INCOMPLETUDE VACINAL NA PRIMEIRA INFÂNCIA: Análise hierárquica dos determinantes aos 12 e 24 meses em São Luís, Maranhão

Abstract

Childhood vaccination in Brazil has shown a significant decline in coverage since 2016, increasing the risk of the re-emergence of vaccine-preventable diseases. This scenario is systematically aggravated in contexts of greater socioeconomic vulnerability and health inequity, such as the municipality of São Luís, Maranhão. The present study aimed to analyze the factors associated with the incompleteness of the vaccination schedule at 12 and 24 months of age in children living in the state capital. This is a cross-sectional study, whose data were analyzed from the perspective of the social determinants of health. Hierarchical analysis was employed to understand the interrelation of explanatory variables across levels of determination (distal, intermediate, and proximal). The evaluation of the epidemiological scenario highlighted a transition in the determinants of vaccination delay as the child ages. In the first year of life (12 months), the incompleteness outcome proved to be strongly linked to distal sociodemographic determinants and factors inherent to the maternal profile and family dynamics. In contrast, the evaluation at 24 months revealed a shift in this landscape, at which point proximal factors related to structural barriers to accessing Primary Healthcare Centers, as well as the use of private services, took a leading role in determining the event. It is concluded that vaccine incompleteness in the municipality transcends individual hesitation, being profoundly influenced by structural socioeconomic inequalities and failures in the organization and retention of care by the public healthcare system. Addressing this issue demands the reorientation of local policies, reinforcing the need for strategies targeted at vulnerable families, the strengthening of support networks, and the proactive restructuring of Primary Health Care to ensure universal immunization.