의료급여가구 영유아의 예방접종률과 관련요인 분석

Abstract

[한글]

이 연구의 목적은 대도시 의료급여가구 영유아의 예방접종률, 적기접종률, 완전접종률 조사를 통해 예방접종 이행실태를 파악하고, 예방접종 관련요인을 분석하여 저소득층의 예방접종률 향상방안과 국가 무료예방접종사업의 개선방향을 제시하는 것이다.

이 연구는 2004년 5월 3일부터 8일까지와 동월 23일부터 30일까지 2차에 걸쳐 총 12일간, 인천광역시 4개구 24개월 미만의 의료급여가구 영유아 127명 중 88명을 대상으로 면담조사를 통해 이루어졌다. 예방접종 관련요인 분석은 BCG-B형간염-DPT-Polio 완전접종률을 종속변수로 선정하고, 관련요인에 따른 완전접종률의 차이를 카이제곱검사로 검정하였다.

의료급여가구 영유아의 예방접종 이행실태 설문결과, 예방접종의 누락 및 지연 사유로 “아이의 질환”이 38.6%, “깜박 잊어버려서“가 22.8%, ”돈이 없어서“가 20.2%순이었다. 접종기관 선택이유에 대하여 보건소를 이용하는 이유로 ”비용저렴”이 54.9%, “신뢰감”이 22.0%순이었고, 민간의료기관을 이용하는 이유로 “이용이 편리한 위치“가 36.7%, ”질병으로 평상시 이용“이 33.3%순이었다. 접종기관 분포는 보건소에서 접종받는 비율이 BCG는 30.0%, B형간염 1차, 2차, 3차는 각각 11.9%, 45.0%, 59.1%, DPT-Polio 1차, 2차, 3차는 각각 55.0%, 59.4%, 60.7%, MMR은 64.7%이었다. 예방접종 수첩보유율은 94.3%이었다. 예방접종률은 BCG가 95.2%, B형간염 1차, 2차, 3차는 각각 100.0%, 97.6%, 90.0%, DPT-Polio 1차, 2차, 3차는 각각 97.5%, 87.7%, 87.1%이었고, MMR은 83.3%이었다. 적기접종률은 BCG가 61.0%, DPT-Polio 1차, 2차, 3차는 각각 87.7%, 78.1%, 74.3%, MMR은 61.1%이었다. B형간염과 DPT-Polio 3회 완전접종률은 각각 90.0%와 85.7%이었다. 예방접종 관련요인 분석결과, 거주지에서 보건소까지의 도달시간이 “20분 이하”인 군의 BCG-B형간염-DPT-Polio 완전접종률은 96.67%인 반면, “20분 초과”인 군의 BCG-B형간염-DPT-Polio 완전접종률은 76.92%로, 거주지에서 보건소까지의 도달시간이 “20분 초과”인 군에서 BCG-B형간염-DPT-Polio 완전접종률이 낮았고 이는 통계적으로 유의하였다(P＜0.05).

이번 연구에서 의료급여가구 영유아의 예방접종률과 적기접종률은 전 계층을 대상으로 조사된 선행연구결과들과 비교해 낮았다. 보건소 무료예방접종사업으로 재정적 장애요인이 제거되었음에도 불구하고 의료급여가구 영유아의 예방접종률과 적기접종률이 낮은 이유는, 이번 연구 결과에서 알 수 있듯이, 보건소가 거주지에서 멀리 떨어진 경우 이동상의 어려움으로 보건소 이용이 제한을 받게 되고, 민간의료기관을 이용할 경우 본인이 부담해야하는 접종비용으로 인해 민간의료기관 이용이 제한을 받기 때문이다. 이러한 보건소 이용시의 지리적 접근성의 차이와 민간의료기관 이용시의 재정적 부담이 발생하는 원인은 무료접종기관을 보건소에 국한시킨 현행 보건소 중심의 무료예방접종사업에서 기인한다. 따라서 어느 영유아나 접종기관 이용에 장애를 받지 않고 적기에 적절한 예방접종이 이루어지기 위해서는 국가 무료예방접종사업의 범위를 민간의료기관으로 확대하는 방안이 추진되어야 할 것이다.

