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영유아의 예방 접종 및 그 관련요인

Up-to-date or Complete Immunization Coverage and Their Related Factors

김건엽|이무식|이진용|장민영|홍지영|김은영
한국농촌의학.지역보건학회 (Korean Society for Agricultural Medicine & Community Health)|2012.12|농촌의학.지역보건 (Journal of Agricultural Medicine&Community Health)|제37권 제4호|pp. 233-245

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참고문헌

키워드

Related factorsVaccination coverageNational Immunization Program

초록

이 연구는 지역단위 예방접종률 시범조사를 통해획득한 다양한 예방접종 자료를 분석하여 예방접종의 수진 관련 요인을 파악, 분석하였다. 2005년 2월부터 4월까지 일개 도농복합 지역사회 영유아 전수를 대상으로 해당 연령의 영유아들이 거주하는가구를 조사자가 직접 방문하여 보호자를 대상으로설문조사하였으며, 접종조사력에 대한 확인은 예방접종수첩자료를 우선적으로 하고, 없을 시에는 보호자의 기억력에 의존하여 조사하였다. 또한 2005년5월부터 7월까지 지역 가구조사에서 확인된 예방접종 의료기관을 대상으로 예방접종력 확인 조사를 실시하였는데, 논산 및 대전지역 병의원에 대해서는 조사자가 직접 방문하였고, 타지역의 경우 우편 설문조사를 시행하였다. 예방접종수첩에 근거한 국가필수예방접종률은DTaP 4차(79.3%)를 제외하고 92.7～96.4%였으며, 국가예방접종 완전접종률은 74.0%, 4:3:1 시리즈완전접종률은 77.1%였다. 국가필수예방접종의 완전접종은 주양육자가 부모인 경우(19개월 이상영유아에서 교차비 0.59, 95% 신뢰구간 0.39-0.87), 출생순위가 셋째 이상에 비해 빠를수록(24개월이상 영유아에서 교차비 1.79, 95% 신뢰구간1.05-3.03) 접종률이 유의하게 높았다. 4:3:1 시리즈완전접종은 19개월 이상 영유아에서 주양육자가부모인 경우(교차비 0.58, 95% 신뢰구간 0.38-0.88), 출생순위가 첫째아일수록(교차비 1.94, 95% 신뢰구간 1.21-3.14) 접종률이 높았으며, 24개월 이상영유아에서는 출생순위가 첫째아에서(교차비 2.23, 95% 신뢰구간 1.27-3.91) 유의하게 높았다. 90% 미만의 예방접종률을 보인 부적절한 수준의예방접종에 대한 대책이 필요하며, 완전접종률을높이기 위해서는 양육하는 부모의 존재와 출생순위 파악과 이에 대한 중재대책이 필요할 것이다.

Abstract

Objectives: Understanding the predictor of immunization status in childhood is critical issue to improve National Immunization Program (NIP). The aims of this study were to verify the status of up-to-date or complete immunization coverage and to investigate its related factors. Methods: As of 2005, according to local residence registry data, there were 2,188 children who aged 12 to 35 months in Nonsan city, Korea. We conducted household survey for aged 12 to 35 months children, using questionnaires to obtain data on the status of immunization such as BCG, DTaP (diphtheria, tetanus, and pertussis), Polio, and MMR (mump, measles, rubella). Finally 1,472 participated in the survey. The operating definitions used in this study were following; “Complete immunization rate” refers to the rate of children who received all immunization within recommended age intervals fully “on-time”; “The 4:3:1 series” means status of receiving the fourth diphtheria-tetanus-pertussis (4 DTP), the third Polio (3 Polio), and the first measles-mumps-rubella (1MMR) doses. Multivariate logistic regression analyses were used to determine factors affecting complete vaccination coverage of children. Results: Immunization rates of vaccine based on the vaccination card were from 92.7% to 96.4% except 4th DTaP (79.3%). Complete immunization rate of Korea NIP was 74.0% and that of the 4:3:1 series was 77.1%. A parent as primary caregiver (OR 0.59, 95% CI 0.39-0.87 at 19-35 months of children's age) and first-born children (OR 1.79, 95% CI 1.05-3.03 at 24-35 months of children's age) were significantly related to complete immunization coverage of Korea NIP. And a parent as primary care giver (OR 0.58, 95% CI 0.38-0.88 at 19-35months of children's age) and first-born children (OR 1.94, 95% CI 1.21-3.14 at 19-35 months, OR 2.23, 95%CI 1.27-3.91 at 24-35 months of children's age) were significantly related to complete immunization rate of 4:3:1 series. Conclusions: Government should take actions to increase complete immunization rate. In particular, intervention on the secondary caregiver and non-first-born children should be needed.

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