Academic literature on the topic 'Immunization Inequality'

This study explores the association between childhood immunization and gender inequality at the national level. Data for the study include annual country-level estimates of immunization among children aged 12–23 months, indicators of gender inequality, and associated factors for up to 165 countries from 2010–2019. The study examined the association between gender inequality, as measured by the gender development index and the gender inequality index, and two key outcomes: prevalence of children who received no doses of the DTP vaccine (zero-dose children) and children who received the third dose of the DTP vaccine (DTP3 coverage). Unadjusted and adjusted fractional logit regression models were used to identify the association between immunization and gender inequality. Gender inequality, as measured by the Gender Development Index, was positively and significantly associated with the proportion of zero-dose children (high inequality AOR = 1.61, 95% CI: 1.13–2.30). Consistently, full DTP3 immunization was negatively and significantly associated with gender inequality (high inequality AOR = 0.63, 95% CI: 0.46–0.86). These associations were robust to the use of an alternative gender inequality measure (the Gender Inequality Index) and were consistent across a range of model specifications controlling for demographic, economic, education, and health-related factors. Gender inequality at the national level is predictive of childhood immunization coverage, highlighting that addressing gender barriers is imperative to achieve universal coverage in immunization and to ensure that no child is left behind in routine vaccination.

The role of gender inequality in childhood immunization is an emerging area of focus for global efforts to improve immunization coverage and equity. Recent studies have examined the relationship between gender inequality and childhood immunization at national as well as individual levels; we hypothesize that the demonstrated relationship between greater gender equality and higher immunization coverage will also be evident when examining subnational-level data. We thus conducted an ecological analysis examining the association between the Subnational Gender Development Index (SGDI) and two measures of immunization—zero-dose diphtheria-tetanus-pertussis (DTP) prevalence and 3-dose DTP coverage. Using data from 2010–2019 across 702 subnational regions within 57 countries, we assessed these relationships using fractional logistic regression models, as well as a series of analyses to account for the nested geographies of subnational regions within countries. Subnational regions were dichotomized to higher gender inequality (top quintile of SGDI) and lower gender inequality (lower four quintiles of SGDI). In adjusted models, we find that subnational regions with higher gender inequality (favoring men) are expected to have 5.8 percentage points greater zero-dose prevalence than regions with lower inequality [16.4% (95% confidence interval (CI) 14.5–18.4%) in higher-inequality regions versus 10.6% (95% CI 9.5–11.7%) in lower-inequality regions], and 8.2 percentage points lower DTP3 immunization coverage [71.0% (95% CI 68.3–73.7%) in higher-inequality regions versus 79.2% (95% CI 77.7–80.7%) in lower-inequality regions]. In models accounting for country-level clustering of gender inequality, the magnitude and strength of associations are reduced somewhat, but remain statistically significant in the hypothesized direction. In conjunction with published work demonstrating meaningful associations between greater gender equality and better childhood immunization outcomes in individual- and country-level analyses, these findings lend further strength to calls for efforts towards greater gender equality to improve childhood immunization and child health outcomes broadly.

SummaryDespite years of health and medical advancement, children still suffer from infectious diseases that are vaccine preventable. India reacted in 1978 by launching the Expanded Programme on Immunization in an attempt to reduce the incidence of vaccine-preventable diseases (VPDs). Although the nation has made remarkable progress over the years, there is significant variation in immunization coverage across different socioeconomic strata. This study attempted to identify the determinants of wealth-based inequality in child immunization using a new, modified method. The present study was based on 11,001 eligible ever-married women aged 15–49 and their children aged 12–23 months. Data were from the third District Level Household and Facility Survey (DLHS-3) of India, 2007–08. Using an approximation of Erreyger’s decomposition technique, the study identified unequal access to antenatal care as the main factor associated with inequality in immunization coverage in India.

