Análise espacial da cobertura vacinal de crianças menores de 1 ano por Município na Paraíba nos anos 2016 e 2017

Abstract

Introduction: Immunization is a human right, and over time, it has consolidated itself worldwide as one of the most cost-effective interventions in public health. It also plays an important role in reducing child mortality, in addition to the completeness of the infant vaccination calendar promoting ""herd immunity."" Objective: Spatially analyze the vaccination coverage rate of under one-year-old children per municipality in the state of Paraiba in the years 2016 and 2017. Methodology: This is a mixed ecological study on the spatial distribution of vaccine coverage in the municipalities of Paraiba, where we obtained secondary data on applied doses from the Information System of the National Immunization Program (IS-NIP) and data of live births from the live birth information system (SINASC). We calculated vaccination coverage by antigen, considering vaccines from the National Vaccination Schedule for under one-year-old children. We also performed a descriptive analysis of the immunization coverage of all immunobiologicals per year of study. The Mann-Whitney U test was used to compare the vaccination coverage between the years of study, and the Chi-square test was used to assess the association between years. VC stratified in four ranges: very low, low, adequate and very high. Spatial distribution was carried out by year of immunobiologicals study and presented in thematic maps. The spatial autocorrelation analysis was assessed using Moran Global statistics, Moran Local statistics. We used SPSS 24.0 for Windows, R, and QGIS. The level of significance was 5%. Results: In 2016, the best vaccination coverage was observed compared to 2017 (p<0.05), except BCG (Mann-Whitney U Test) which presented a slight increase in vaccination coverage but it remained below the announced goal. In the spatial analysis, the Global Moran Index, for all studied immunobiologicals, did not show spatial autocorrelation (p>0.05). Nevertheless, the Local Moran Index showed municipalities with high vaccination coverage, high similarity, and positive influence on their neighbors (p<0.05), with emphasis on the municipalities of the region of the Paraiba Sertão. In the region of Paraiba Mata, the majority of municipalities with low vaccination coverage were concentrated, negatively influencing their neighbors (p<0.05). Conclusion: Vaccination coverage in Paraiba is heterogeneous among the municipalities; the analysis space is a useful tool in visualizing uneven geographical areas. Pockets of low or high vaccination coverage demonstrate the urgency in the elaboration and coordination of an action plan by public policymakers and health planners in Paraiba directed to each region, reverse the vulnerability of this age group with a higher risk to preventable diseases.