Journal articles: 'Immunization Inequality'

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Fuertes, Cecilia Vidal, Nicole E. Johns, Tracey S. Goodman, Shirin Heidari, Jean Munro, and Ahmad Reza Hosseinpoor. "The Association between Childhood Immunization and Gender Inequality: A Multi-Country Ecological Analysis of Zero-Dose DTP Prevalence and DTP3 Immunization Coverage." Vaccines 10, no. 7 (June 27, 2022): 1032. http://dx.doi.org/10.3390/vaccines10071032.

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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.

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Johns, Nicole E., Katherine Kirkby, Tracey S. Goodman, Shirin Heidari, Jean Munro, Stephanie Shendale, and Ahmad Reza Hosseinpoor. "Subnational Gender Inequality and Childhood Immunization: An Ecological Analysis of the Subnational Gender Development Index and DTP Coverage Outcomes across 57 Countries." Vaccines 10, no. 11 (November 18, 2022): 1951. http://dx.doi.org/10.3390/vaccines10111951.

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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.

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Debnath, Avijit, and Nairita Bhattacharjee. "WEALTH-BASED INEQUALITY IN CHILD IMMUNIZATION IN INDIA: A DECOMPOSITION APPROACH." Journal of Biosocial Science 50, no. 3 (August 14, 2017): 312–25. http://dx.doi.org/10.1017/s0021932017000402.

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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.

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Colomé-Hidalgo, Manuel, Juan Donado Campos, and Ángel Gil de Miguel. "Monitoring inequality changes in full immunization coverage in infants in Latin America and the Caribbean." Revista Panamericana de Salud Pública 44 (June 8, 2020): 1. http://dx.doi.org/10.26633/rpsp.2020.56.

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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.

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MINH THANG, NGUYEN, INDU BHUSHAN, ERIK BLOOM, and SEKHAR BONU. "CHILD IMMUNIZATION IN VIETNAM: SITUATION AND BARRIERS TO COVERAGE." Journal of Biosocial Science 39, no. 1 (January 27, 2006): 41–58. http://dx.doi.org/10.1017/s0021932006001234.

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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.

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Johns, Nicole E., Thiago M. Santos, Luisa Arroyave, Bianca O. Cata-Preta, Shirin Heidari, Katherine Kirkby, Jean Munro, et al. "Gender-Related Inequality in Childhood Immunization Coverage: A Cross-Sectional Analysis of DTP3 Coverage and Zero-Dose DTP Prevalence in 52 Countries Using the SWPER Global Index." Vaccines 10, no. 7 (June 21, 2022): 988. http://dx.doi.org/10.3390/vaccines10070988.

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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.

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Pal, Rama. "Decomposing Inequality of Opportunity in Immunization by Circumstances: Evidence from India." European Journal of Development Research 28, no. 3 (March 12, 2015): 431–46. http://dx.doi.org/10.1057/ejdr.2015.11.

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Wondimu, A., J. van der Schans, M. van Hulst, and M. Postma. "PIN115 ANALYZING SOCIO-ECONOMIC INEQUALITY IN CHILDHOOD IMMUNIZATION COVERAGE IN ETHIOPIA." Value in Health 22 (November 2019): S658. http://dx.doi.org/10.1016/j.jval.2019.09.1356.

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Hong, Rathavuth, and Vathany Chhea. "Trend and Inequality in Immunization Dropout Among Young Children in Cambodia." Maternal and Child Health Journal 14, no. 3 (April 7, 2009): 446–52. http://dx.doi.org/10.1007/s10995-009-0466-1.

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Singh, Ashish. "Inequality of Opportunity in Indian Children: The Case of Immunization and Nutrition." Population Research and Policy Review 30, no. 6 (September 4, 2011): 861–83. http://dx.doi.org/10.1007/s11113-011-9214-5.

