农村儿童乙肝疫苗首针及时接种的多水平模型分析——中国公共卫生.docVIP

农村儿童乙肝疫苗首针及时接种的多水平模型分析( 刘彩 摘 要: 目的 探讨河北省农村儿童乙肝疫苗首针及时接种现状及其影响因素。方法 采用多阶段与概率比例规模抽样结合方法，抽取保定和石家庄市4个县12 个村的1106名≤15岁儿童，对其乙肝疫苗接种史、父母人口社会学状况进行问卷调查，以个体为水平1，村为水平2，构建多水平logistic回归模型拟合数据。结果 儿童乙肝疫苗首针及时接种存在村一级聚集性（χ2=6.346，P=0.012）；多水平模型发现：年龄越小、出生在高级别医疗卫生服务机构、具有户口和父母受教育程度较高的儿童首针及时接种较好。结论 多水平模型适用于层次结构数据的儿童乙肝疫苗首针及时接种分析，确保儿童在医疗机构出生，重视无户口新生儿及提高父母认知是提高农村儿童乙肝疫苗首针及时接种的重要举措。 关键词：乙肝疫苗；首针及时接种；多水平模型 Application of Multilevel Model on Timely First Dose of Hepatitis B Vaccine of Children in Rural Area LIU Cai, Faculty of public services management, School of Management, Tianjin University of Traditional Chinese Medicine, Tianjin, 300073, China. Abstract: Objective To explore current situation and influence factors of timely first dose of children in rural area in Hebei province. Methods 1106 children aged 15 years old and younger were selected from 12 villages in 4 counties by probability proportionate to size sampling in Baoding and Shijiazhuang city, investigated them on hepatitis B vaccination history and parents’ demography and social status using questionnaire. Multilevel logistic model was employed with individual as level 1 and village as level 2. Results there is aggregation effect on village level in timely first dose of children（χ2=6.346，P=0.012）；Multilevel logistic model find that better timely first dose with the younger, born in higher level health care institutions, registered and higher education level parents. Conclusion It is proper to apply multilevel model to analyze timely first dose of children. To make sure children born in hospital, pay more attention to newborns not being registered and improve parents’ cognition level are important measures for increasing coverage of timely first dose of children in rural area. Keywords: Hepatitis B; timely first dose; multilevel logistic model 乙肝疫苗首针及时接种是指新生儿出生后24小时内接种第1针乙肝疫苗有研究报道，新生儿首针乙肝疫苗的及时接种可减少＞90%的由 HBsAg 阳性母亲传给子女的发病数[1]。因此乙肝疫苗首针及时接种是预防乙肝感染的最重要环节。且我国现有乙肝患者多数为母婴或父婴垂直传播感染，而首针及时接种对阻断代代相传具有重要作用。但2006年卫生部在1～14岁儿童乙肝血清流行病学调查中发现，有乙