Résumé :
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[BDSP. Notice produite par INIST-CNRS rIkkR0xm. Diffusion soumise à autorisation]. 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
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