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Matos, Camila Carvalho de Souza Amorim, Carolina Luísa Alves Barbieri, and Marcia Thereza Couto. "Covid-19 and its impact on immunization programs: reflections from Brazil." Revista de Saúde Pública 54 (December 15, 2020): 114. http://dx.doi.org/10.11606/s1518-8787.2020054003042.

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Due to social distancing guidelines and the displacement of both human and material resources to fight the covid-19 pandemic, individuals seeking healthcare services face certain challenges. Immunization programs have already been a worrisome topic for health authorities due to declines in vaccine uptake rates and are now especially affected by the covid-19 pandemic. Disbelief in science, dissemination of fake news about vaccines, socioeconomic vulnerability and social inequality are some of the challenges faced. This commentary article discusses the impacts of the covid-19 pandemic on immunization programs in Brazil. In light of advances (and notability) of Brazil’s national immunization program, established in the 1970s, the programs face challenges, such as the recent drop in vaccine uptake rates. In addition to this health crisis, there is also Brazil’s current political crisis, which will undoubtedly require assistance from researchers, policymakers and society to be fixed.

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Meheus, Filip, and Eddy Van Doorslaer. "Achieving better measles immunization in developing countries: does higher coverage imply lower inequality?" Social Science & Medicine 66, no. 8 (April 2008): 1709–18. http://dx.doi.org/10.1016/j.socscimed.2007.12.036.

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Gajek, Lesław, and Elżbieta Krajewska. "A new immunization inequality for random streams of assets, liabilities and interest rates." Insurance: Mathematics and Economics 53, no. 3 (November 2013): 624–31. http://dx.doi.org/10.1016/j.insmatheco.2013.08.012.

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Xie, Zhifei. "The Correlation between HPV Vaccination Rate and Income Inequality." Health Informatics - An International Journal 9, no. 4 (November 30, 2020): 19–27. http://dx.doi.org/10.5121/hiij.2020.9402.

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According to the 2018 National Immunization Survey - Teen (NIS-Teen), the human papillomavirus (HPV) vaccination coverage in the U.S. increased from 48.6% to 51.1%.[1] Certain factors contribute to disparity between teenagers receiving HPV vaccination.[1]The factors are geography, race, gender, education level, household income, and etc. Within these factors, household income and income inequality were chosen to be the focus of this study. The relationship between HPV vaccination coverage in the U.S., the household income of interviewed individuals, and the Gini index in the U.S. have been studied in RStudio [2]. By merging the NIS-Teen data of vaccination rate and Gini index data in RStudio, charts and graphs are formed to illustrate the relationship between HPV vaccination rate and income inequality. There seem to be limited correlations between vaccination rate and Gini index, but unexpected connections between vaccination rate and household income have been found.

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Hu, Yu, Hui Liang, Ying Wang, and Yaping Chen. "Inequities in Childhood Vaccination Coverage in Zhejiang, Province: Evidence from a Decomposition Analysis on Two-Round Surveys." International Journal of Environmental Research and Public Health 15, no. 9 (September 13, 2018): 2000. http://dx.doi.org/10.3390/ijerph15092000.

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Objective: The objectives of this study were to determine the degree and risk factors of the inequity in the childhood coverage of full primary immunization (FPI) in Zhejiang province. Method: We used data from two rounds of vaccination coverage surveys among children aged 24–35 months conducted in 2014 and 2017, respectively. The household income per month was used as an index of socioeconomic status for the inequality analysis. The concentration index (CI) was used to quantify the degree of inequality, and the decomposition approach was applied to quantify the contributions from demographic factors to inequality in the coverage of FPI. Results: The coverage rates of FPI were 80.6%, with a CI value of 0.12028 for the 2014 survey, while the coverage rates of FPI were 85.2%, with a CI value of 0.10129 for the 2017 survey. The results of decomposition analysis suggested that 68.2% and 67.1% of the socioeconomic inequality in the coverage of FPI could be explained by the mother’s education level for the 2014 and 2017 survey, respectively. Other risk factors including birth order, ethnic group, mother’s age, maternal employment status, residence, immigration status, GDP per-capita, and the percentage of the total health spending allocated to public health could also explain this inequality. Conclusion: The socioeconomic inequity in the coverage of FPI still remained, although this gap was reduced between 2014 and 2017. Policy recommendations for health interventions on reducing the inequality in the coverage of FPI should be focused on eliminating poverty and women’s illiteracy.

