Predictors of Completed Childhood Vaccination in Bolivia Open Access

Abstract

This research examines how access issues, ethnicity, and geographic region affect under 5 vaccination in Bolivia. Bolivia's rich variation in culture and geography may result in unequal healthcare utilization even for basic interventions such as childhood vaccination. This study utilizes secondary data from the 2008 Demographic and Health Survey for Bolivia to examine predictors of vaccination completion in children by two years of age. Using logistic regression methods, we control for health system variables (difficulty getting to a health center and type of health center as well as demographic and socio-economic covariates). The results indicated that children whose parents reported distance as a problem in obtaining health care were less likely to have completed all vaccinations. Ethnicity was not independently statistically significant, however in a sub-analysis, people from the Quechua ethnic group were more likely to report 'distance as a problem in obtaining healthcare.' Surprisingly, living in a rural environment has a protective effect on completed vaccinations. However, geographic region did predict significant differences in the probability that children would be fully vaccinated; children in the region with the lowest vaccination completion coverage were 80% less likely to have completed vaccination as children in the best performing region, which may indicate demonstrated unequal access and utilization of health services nationally. Further study on regional differences, urbanicity, and distance as a healthcare access problem will help refine implications for the Bolivian health system.

Table of Contents

INTRODUCTION................................................................................................ 1

BACKGROUND................................................................................................... 1

LITERATURE REVIEW......................................................................................... 3

Vaccinations in Low and Middle Income Countries................................................... 3

Vaccination in Bolivia........................................................................................ 4

METHODS....................................................................................................... 6

Research Questions.......................................................................................... 6

Data.............................................................................................................. 7

Theoretical Framework...................................................................................... 8

Dependent Variable.......................................................................................... 9

Key Independent Variables............................................................................... 10

Covariates.................................................................................................... 10

Analysis........................................................................................................ 11

Results......................................................................................................... 11

Descriptive Statistics...................................................................................... 12

Model 1: Research Questions 1-3 Completed Vaccination....................................... 13

Model 2: Research Question 4 Distance.............................................................. 14

Discussion.................................................................................................... 16

Limitations.................................................................................................... 18

Policy and Practice Implications........................................................................ 20

Conclusion.................................................................................................... 21

References................................................................................................... 21

About this Master's Thesis

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School	Rollins School of Public Health
Department	Health Policy and Management
Degree	MSPH
Submission	Master's Thesis
Language	English
Research Field	Health Sciences, Public Health
Keyword	Bolivia Child Health Vaccination
Committee Chair / Thesis Advisor	Gaydos, Laurie, Emory University
Committee Members	Leon, Juan, Emory University
Partnering Agencies	Does not apply (no collaborating organization)

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