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  • Area-based determinants of outreach vaccination for reaching vulnerable populations: A cross-sectional study in Pakistan
Title: Area-based determinants of outreach vaccination for reaching vulnerable populations: A cross-sectional study in Pakistan
The objective of this study is to gain a comparative understanding of spatial determinants for outreach and clinic vaccination, which is critical for operationalizing efforts and breaking down structural biases; particularly relevant in countries where resources are low, and sub-region variance is high. Leveraging a massive effort to digitize public system reporting by Lady and Community Health Workers (CHWs) with geo-located data on over 4 million public-sector vaccinations from September 2017 through 2019, understanding health service operations in relation to vulnerable spatial determinants were made feasible. Location and type of vaccinations (clinic or outreach) were compared to regional spatial attributes where they were performed. Important spatial attributes were assessed using three modeling approaches (ridge regression, gradient boosting, and a generalized additive model). Consistent predictors for outreach, clinic, and proportion of third dose pentavalent vaccinations by region were identified. Of all Penta-3 vaccination records, 86.3% were performed by outreach efforts. At the tehsil level (fourth-order administrative unit), controlling for child population, population density, proportion of population in urban areas, distance to cities, average maternal education, and other relevant factors, increased poverty was significantly associated with more in-clinic vaccinations (β = 0.077), and lower proportion of outreach vaccinations by region (β = -0.083). Analyses at the union council level (fifth-administrative unit) showed consistent results for the differential importance of poverty for outreach versus clinic vaccination. Relevant predictors for each type of vaccination (outreach vs. in-clinic) show how design of outreach vaccination can effectively augment vaccination efforts beyond healthcare services through clinics. As Pakistan is third among countries with the most unvaccinated and under-vaccinated children, understanding barriers and factors associated with vaccination can be demonstrative for other national and sub-national regions facing challenges and also inform guidelines on supporting CHWs in health systems.  more » « less
Award ID(s):
1845487
PAR ID:
10510712
Author(s) / Creator(s):
; ; ; ; ;
Editor(s):
Singh, Aditya
Publisher / Repository:
PLOS Global Health
Date Published:
Journal Name:
PLOS Global Public Health
Volume:
3
Issue:
9
ISSN:
2767-3375
Page Range / eLocation ID:
e0001703
Format(s):
Medium: X
Sponsoring Org:
National Science Foundation
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