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Sharma, Shailja, Mitasha Singh, and Rajesh Ranjan. "Inequality in the immunization schedules of different states of the Same Country: Are we aware?" Journal of Medical Sciences 38, no. 1 (2018): 1. http://dx.doi.org/10.4103/jmedsci.jmedsci_120_17.

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MOHANTY, S. K., and P. K. PATHAK. "RICH–POOR GAP IN UTILIZATION OF REPRODUCTIVE AND CHILD HEALTH SERVICES IN INDIA, 1992–2005." Journal of Biosocial Science 41, no. 3 (May 2009): 381–98. http://dx.doi.org/10.1017/s002193200800309x.

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SummaryThis paper examines the trends in utilization of five indicators of reproductive and child health services, namely, childhood immunization, medical assistance at delivery, antenatal care, contraceptive use and unmet need for contraception, by wealth index of the household in India and two disparate states, Uttar Pradesh and Maharashtra. The data from three rounds of the National Family and Health Survey conducted during 1992–2005 are analysed. The wealth index is computed using principal component derived weights from a set of consumer durables, land size, housing quality and water and sanitation facilities of the household, and classified into quintiles for all three rounds. Bivariate analyses, rich–poor ratio and concentration index are used to understand the trends in utilization of, and inequality in, reproductive and child health services. The results indicate huge disparities in utilization of these services, largely to the disadvantage of the poor. Utilization of basic childhood immunization among the poorest and the poor stagnated in India, as well as in both states, during 1998–2005 compared with 1992–1998. The use of maternal care services such as medical assistance at delivery and antenatal care remained at a low level among the poor over this period. However, contraceptive use increased relatively faster among the poor, even with higher unmet need. Of all these services, the inequality in medical assistance at delivery is consistently large, while that of contraceptive use is small. The state-level differences in service coverage by wealth quintiles over time are large.

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Singh, Ashish. "Gender Based Within-Household Inequality in Childhood Immunization in India: Changes over Time and across Regions." PLoS ONE 7, no. 4 (April 11, 2012): e35045. http://dx.doi.org/10.1371/journal.pone.0035045.

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Bergen, Nicole, Bianca O. Cata-Preta, Anne Schlotheuber, Thiago M. Santos, M. Carolina Danovaro-Holliday, Tewodaj Mengistu, Samir V. Sodha, Daniel R. Hogan, Aluisio J. D. Barros, and Ahmad Reza Hosseinpoor. "Economic-Related Inequalities in Zero-Dose Children: A Study of Non-Receipt of Diphtheria–Tetanus–Pertussis Immunization Using Household Health Survey Data from 89 Low- and Middle-Income Countries." Vaccines 10, no. 4 (April 18, 2022): 633. http://dx.doi.org/10.3390/vaccines10040633.

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Despite advances in scaling up new vaccines in low- and middle-income countries, the global number of unvaccinated children has remained high over the past decade. We used 2000–2019 household survey data from 154 surveys representing 89 low- and middle-income countries to assess within-country, economic-related inequality in the prevalence of one-year-old children with zero doses of diphtheria–tetanus–pertussis (DTP) vaccine. Zero-dose DTP prevalence data were disaggregated by household wealth quintile. Difference, ratio, slope index of inequality, concentration index, and excess change measures were calculated to assess the latest situation and change over time, by country income grouping for 17 countries with high zero-dose DTP numbers and prevalence. Across 89 countries, the median prevalence of zero-dose DTP was 7.6%. Within-country inequalities mostly favored the richest quintile, with 19 of 89 countries reporting a rich–poor gap of ≥20.0 percentage points. Low-income countries had higher inequality than lower–middle-income countries and upper–middle-income countries (difference between the median prevalence in the poorest and richest quintiles: 14.4, 8.9, and 2.7 percentage points, respectively). Zero-dose DTP prevalence among the poorest households of low-income countries declined between 2000 and 2009 and between 2010 and 2019, yet economic-related inequality remained high in many countries. Widespread economic-related inequalities in zero-dose DTP prevalence are particularly pronounced in low-income countries and have remained high over the previous decade.