Objective. To compare inequalities in full infant vaccination coverage at two different time points between 1992 and 2016 in Latin American and Caribbean countries. Methods. Analysis is based on recent available data from Demographic and Health Surveys, Multiple Indicator Cluster Surveys, and Reproductive Health Surveys conducted in 18 countries between 1992 and 2016. Full immunization data from children 12–23 months of age were disaggregated by wealth quintile. Absolute and relative inequalities between the richest and the poorest quintile were measured. Differences were measured for 14 countries with data available for two time points. Significance was determined using 95% confidence intervals. Results. The overall median full immunization coverage was 69.9%. Approximately one-third of the countries have a high-income inequality gap, with a median difference of 5.6 percentage points in 8 of 18 countries. Bolivia, Colombia, El Salvador, and Peru have achieved the greatest progress in improving coverage among the poorest quintiles of their population in recent years. Conclusion. Full immunization coverage in the countries in the study shows higher-income inequality gaps that are not seen by observing national coverage only, but these differences appear to be reduced over time. Actions monitoring immunization coverage based on income inequalities should be considered for inclusion in the assessment of public health policies to appropriately reduce the gaps in immunization for infants in the lowest-income quintile.

This paper addresses the overall performance and inequalities in the immunization of children in Vietnam. Descriptive and logistic analysis of cross-national demographic and health data was used to examine inequality in immunization, identify the most vulnerable groups in immunization coverage, and identify the gap in coverage between hard-to-access people and the remainder of the population. The gap in the coverage was found to occur primarily in vulnerable groups such as the poor minority or poor rural children. No evidence was found of a difference in immunization coverage because of sex or birth order. However, the age of children showed a significant influence on the rate of immunization. Mother’s education and regular watching of television had a significant influence on child immunization. In order to improve child immunization coverage in Vietnam, efforts should be concentrated on poor children from minority groups and those living in rural areas, especially remote ones. Community development, investment for immunization and re-organization of immunization services at the grassroots level are also key factors to remove the barriers to immunization for vulnerable populations in Vietnam.

Gender-related barriers to immunization are key targets to improve immunization coverage and equity. We used individual-level demographic and health survey data from 52 low- and middle-income countries to examine the relationship between women’s social independence (measured by the Survey-based Women’s emPowERment (SWPER) Global Index) and childhood immunization. The primary outcome was receipt of three doses of the diphtheria-tetanus-pertussis vaccine (DTP3) among children aged 12–35 months; we secondarily examined failure to receive any doses of DTP-containing vaccines. We summarized immunization coverage indicators by social independence tertile and estimated crude and adjusted summary measures of absolute and relative inequality. We conducted all analyses at the country level using individual data; median results across the 52 examined countries are also presented. In crude comparisons, median DTP3 coverage was 12.3 (95% CI 7.9; 16.3) percentage points higher among children of women with the highest social independence compared with children of women with the lowest. Thirty countries (58%) had a difference in coverage between those with the highest and lowest social independence of at least 10 percentage points. In adjusted models, the median coverage was 7.4 (95% CI 5.0; 9.1) percentage points higher among children of women with the highest social independence. Most countries (41, 79%) had statistically significant relative inequality in DTP3 coverage by social independence. The findings suggest that greater social independence for women was associated with better childhood immunization outcomes, adding evidence in support of gender-transformative strategies to reduce childhood immunization inequities.

