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      • HARVEST
      • Electronic Theses and Dissertations
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      EQUITY-BASED CHILDHOOD IMMUNIZATION POLICY-MAKING IN URBAN PUBLIC HEALTH UNITS ACROSS THE CANADIAN PRAIRIES: A COMPARATIVE STUDY

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      BANDARA-DISSERTATION-2019.pdf (3.717Mb)
      Date
      2019-04-30
      Author
      Bandara, Thilina 1987-
      Type
      Thesis
      Degree Level
      Doctoral
      Metadata
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      Abstract
      Inequities in childhood immunization coverage rates increase the risk of disease outbreaks among vulnerable populations. This study assessed inequities in childhood measles, mumps and rubella (MMR) immunization coverage of four major cities across the Canadian prairies and the public health practices that were deployed to reduce inequities. One-dose by age-two MMR coverage rate inequities-over-time-measurements, and a policy-based inquiry into public health practices between 2009 and 2015 were conducted for each case study city. The results show that there were substantial differences in inequities between the provinces. The Saskatchewan case cities both exhibited low but increasing coverage rates, and large but reducing coverage inequities, over the study period. The Albertan case cities exhibited high coverage rates throughout the study period, with predominantly low inequities, except at a neighborhood-coverage level, in both cities. These results suggest that there are provincial differences in immunization policy and programming practices. For the Saskatchewan cases, geographically-based epidemiology, visual management initiatives, and targeted interventions led to successful public health efforts to reduce coverage inequities. Reminder-based interventions were reported as successful initiatives to increase coverage rates across all cases. Finally, in Alberta, a measles outbreak occurred during the study period, and the subsequent intensive efforts in Calgary differentially reached high-income and high home-ownership neighborhoods. Overall, the study suggests that when public health units detect local MMR coverage inequities and make intentional evidence-based efforts, they can be successful in reducing MMR coverage inequities.
      Degree
      Doctor of Philosophy (Ph.D.)
      Department
      Community Health and Epidemiology
      Program
      Community and Population Health Science
      Supervisor
      Neudorf, Cordell
      Committee
      Muhajarine, Nazeem; Farag, Marwa; Béland, Daniel; Janzen, Bonnie
      Copyright Date
      April 2019
      URI
      http://hdl.handle.net/10388/12051
      Subject
      Public health
      Health inequities
      MMR
      Public health system
      Population Health
      Children's health
      Public Health Systems and Service Research
      Health inequalities
      Public health policy
      Health policy
      Collections
      • Graduate Theses and Dissertations

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