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Choi, Sol Seo, and BongKyoo Choi. "Comparison of Social Inequality in Human Papillomavirus (HPV) Vaccination among Teenagers with Parental Reports and Healthcare Providers’ Records in the 2019 National Immunization Survey-Teen." Vaccines 10, no. 2 (January 24, 2022): 178. http://dx.doi.org/10.3390/vaccines10020178.

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Background: Relatively little is known about social inequality in human papillomavirus (HPV) vaccination among teenagers in the United States. This study aims to investigate whether there is a social disparity in HPV vaccination among teenagers and if so, whether it can differ according to the source of teen vaccination information (parental reports and provider records). Methods: We used the data from the 2019 National Immunization Survey-Teen (NIS-Teen; 42,668 teenagers, aged 13–17) including parent-reported vaccination status. Among them, 18,877 teenagers had adequate provider-reported vaccination records. Two socioeconomic status (SES) measures were used: mother’s education and annual family income. Multivariate logistic analyses were conducted. Results: False negatives of parental reports against provider records were more than two times higher (p < 0.001) in low-SES teens than in high-SES teens. In both SES measures, the proportion of HPV-unvaccinated teenagers was lowest at the highest SES level in analyses with parental reports. However, it was the opposite in analyses with provider records. Interestingly, regardless of the vaccination information source, the HPV unvaccinated rate was highest in the middle-SES teens (>12 years, non-college graduates; above poverty level, but not >USD 75 K). Conclusions: Significant social inequality in HPV vaccination among teenagers exists in the United States. The pattern of social inequality in HPV vaccination can be distorted when only parent-reported vaccination information is used.

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Singh, Ashish. "Correction: Gender Based Within-Household Inequality in Childhood Immunization in India: Changes over Time and across Regions." PLOS ONE 12, no. 3 (March 3, 2017): e0173544. http://dx.doi.org/10.1371/journal.pone.0173544.

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Su, Zhaohui, Dean McDonnell, Xiaoshan Li, Bindi Bennett, Sabina Šegalo, Jaffar Abbas, Ali Cheshmehzangi, and Yu-Tao Xiang. "COVID-19 Vaccine Donations—Vaccine Empathy or Vaccine Diplomacy? A Narrative Literature Review." Vaccines 9, no. 9 (September 15, 2021): 1024. http://dx.doi.org/10.3390/vaccines9091024.

