Article Text


Household survey analysis of the impact of comprehensive strategies to improve the expanded programme on immunisation at the county level in western China, 2006–2010
  1. Yuqing Zhou1,
  2. Yi Xing2,
  3. Xiaofeng Liang1,
  4. Chenyan Yue1,
  5. Xu Zhu3,
  6. David Hipgrave4
  1. 1National Immunization Program, Chinese Centre for Disease Control and Prevention, Beijing, People's Republic of China
  2. 2Peking University Health Science Centre, Beijing, People's Republic of China
  3. 3UNICEF China Country Office, Beijing, People's Republic of China
  4. 4UNICEF Headquarters, New York, New York, USA
  1. Correspondence to Dr Xiaofeng Liang; liangxf{at} and Dr David Hipgrave; dhipgrave{at}


Objective To evaluate interventions to improve routine vaccination coverage and caregiver knowledge in China's remote west, where routine immunisation is relatively weak.

Design Prospective pre–post (2006–2010) evaluation in project counties; retrospective comparison based on 2004 administrative data at baseline and surveyed post-intervention (2010) data in selected non-project counties.

Setting Four project counties and one non-project county in each of four provinces.

Participants 3390 children in project counties at baseline, and 3299 in project and 830 in non-project counties post-intervention; and 3279 caregivers at baseline, and 3389 in project and 830 in non-project counties post-intervention.

Intervention Multicomponent inexpensive knowledge-strengthening and service-strengthening and innovative, multisectoral engagement.

Data collection Standard 30-cluster household surveys of vaccine coverage and caregiver interviews pre-intervention and post-intervention in each project county. Similar surveys in one non-project county selected by local authorities in each province post-intervention. Administrative data on vaccination coverage in non-project counties at baseline.

Primary outcome measures Changes in vaccine coverage between baseline and project completion (2010); comparative caregiver knowledge in all counties in 2010.

Analysis Crude (χ2) analysis of changes and differences in vaccination coverage and related knowledge. Multiple logistic regression to assess associations with timely coverage.

Results Timely coverage of four routine vaccines increased by 21% (p<0.001) and hepatitis B (HepB) birth dose by 35% (p<0.001) over baseline in project counties. Comparison with non-project counties revealed secular improvement in most provinces, except new vaccine coverage was mostly higher in project counties. Ethnicity, province, birthplace, vaccination site, dual-parental out-migration and parental knowledge had significant associations with coverage. Knowledge increased for all variables but one in project counties (highest p<0.05) and was substantially higher than in non-project counties (p<0.01).

Conclusions Comprehensive but inexpensive strategies improved vaccination coverage and caretaker knowledge in western China. Establishing multisectoral leadership, involving the education sector and including immunisation in public-sector performance standards, are affordable and effective interventions.


This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:

Statistics from

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.