The association between travel time to health facilities and childhood vaccine coverage in rural Ethiopia. A community based cross sectional study.

BACKGROUND: Few studies have examined associations between access to health care and childhood vaccine coverage in remote communities that lack motorised transport. This study assessed whether travel time to health facilities was associated with childhood vaccine coverage in a remote area of Ethiopia. METHODS: This was a cross-sectional study using data from 775 children aged 12-59 months who participated in a household survey between January -July 2010 in Dabat district, north-western Ethiopia. 208 households were randomly selected from each kebele. All children in a household were eligible for inclusion if they were aged between 12-59 months at the time of data collection. Travel time to vaccine providers was collected using a geographical information system (GIS). The primary outcome was the percentage of children in the study population who were vaccinated with the third infant Pentavalent vaccine ([Diphtheria, Tetanus,-Pertussis Hepatitis B, Haemophilus influenza type b] Penta3) in the five years before the survey. We also assessed effects on BCG, Penta1, Penta2 and Measles vaccines. Analysis was conducted using Poisson regression models with robust standard error estimation and the Wald test. RESULTS: Missing vaccination data ranged from 4.6% (36/775) for BCG to 16.4% (127/775) for Penta3 vaccine. In children with complete vaccination records, BCG vaccine had the highest coverage (97.3% [719/739]), Penta3 coverage was (92.9% [602/648]) and Measles vaccine had the lowest coverage (81.7% [564/690]). Children living ≥60mins from a health post were significantly less likely (adjRR = 0.85 [0.79-0.92] p value < =0.001) to receive Penta3 vaccine compared to children living <30mins from a health post. This effect was not modified by household wealth (p value = 0.240). Travel time also had a highly significant association with BCG (adjRR = 0.95 [0.93-0.98] p value =0.002) and Measles (adjRR = 0.88 [0.79-0.97] p value =0.027) vaccine coverage. CONCLUSIONS: Travel time to vaccine providers in health posts appeared to be a barrier to the delivery of infant vaccines in this remote Ethiopian community. New vaccine delivery strategies are needed for the hardest to reach children in the African region

Administrative applications

Nurse managers play a critical role in ensuring an appropriate number and mix of staff are available to ensure safe patient care is provided. When leadership decisions are effective, we see improved patient care outcomes, better staff performance, increased job satisfaction and staff retention. However, when decision making is less effective both patients and staff can be negatively impacted. The impact is particularly noticeable for patients who may experience increased adverse events, including greater risk of dying. Making evidence-based staffing decisions can be challenging for nurse managers given the complexity of today’s workplace and importantly, a lack of access to real-time data. Many factors impact on their decisions including nursing shortages; challenges to skills mix (human capital such as experience and qualifications); staff stress, burnout and fatigue; changes to the complexity of patient care needs; an aging workforce and communication inefficiencies. There are many workload measurement tools used internationally, but most are not based on real-time data showing patient acuity, bed occupancy rates and the quality and availability of staffing resources, all factors which are necessary to make cost-effective staffing decisions. Instead, nurse managers are left with many static and disparate reporting systems that do not meet managerial requirements for decision-making. This can result in increased workloads and stress for nurse managers, which also ultimately impact clinical staff. Hospitals need to develop and use software systems which will harness existing data, allowing nurse managers to extract, analyze and interpret data in a timely manner to support appropriate and safe nurse staffing decisions