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Introduction: Vaccine inequality inflames the COVID-19 pandemic. Ensuring equitable immunization, vaccine empathy is needed to boost vaccine donations among capable countries. However, damaging narratives built around vaccine donations such as “vaccine diplomacy” could undermine nations’ willingness to donate their vaccines, which, in turn, further exacerbate global vaccine inequality. However, while discussions on vaccine diplomacy are on the rise, there is limited research related to vaccine diplomacy, especially in terms of its characteristics and effects on vaccine distribution vis-à-vis vaccine empathy. Thus, to bridge the research gap, this study aims to examine the defining attributes of vaccine diplomacy and its potential effects on COVID-19 immunization, particularly in light of vaccine empathy. Methods: A narrative review was conducted to shed light on vaccine diplomacy’s defining attributes and effects in the context of COVID-19 vaccine distribution and dissemination. Databases such as PubMed and Medline were utilized for literature search. Additionally, to ensure up-to-date insights are included in the review, validated reports and reverse tracing of eligible articles’ reference lists in Google Scholar have also been conducted to locate relevant records. Results: Vaccine empathy is an individual or a nation’s capability to sympathize with other individuals or nations’ vaccine wants and needs, whereas vaccine diplomacy is a nation’s vaccine efforts that aim to build mutually beneficial relationships with other nations ultimately. Our findings show that while both vaccine empathy and vaccine diplomacy have their strengths and weaknesses, they all have great potential to improve vaccine equality, particularly amid fast-developing and ever-evolving global health crises such as COVID-19. Furthermore, analyses show that, compared to vaccine empathy, vaccine diplomacy might be a more sustainable solution to improve vaccine donations mainly because of its deeper and stronger roots in multilateral collaboration and cooperation. Conclusion: Similar to penicillin, automated external defibrillators, or safety belts amid a roaring global health disaster, COVID-19 vaccines are, essentially, life-saving consumer health products that should be available to those who need them. Though man-made and complicated, vaccine inequality is nonetheless a solvable issue—gaps in vaccine distribution and dissemination can be effectively addressed by timely vaccine donations. Overall, our study underscores the instrumental and indispensable role of vaccine diplomacy in addressing the vaccine inequality issue amid the COVID-19 pandemic and its potentials for making even greater contributions in forging global solidarity amid international health emergencies. Future research could investigate approaches that could further inspire and improve vaccine donations among capable nations at a global scale to advance vaccine equity further.

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Latif, Muhamamad Mehran, Muhammad Farhan Ashraf, and Muhammad Zeeshan. "Factors Determining Poverty and Child Mortality in Pakistan." iRASD Journal of Economics 1, no. 1 (June 30, 2019): 32–41. http://dx.doi.org/10.52131/joe.2019.0101.0003.

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The objective of the study was to check the factors determining poverty and child mortality in Pakistan. We used secondary data, collected from various economic surveys and the World Bank. OLS technique used to find the relationship between variables. Consumer Price Index (CPI), GDP growth, number of hospitals, and unemployment used as independent variables. For poverty, female literacy rate, male literacy rate, immunization, and GDP growth used as independent variables for child mortality. The study showed that CPI, GDP growth, and the unemployment rate have a positive relationship with poverty whereas the number of hospitals has a negative relationship with poverty. Furthermore, the study revealed that the female literacy rate has a negative impact on infant mortality while the male literacy rate has no significant impact on the infant mortality rate. Immunization has a negative and significant relationship with the infant mortality rate. GDP growth has a positive impact on the infant mortality rate due to high inequality in Pakistan. Authors recommended that parental education, water quality, and motivation to mothers to utilize health facilities can play an important role to reduce poverty and child mortality.

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Vo, Hoang-Long, Le-Thai-Bao Huynh, Hao Nguyen Si Anh, Dang-An Do, Thi-Ngoc-Ha Doan, Thi-Huyen-Trang Nguyen, and Huy Nguyen Van. "Trends in Socioeconomic Inequalities in Full Vaccination Coverage among Vietnamese Children aged 12–23 Months, 2000–2014: Evidence for Mitigating Disparities in Vaccination." Vaccines 7, no. 4 (November 18, 2019): 188. http://dx.doi.org/10.3390/vaccines7040188.

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There has been no report on the situation of socioeconomic inequalities in the full vaccination coverage among Vietnamese children. This study aims to assess the trends and changes in the socioeconomic inequalities in the full vaccination coverage among Vietnamese children aged 12–23 months from 2000 to 2014. Data were drawn from Multiple Indicator Cluster Surveys (2000, 2006, 2011, and 2014). Concentration index (CCI) and concentration curve (CC) were applied to quantify the degree of the socioeconomic inequalities in full immunization coverage. The prevalence of children fully receiving recommended vaccines was significantly improved during 2000–2014, yet, was still not being covered. The total CCI of full vaccination coverage gradually decreased from 2000 to 2014 (CCI: from 0.241 to 0.009). The CC increasingly became close to the equality line through the survey period, indicating the increasingly narrow gap in child full immunization amongst the poor and the rich. Vietnam witnessed a sharp decrease in socioeconomic inequality in the full vaccination coverage for over a decade. The next policies towards children from vulnerable populations (ethnic minority groups, living in rural areas, and having a mother with low education) belonging to lower socioeconomic groups may mitigate socioeconomic inequalities in full vaccination coverage.