[영문]The purpose of this study is (1) to grasp the performance levels of state immunization through the examination of (i) immunization rate, (ii) timely immunization rate, and (iii) three-stage complete immunization rate of children receiving medical Assistance in large cities and (2) to present different means of increasing low-income household immunization rates and to suggest various avenues of improving government-funded free vaccination program.

Over periods extending from May 3rd through 8th of 2004 and from May 23th through 30th of the same year, the interviews were conducted to 88 children under the age of 24 months who were residing in Incheon Metropolitan City and receiving medical assistance. In the analysis of immunization related-factors, Chi-square test was adopted and by using the BCG-Hepatitis B vaccine-DPT-Polio complete immunization rate as a dependent variable, the study examines the differences in complete immunization rate according to the studied immunization related-factors.

The results are as follows;

1.As reasons of delayed or ommitted to get vaccinations, 38.6% of the interviewee responded "illnesses of a child", 22.8% answered "just forgot to get one", and 20.2% replied "lack of money".

2. As reasons for using the public health centers, 54.9% responded "low cost", 22.0% answered "trust", and as reasons for using private medical centers, 36.7% replied "the convenient location", 33.3% answered "familiar through visits for other illnesses".

3.The rates of getting vaccination at the public medical centers varied according to the kind of a vaccination. In case of the BCG vaccine, the rate marked 30.0%, as for the Hepatitis B vaccine, the rate marked 11.9%, 45.0%, 59.1% (in order of the 1st, 2nd, and the 3rd vaccination), as to the DPT-Polio vaccine, the rate marked 55.0%, 59.4%, 60.7%(in order of the 1st, 2nd, and the 3rd vaccination), and in case of the MMR vaccine, the rate reached 64.7%.

4. The percentage of possessing a vaccination schedule book was 94.3%.

5.Concerning the immunization rate, the BCG vaccine reached 95.2%, the Hepatitis B vaccine marked 100.0%, 97.6%, 90.0%(in order of the 1st, 2nd, and the 3rd vaccination), the DPT-Polio vaccine rated 97.5%, 87.7%, 87.1% respectively(in order of the 1st, 2nd, and the 3rd vaccination), and the MMR vaccine marked 83.3%.

6. Regarding the timely immunization rate, the BCG vaccine rated 61.0%, the DPT-Polio vaccine marked 87.7%, 78.1%, 74.3%(in order of the 1st, 2nd, and the 3rd vaccination), and the MMR vaccine reached 61.1%.

7. As to the complete immunization rate, as defined the percentage of children who recieved three doses of Hepatitis B vaccine and DPT-Polio vaccine, rated 90.0% and 85.7% respectively.

8.The BCG-Hepatitis B vaccine-DPT-Polio complete immunization rate of the group of less than 20 minute-distances from the public health centers turned out to be 96.67%. Meanwhile, the BCG-Hepatitis B vaccine-DPT-Polio complete immunization rate of the group of over 20 minute-distances recorded 76.92%, which is statistically meaningful(P<0.05).

The immunization rates of the children with medical assistance were lower than the results of the whole population in preceding studies. Despite the removal of financial barriers through free services provided at the public health centers, the main reasons behind lower immunization rates were (1) the inconvenient and far locations of the public health center and (2) the financial costs of vaccinations incurred in case of private medical clinic use. Such barriers arising from demographic barriers of public health center use and financial burdens from private medical clinic use means can be attributed to the fact that free services provided by the government are limited only to the public health centers. Therefore, the government must explore different means of expanding the free services to the private sector in order to adequately and timely provide its services of free vaccinations.