Associations between vaccination clinic factors and DTaP dropout in China: A cross-sectional study

Diphtheria, tetanus, and acellular pertussis combined vaccine (DTaP) dropout reflects negatively on the ability of a vaccination clinic to ensure children are fully vaccinated with recommended vaccines. Our study examined associations between modifiable vaccination clinic factors and DTaP dropout in clinics in China. A cross-sectional study of 42,282 clinics used clinic-reported clinic-level factors and clinic-level vaccination data from the National Immunization Information Management System and the Coding Management System during calendar year 2021. We defined low dropout as < 5% and high dropout as ≥ 5%. Multivariable logistic regression analysis showed clinics having 18%-25% of their area devoted to vaccination were more likely to have low dropout rates than clinics with ≤ 17% (OR = 1.09 [95% CI, 1.03-1.16]. Clinics with 2, 3, 4, and ≥ 5 vaccination tables were more likely to have low dropout rates compared with single-table clinics (OR = 1.21 [1.13-1.30]; OR = 1.29 [1.20-1.38]; OR = 1.28 [1.17-1.39]; OR = 1.32 [1.20-1.45]). Clinics with 4-5, 6-8, and ≥ 9 staff were more likely to have low dropout rates compared with clinics with ≤ 3 staff (OR = 1.13 [1.07-1.20]; OR = 1.18 [1.10-1.25]; OR = 1.15 [1.08-1.23]). Compared to clinics with travel-based service radii of ≤ 5 km, clinics with 6-10 km radii were more likely to have low dropout rates (OR = 1.06 [95% CI,1.00-1.12]), and clinics with service radii of ≥ 21 km (OR = 0.90 [95% CI, 0.83-0.98]) were less likely. These four factors were independently associated with DTaP dropout. While considering environmental factors such as population size and level of economic development, these factors can be adjusted to help minimize dropout.