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Sharma, Shantanu, Sonali Maheshwari, Ajit Kumar Jaiswal, and Sunil Mehra. "Income-based inequality in full immunization coverage of children aged 12-23 months in Eastern India: A decomposition analysis." Clinical Epidemiology and Global Health 11 (July 2021): 100738. http://dx.doi.org/10.1016/j.cegh.2021.100738.

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Wagstaff, Adam. "The bounds of the concentration index when the variable of interest is binary, with an application to immunization inequality." Health Economics 14, no. 4 (2005): 429–32. http://dx.doi.org/10.1002/hec.953.

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Hu, Yu, Ying Wang, Yaping Chen, and Hui Liang. "Analyzing the Urban-Rural Vaccination Coverage Disparity through a Fair Decomposition in Zhejiang Province, China." International Journal of Environmental Research and Public Health 16, no. 22 (November 19, 2019): 4575. http://dx.doi.org/10.3390/ijerph16224575.

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Objectives: Exploring determinants underlying disparities in full vaccination coverage (FVC) can contribute to improved immunization interventions. FVC and its risk factors in Zhejiang province have been studied, yet the determinants explaining the rural–urban disparity in FVC have not been studied. This study aimed to disentangle the factors explaining rural–urban disparities in FVC of vaccine doses scheduled during the first year of life in Zhejiang province. Methods: We used data from a vaccination coverage survey among children aged 24–35 months conducted in 2016. The outcome measure was full vaccination status, and the grouping variable was the area of residence. Descriptive statistics were used to analyze the FVC and rural–urban residence across the exposure variables. The Fairlie decomposition technique was used to decompose factors contributing to explaining the FVC disparity. Results: There were 847 children included in this study, of which 49.6% lived in a rural area. FVC was 94% in rural areas and 85% in urban areas. A disparity of 9% to the advantage of the rural areas and the exposure variables explained 81.1% of the disparity. Maternal factors explained 49.7% of the explained disparity with education, occupation, and ethnicity being the significant contributors to the explained disparity. Children’s birth order and immigration status contributed somewhat to the explained inequality. Conclusion: There was a significant disparity in FVC in Zhejiang province, a disadvantage to the urban areas. Policy recommendations or health interventions to reduce the inequality should be focused on eliminating poverty and women’s illiteracy, targeted at migrant children or children from minority ethnicities.

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Hu, Yu, Ying Wang, Yaping Chen, and Qian Li. "Determinants of inequality in the up-to-date fully immunization coverage among children aged 24–35 months: Evidence from Zhejiang province, East China." Human Vaccines & Immunotherapeutics 13, no. 8 (June 12, 2017): 1902–7. http://dx.doi.org/10.1080/21645515.2017.1327108.

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Noznesky, Elizabeth A., Usha Ramakrishnan, and Reynaldo Martorell. "A Situation Analysis of Public Health Interventions, Barriers, and Opportunities for Improving Maternal Nutrition in Bihar, India." Food and Nutrition Bulletin 33, no. 2_suppl1 (June 2012): S93—S103. http://dx.doi.org/10.1177/15648265120332s106.

