The impact of community-based outreach immunisation services on immunisation coverage with GIS network accessibility analysis in peri-urban areas, Zambia.

Background: Accessibility to health services is a critical determinant for health outcome. Objectives: To examine the association between immunisation coverage and distance to an immunisation service as well as socio-demographic and economic factors before and after the introduction of outreach immunisation services, and to identify optimal locations for outreach immunisation service points in a peri-urban area in Zambia. Methods: Repeated cross-sectional surveys were conducted for two groups of children born between 1999 and 2001, and between 2003 and 2005.The association between immunisation coverage for DPT3 and measles, and access distance, child sex, female headed households, and monthly household income were assessed using logistic regression analysis. Optimal locations for outreach service points were identified using GIS network analysis and genetic algorithms. Results: Before the introduction of outreach services, longer distances to the service points were associated with lower DPT3 and measles immunisation coverage (OR=0.24, 95% CI 0.10 to 0.56, p<0.01 for DPT3; and OR=0.38, 95% CI 0.17 to 0.83, p<0.05 for measles). However, access distances were not an impediment to immunisation coverage once the outreach services were introduced. The average distance to immunisation services could be decreased from 232.3 to 168.4 metres if the current 12 outreach service points were repositioned at optimal locations. Conclusion: Access distance to immunisation services was a critical determinant of immunisation coverage in a peri-urban area. Intervention via outreach services played an important role in averting the risk of missing out on immunisation. Optimal location analysis has the potential to contribute to efficient decision making regarding the delivery of immunisation services.