Análise da cobertura vacinal de crianças até 2 anos de idade na macrorregião oeste da Bahia entre 2016 a 2019

Abstract

Introduction: Immunization is the public health policy most effective for saving millions of lives worldwide. Objective: To analyze the vaccination coverage of children from 0 to 2 years of age in the Western macro-region of Bahia between 2016 and 2019. Methodology: Mixed ecological study using information on applied doses obtained from the Information System of the National Immunization Program (SIPNI), data on live births obtained from the Information System on Live Births (SINASC), mortality data obtained from the Mortality Information System (SIM) provided by the Informatics Department of the Unified Health System (DATASUS). Socioeconomic, demographic, and environmental information was obtained from the Brazilian Institute of Geographic and Statistics (SIDRA - IBGE). Vaccination coverage (CV) per antigen was calculated considering the dose applied for single-dose vaccines was considered, and the last dose for vaccines with the multi-dose regimen. Descriptive analysis of all study variables was performed. Kruskal-Wallis tests were used, followed by Dunn’s multiple comparison test to compare the three macro-regions. Thematic maps were elaborated to analyze the spatial dynamics of the vaccine coverage of each immunobiological per year of study. The significance level was 5%. The statistical package used was SPSS 24.0 for Windows and QGIZ 4.0. Results: For the year 2016, it was observed that Barreiras has the lowest BCG CV in relation to the other two macro-regions (p<0.05); Ibotirama has all adequate CV means; and Santa Maria has the worst cv averages. In 2017, by the Kruskal-Wallis test, it was observed that the three regions differ from each other for BCG vaccines (p=0.003), hepatitis B (p=0.010), HIB (p=0.010), DPT (p=0.010), poliomyelitis rotavirus (p=0.018), pneumococcal (p=0.014), meningococcal (p=0.036) and hepatitis A (p=0.036). By Dunn’s multiple comparation test, the Barriers macro-region has the lowest CV in relation to Ibotirama (p=0.006) and Santa Maria (p=0.029). For the other immunobiologicals, we have that the Ibotirama macro-region has the best CV compared to the macro-region of Santa Maria (p<0.05). In 2018, by the Kruskal-Wallis test, a difference was observed between the three regions for BCG CV (p=0.008), meningococcal (p=0.016), SCR2 (p=0.041) and chickenpox (p=0.015). Dunn's multiple-rate analysis test showed that Barreiras has the lowest BCG CV in relation to the Ibotirama macro-region (p=0.005) and Santa Maria (p=0.022). Meningococcal CV in the Santa Maria macro-region presents the lowest mean in relation to Ibotirama (p=0.046) and Barreiras (p=0.037); Ibotirama has a higher mean CV for SCR2 and chickenpox than the other macro-regions (p<0.05). In 2019, by the Kruskal-Wallis test, it was observed that the three regions differ from each other for BCG CV (p=0.001), SCR2 (p=0.041) and chickenpox (p=0.015). By Dunn’s multiple comparation test we have that Ibotirama has the best BCG CV average in relation to a Barreiras (p<0.01) and Santa Maria (p=0.007); Ibotirama presents a higher mean CV for SCR2 and chickenpox than the other macro-regions (p<0.05). Conclusion: The data presented prove the importance of an efficient CV, with a competent structure, which allows a reach in less favored rural areas, in the construction of a State that values human life.