Effect of several sociodemographic factors on measles immunization in children of Eastern Turkey

doi:10.1016/j.puhe.2004.01.004

Public Health

Volume 118, Issue 8, December 2004, Pages 565-569

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Abstract

This study was performed to determine the status of measles immunization and the effect of several sociodemographic factors on immunization in children aged between 10 months and 6 years.

Using cluster sampling, 663 healthy children were selected at random from three provinces in Eastern Turkey. The immunization histories of these children were obtained from their immunization cards. With respect to their vaccination status, children were categorized as vaccinated, unvaccinated or unknown. If the child had no immunization card, he or she was classified as unknown.

Of these children, 81.6% were vaccinated and 15.1% were unvaccinated. The vaccination status was not known in 3.3% of the children. In children aged 10–12 months, the vaccination rate was 68.6%. For age groups of 1–2, 2–3, 3–4, 4–5 and 5–6 years, the vaccination rates were 84.2, 82.2, 85.3, 82.1 and 76.8%, respectively, but these differences were not significant. The vaccination rates increased in parallel with maternal education level (P=0.009). Also, vaccination rates were significantly correlated with settlement area (P=0.036), and were higher in urban regions than suburban and rural regions. There was no difference in vaccination rates with respect to gender, paternal education level, number of siblings and socio-economic status.

The results of this study show that the level of immunization necessary for measles elimination has not yet been reached in Eastern Turkey. Priority should be given to increase the immunization levels to 90–95% among children.

Introduction

Measles is a highly contagious, viral disease. The risk of serious complications is highest in young children and adults.1., 2. Of vaccine-preventable diseases, measles remains one of the most important causes of childhood morbidity and mortality in developing countries. Almost all unvaccinated children contract measles, and over 2 million children die of this disease each year.3., 4. Worldwide, it is estimated that 81% of children aged 1 year receive one dose of measles vaccine.⁵ An estimated 36.5 million cases still occur each year in the world, and measles still accounts for 10% of global mortality from all causes among children aged <5 years.⁶

In 1978, it was believed that measles could be eliminated from the USA in the near future;⁷ however, continued measles outbreaks have induced public health authorities to review measles vaccination strategies. In Turkey, a single-dose vaccination is administered at 9 months of age, as recommended by the World Health Organization (WHO). Mortality from measles has decreased significantly in Turkey since 1985, when the first nationwide measles vaccination campaign started and the vaccination schedule changed from 15 to 9 months.⁸ However, because vaccine coverage is still about 80% and a single-dose vaccination schedule is used in most Turkish cities, measles outbreaks occur every 2–3 years. Every effort should be made to increase vaccine coverage to over 90% for each dose in all regions of Turkey.⁹ Parents living in Western Turkey have a higher level of education, and hence a higher socio-economic status, than parents living in Eastern Turkey.¹³ Although essential vaccines, including measles, are free of charge for children in Turkey, immunization coverage is lower in Eastern Turkey as parents are unaware of the importance of the vaccines for childhood health.

To achieve elimination of measles, knowledge of vaccination coverage is important. This study was performed to determine the status of measles vaccination and the effect of several sociodemographic factors on vaccination in children.

Section snippets

Patients and method

In this study, the rate of measles vaccination in children aged 10 months to 6 years (n=663) was investigated in Eastern Turkey between July 2000 and April 2001 with respect to several sociodemographic characteristics.

A sampling method of 30 clusters was used to select a predetermined number of subjects from the rural and urban areas in three cities. This is a practical method recommended by the WHO for field studies.10., 11. For this purpose, 30 clusters in the rural areas and 30 clusters in

Results

Table 1 shows the vaccination status of children according to several sociodemographic characteristics. Of the study population, 81.6% were vaccinated and 15.1% were unvaccinated. The vaccination status was not known in 3.3% of the children. At 10–12 months of age, 68.6% of children were vaccinated, 29.4% were unvaccinated, and the vaccination status was not known in 2%. As the age of children increased, the proportion of vaccinated children increased but there was no difference in vaccination

Discussion

Despite the advent of the measles vaccine in 1959, measles is still an important public health problem in the developing world. National recommendations for measles vaccination differ significantly between developing and developed countries. In Turkey, a mass measles immunization campaign was initiated in 1985, and the decision was made to administer the first measles vaccination in the series at 9 months of age instead of 12–15 months.¹³ At this age, transplacental antibodies have disappeared

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^☆: Presented at the 6th International Congress of Tropical Paediatrics, Ankara, Turkey, 26–30 September 2002.

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Effect of several sociodemographic factors on measles immunization in children of Eastern Turkey☆

Abstract

Introduction

Section snippets

Patients and method

Results

Discussion

Lancet

Public Health

Measles

New York State's two-dose schedule for measles immunization

Public Health Rep

Strategic plan for the elimination of measles in the European region

Country Health Report 1997

Cluster sampling to assess immunization coverage: a review of experience with a simplified sampling method

Bull World Health Organ

Observations on the application of EPI cluster survey methods for estimating disease incidence

Bull World Health Organ