title: Predictors of completed childhood vaccination in Bolivia.
abstract: This project examines how access issues, ethnicity, and geographic region affect vaccination of children by two years of age in Bolivia. Bolivia's rich variation in culture and geography results in unequal healthcare utilization even for basic interventions such as childhood vaccination. This study utilizes secondary data from the 2008 Demographic and Health Survey for Bolivia to examine predictors of vaccination completion in children by two years of age. Using logistic regression methods, we control for health system variables (difficulty getting to a health center and type of health center as well as demographic and socio-economic covariates). The results indicated that children whose parents reported distance as a problem in obtaining health care were less likely to have completed all vaccinations. Ethnicity was not independently statistically significant, however, in a sub-analysis, people from the Quechua ethnic group were more likely to report 'distance as a problem in obtaining healthcare.' Surprisingly, living in a rural environment has a protective effect on completed vaccinations. However, geographic region did predict significant differences in the probability that children would be fully vaccinated; children in the region with the lowest vaccination completion coverage were 80% less likely to have completed vaccination compared to children in the best performing region, which may indicate unequal access and utilization of health services nationally. Further study of regional differences, urbanicity, and distance as a healthcare access problem will help refine implications for the Bolivian health system.
authors.affiliation: Department of Health Policy and Management and Hubert Department of Global Health, Emory University Rollins School of Public Health, Atlanta, Georgia, United States of America.
authors.forename: Brianna
authors.initials: B
authors.lastname: Osetinsky
authors.affiliation: Department of Health Policy and Management and Hubert Department of Global Health, Emory University Rollins School of Public Health, Atlanta, Georgia, United States of America.
authors.forename: Laura M
authors.initials: LM
authors.lastname: Gaydos
authors.affiliation: Department of Health Policy and Management and Hubert Department of Global Health, Emory University Rollins School of Public Health, Atlanta, Georgia, United States of America.
authors.forename: Juan S
authors.initials: JS
authors.lastname: Leon
keywords: Aimara; Bolivia; Quechua; Spanish; Vaccination; access; child health; ethnicity; health services; public health