysis indicated a significant negative association between lack of security in the region and achievement of 80% coverage of immunisation regardless of available resources for immunisation, while resource availability showed no relation to immunisation coverage.


CONCLUSIONS
Although progress was observed in all 7 regions, geographic inequalities in these improvements remain a cause for concern. The results of the present study indicated that security within a country is an important factor for affecting the delivery of immunisation services.
Mashal
Taufiq
T
Health Promotion Section, Division of Public Health, Graduate School of Tokyo Medical and Dental University, Tokyo, Japan. mtmashal.hlth@tmd.ac.jp
Nakamura
Keiko
K
Kizuki
Masashi
M
Seino
Kaoruko
K
Takano
Takehito
T
D000346:Afghanistan; D001500:BCG Vaccine / Q000008:administration & dosage; D003140:Communicable Disease Control / Q000458:organization & administration*; D016265:Conflict of Interest; D003906:Developing Countries; D015721:Diphtheria-Tetanus-Pertussis Vaccine / Q000008:administration & dosage; D005260:Female; D019538:Health Care Surveys; D006801:Humans; D017589:Immunization Programs / Q000458:organization & administration*; D007115:Immunization Schedule; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D011055:Poliovirus Vaccine, Oral / Q000008:administration & dosage; D015397:Program Evaluation; D011634:Public Health / Q000592:standards / Q000639:trends; D012189:Retrospective Studies; D018570:Risk Assessment; D012424:Rural Population; D012959:Socioeconomic Factors; D014505:Urban Population; D014611:Vaccination / Q000592:standards / Q000639:trends; D014944:World Health Organization
D001500:BCG Vaccine; D015721:Diphtheria-Tetanus-Pertussis Vaccine; D011055:Poliovirus Vaccine, Oral