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Background Maternal underweight and anemia are highly prevalent in Bihar, especially among adolescent girls aged 15 to 19 years. Although numerous programs and platforms exist for delivering efficacious interventions for improving maternal nutrition, the coverage and quality of these interventions are low. Objective To examine existing interventions for reducing maternal undernutrition in Bihar and identify barriers to and opportunities for expanding their coverage and quality. Methods The research was conducted in New Delhi and Bihar between May and August 2010. Forty-eight key informant interviews were conducted with policy makers, program managers, and service providers at multiple levels. Secondary data were collected from survey reports and program documents. All data were analyzed thematically. Results Barriers to the delivery and uptake of interventions to improve maternal nutrition include the shortage of essential inputs, low prioritization of maternal undernutrition, sterilization bias within the family planning program, weak management systems, poverty, gender inequality, caste discrimination, and flooding. In order to overcome barriers and improve service delivery, the current government and its partners have introduced structural reforms within the public health system, launched new programs for underserved groups, developed innovative approaches, and experimented with new technologies. Conclusions Since coming to power, the Government of Bihar has achieved impressive increases in the coverage of prioritized health services, such as institutional deliveries and immunization. This success presents it with an excellent opportunity to further reduce maternal and infant mortality by turning its attention to the serious problem of maternal undernutrition and low birthweight.

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Johns, Nicole E., Ahmad Reza Hosseinpoor, Mike Chisema, M. Carolina Danovaro-Holliday, Katherine Kirkby, Anne Schlotheuber, Messeret Shibeshi, Samir V. Sodha, and Boston Zimba. "Association between childhood immunisation coverage and proximity to health facilities in rural settings: a cross-sectional analysis of Service Provision Assessment 2013–2014 facility data and Demographic and Health Survey 2015–2016 individual data in Malawi." BMJ Open 12, no. 7 (July 2022): e061346. http://dx.doi.org/10.1136/bmjopen-2022-061346.

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ObjectivesDespite significant progress in childhood vaccination coverage globally, substantial inequality remains. Remote rural populations are recognised as a priority group for immunisation service equity. We aimed to link facility and individual data to examine the relationship between distance to services and immunisation coverage empirically, specifically using a rural population.Design and settingRetrospective cross-sectional analysis of facility data from the 2013–2014 Malawi Service Provision Assessment and individual data from the 2015–2016 Malawi Demographic and Health Survey, linking children to facilities within a 5 km radius. We examined associations between proximity to health facilities and vaccination receipt via bivariate comparisons and logistic regression models.Participants2740 children aged 12–23 months living in rural areas.Outcome measuresImmunisation coverage for the six vaccines included in the Malawi Expanded Programme on Immunization schedule for children under 1 year at time of study, as well as two composite vaccination indicators (receipt of basic vaccines and receipt of all recommended vaccines), zero-dose pentavalent coverage, and pentavalent dropout.Findings72% (706/977) of facilities offered childhood vaccination services. Among children in rural areas, 61% were proximal to (within 5 km of) a vaccine-providing facility. Proximity to a vaccine-providing health facility was associated with increased likelihood of having received the rotavirus vaccine (93% vs 88%, p=0.004) and measles vaccine (93% vs 89%, p=0.01) in bivariate tests. In adjusted comparisons, how close a child was to a health facility remained meaningfully associated with how likely they were to have received rotavirus vaccine (adjusted OR (AOR) 1.63, 95% CI 1.13 to 2.33) and measles vaccine (AOR 1.62, 95% CI 1.11 to 2.37).ConclusionProximity to health facilities was significantly associated with likelihood of receipt for some, but not all, vaccines. Our findings reiterate the vulnerability of children residing far from static vaccination services; efforts that specifically target remote rural populations living far from health facilities are warranted to ensure equitable vaccination coverage.

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Ariratana, Wallapha, Pattamaporn Pimtong, and Nilmanee Pitak. "Teacher Professional Development for Learning Organization on Sufficiency Economy in Small Schools." European Journal of Social & Behavioural Sciences 4, no. 1 (January 1, 2013): 138–45. http://dx.doi.org/10.15405/ejsbs.2013.1.16.

