Symbolic barriers for access to health services in Guatemala: children's immunization as marker
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Universidad Rafael Landivar, Guatemala
Instituto de Saúde Coletiva (ISC-UFBA), Guatemala
Publication date: 2023-04-27
Popul. Med. 2023;5(Supplement):A2052
Background and Objective: Guatemala’s immunization coverage lowered between 10-12% in the past five years. Previous studies show that users’ untrust of health services has a great influence on children’s immunization, mainly due to Institutionalized racism. Thus, this study aimed to determine the association between symbolic barriers for access to health services and updated immunization card of children <5 years in Guatemala. Methods: We conducted a cross-sectional study using data from Guatemala’s VI Demographic and Health Survey (2014-2015). We delimited the sample to all children < 5 years. We selected health services’ linguistic competence and mother’s unwillingness to visit health services alone as markers for symbolic barriers. Language spoken by the mother, self-identification as Indigenous, using Indigenous clothing, religion, and place of birth were selected as indirect markers, as they may affect health services’ welcoming process due to institutionalized racism. Updated immunization was defined as having all doses recommended by age group, according to Guatemala’s Immunization Program. Bivariate and multivariate analysis included OR estimation, and binary logistic regression modelling. Results: We found 73% of children not fully vaccinated. Individually, not wanting to go alone (OR: 1.26), linguistic competence (OR: 1.16), language spoken by the mother (OR: 1.51), self-identification as Indigenous (OR: 1.44), using Indigenous clothing (1.51), and place of birth (OR: 1.80) increased the risk of children not being fully vaccinated (p<0.05). After adjustment, not wanting to go alone (OR: 1.14), place of birth (OR: 1.53), and self-identification as Indigenous (OR: 1.19) remained significantly associated (p<0.05). Conclusions: Symbolic barriers for access to health services are associated with lower rates of fully vaccinated children <5 in Guatemala. Public policies oriented to mitigate Institutionalized racism on Guatemala’s Health System urge. New studies approaching racism on health services are needed for a better description of the phenomenon.