Identification of factors associated with deficient immunization coverage: An instrument to manage preventive health services

One of the most important challenges in the management of childhoodimmunization programmes is the persistence of some populationgroups with deficient immunization coverage. In the presentstudy we identify some factors associated with deficient immunizationcoverage in pre-school populations living in Murcia (Spain).The main purpose is to develop some instruments to help managersof immunization programmes in developing strategies directedat high risk groups. Case-control study was designed on thebasis of pre-school population (8579 children) living in thecity during 1989 and 1990. All of the 380 cases and a similarnumber of randomly chosen controls were studied. Multivariatelogistic regression method was used for statistical analysis.Secondly, two nominal group techniques were conducted with healthand social professionals, and, lastly, one group interview wasconducted with some mothers of deficiently immunized children.Variables associated with a deficient immunization coverageincluded: a large number of children in the family, being bornat public hospitals, a greater age of the child, and livingin certain city zones. The most important problems detectedby professionals are lack of social and health services coordination,poor functioning of administrative registers, lack of strategiesto catch marginal groups, and missed opportunities for the immunizationof high-risk children. Mothers identified some problems in servicesaccessibility, inadequate information from health professionals,and special characteristics of marginal groups. Informationfrom registers (case-control study), professionals, and consumersproves some useful in the management of preventive services.Early identification of high-risk children with deficient immunizationcoverage would make it possible to assign more resources togroups with greater needs.