Basic immunisation coverage for children between 12-23 months in Zambia was 68% in 2013. Nevertheless, a substantial number of child deaths persist as a result of preventable disease. This study assesses the relationship between women empowerment and immunisation coverage in Zambia. It also investigates socio-economic inequality in full, partial, and immunisation intensity. Thus, the findings will support improved immunisation coverage, especially for those who are the poorest in Zambia. The study uses the 2013-14 Zambia Demographic and Health Surveys (ZDHS), which are nationally representative household surveys [12]. This dataset incorporates information regarding children from 0 to 59 months and for men and women aged 15- 49 years old. The two main study variables are women empowerment and immunisation. Immunisation was divided into three categories namely, full, partial and no immunisation. Concentration indices are used to assess inequality in full, partial and no immunisation coverage as well as in the intensity of immunisation coverage. Briefly, a positive concentration index means that immunisation coverage is pro-rich as richer children are more likely to be immunised. A negative index indicates the opposite. The main finding of this study was that socioeconomic status has a significant impact on the immunisation coverage of a child. For children who were fully immunised, immunisation was found to be pro-rich (concentration index = 0.046). The distribution of partially immunised children (concentration index = -0.114) and not immunised children (concentration index = -0.138) is pro-poor. This confirmed that poorer women were more likely to have a partially immunised/not immunised children compared to a child whose mother is richer. Immunisation intensity had a pro-rich outcome (concentration index = 0.153). In addition, the study confirmed the importance of household decision making as a determinant of a child's likelihood of being fully immunised (p-value< 0.01). This study has shown that close attention to factors such as women empowerment and a mother's education can support improved immunisation coverage, especially for those who are the poorest in Zambia. This paper further highlighted the importance of socio-economic status as it impacts on immunisation coverage.

Antibiotics and vaccines are undoubtedly among the greatest milestone discoveries in human history. The introduction of antibiotics and vaccines has revolutionized modern medicine by arming health care workers with prevention and curative tools across a wide spectrum of infectious diseases. However, the appropriate use of both antibiotics and vaccines has been a subject of scrutiny and debate within the health and development literature. As a matter of fact, while antibiotics are misused and overused, vaccines – which have the potential to reduce the need for antibiotics – are underutilized. Recent decades have witnessed a rise in antibiotic resistance attributed to burgeoning antibiotic consumption along with failures in implementing antibiotic stewardship in health care settings. Studies have shown that regulatory and socioeconomic environments in developing countries encourage unregulated and indiscriminate use of antibiotics. In this thesis, we propose a novel approach to tackle the unjustified sales of antibiotics in community pharmacies. The first chapter reports the results of a field experiment aimed at reducing the non-prescription sale of antibiotics in the developing world. Using a randomized controlled trial in Ethiopia we examine, in collaboration with the Addis Ababa Food Medicine Health Care Administration and Control Authority (AAFMHACA), the effectiveness of three types of nudges – namely, a coercive letter, a moral appeal letter, and an informational sticker with evocative messages placed in pharmacies – in reducing over-the-counter sales of antibiotics. The results of an audit study, conducted two to three weeks after the intervention, indicate that all three inexpensive nudges lead to a significant decrease in the sale of antibiotics without prescription, compared to the control (untreated) group of pharmacies. The coercive letter has the highest impact (reducing over-the-counter sales of antibiotics by 23.3 percent in comparison to the control group), followed by the appeal letter and the sticker treatment (with a reduction of 17.5 and 15.7 percent compared to the control, respectively). The second chapter is a sequel to the first one and reports on the persistent and heterogeneous effects of the treatments five months after the intervention. The results show that our treatments persisted well into the fifth month, despite some waning down of the effects of the letter treatments. The heterogeneity analysis indicates that the findings are robust across different subgroups of characteristics. The third chapter assesses the determinants of inequities in child immunization status. One approach to reducing excessive antibiotic use is through investing resources in protection strategies that reduce the need for antibiotic prescription in the first place. One strategy is the wider use of vaccines in the population particularly through childhood immunization programs. Tragically, not all children of tantamount age partake in the fruit of vaccines as the odds of getting immunized largely depend on several socioeconomic factors. In the last chapter of the thesis, we quantify and study the determinants and decomposition of immunization inequality in Ethiopia using two rounds of Demographic and Health Surveys (DHS) data. We find that while the Human Opportunity Index (HOI) increased from 18 per cent to 28.1 per cent, the inequality index only showed a marginal improvement of declining by a meagre 2 per cent. These improvements are largely appropriated by the urban population as inequality remains constant in rural areas over the study period. The Shapley decomposition analysis reveals that regional variations, distance to health facilities, religion affiliations, household economic status and maternal education consistently contribute to the inequality.