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The Ministry of Education, Thailand announced the major scheme for the implementation of Sufficiency Economy in Schools in the country along with the 1999 National Education Act Amendment in 2003. The purposes were to establish self immunization in human capital and develop learners to their full capacity. However, the inequality among schools in Thailand was one of the main problems in educational development. The small schools were among the disadvantage groups. There were not having sufficient learning resources, teaching personnel and teachers with major in special subject areas, the small schools needed help in their development programs as well as integrating sufficient economy into the learning and teaching situations. The purposes of this study are to develop teacher professional for learning organization on sufficiency economy in small schools as well as to develop principals and teachers' concepts about learning organization on sufficient economy. This study employs qualitative design by analyzing document and interviewing key informants. The research samples consist of five small schools under the Office of Khon Kaen Primary Educational Service Area. The findings reveal that the training strategy with the emphasis on brain storming, working in small groups, learning from success stories experiences of their peers and friendly supervision in the teacher professional development for learning organization based on the philosophy of sufficiency economy. Furthermore, the support from school administrators also created confidence among teachers in implementing the integration of the innovation based on the philosophy of sufficiency economy in a whole school system. Therefore, the project was implemented and progress under the same ideology in both administrators and teachers. Regarding the guidelines for teacher development for learning organization based on the philosophy of sufficient economy among small schools, the findings revealed that there are six steps of work procedures. The six steps comprise of (i) awareness creation, the research employed a study trip to visit good practice sites in sufficiency economy; (ii) professional development; (iii) consensus concept of creation of innovation based on sufficiency economy and classroom research; (iv) using community learning resources; (v) observation and reflection, and (vi) supervision and coaching. In conclusion, all teachers accepted and implemented the integration of sufficiency economy into their classroom. Moreover, they showed their ability for integrating the philosophy of sufficiency economy into their activities. Finally, most of the students showed their developments in achievement and attitude.

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DuPre, Natalie, Lyndsey Blair, Sarah Moyer, E. Francis Cook, Bert Little, and Jeffrey Howard. "Hepatitis A Outbreaks Associated With the Opioid Epidemic in Kentucky Counties, 2017–2018." American Journal of Public Health 110, no. 9 (September 2020): 1332. http://dx.doi.org/10.2105/ajph.2020.305789.

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Objectives. To describe county-level socioeconomic profiles associated with Kentucky’s 2017–2018 hepatitis A outbreak that predominately affected communities affected by the opioid epidemic. Methods. We linked county-level characteristics on socioeconomic and housing variables to counties’ hepatitis A rates. Principal component analysis identified county profiles of poverty, education, disability, income inequality, grandparent responsibility, residential instability, and marital status. We used Poisson regression to estimate adjusted relative risks (RRs) and 95% confidence intervals (CIs). Results. Counties with scores reflecting an extremely disadvantaged profile (RR = 1.21; 95% CI = 0.99, 1.48) and greater percentage of nonmarried men, residential instability, and income inequality (RR = 1.15; 95% CI = 0.94, 1.41) had higher hepatitis A rates. Counties with scores reflecting more married adults, residential stability, and lower income inequality despite disability, poverty, and low education (RR = 0.77; 95% CI = 0.59, 1.00) had lower hepatitis A rates. Counties with a higher percentage of workers in the manufacturing industry had slightly lower rates (RR = 0.97; 95% CI = 0.94, 1.00). Conclusions. As expected, impoverished counties had higher hepatitis A rates. Evaluation across the socioeconomic patterns highlighted community-level factors (e.g., residential instability, income inequality, and social structures) that can be collected to augment hepatitis A data surveillance and used to identify higher-risk communities for targeted immunizations.

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ROBERTS, S. A., L. BRABIN, R. STRETCH, D. BAXTER, P. ELTON, H. KITCHENER, and R. McCANN. "Human papillomavirus vaccination and social inequality: results from a prospective cohort study." Epidemiology and Infection 139, no. 3 (March 25, 2010): 400–405. http://dx.doi.org/10.1017/s095026881000066x.

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SUMMARYWe investigated the effect of social inequalities on the uptake of human papillomavirus (HPV) vaccination, combining data from a feasibility study conducted in 2007–2008 in 2817 secondary schoolgirls in two UK primary-care trusts, with census and child health records. Uptake was significantly lower in more deprived areas (P<0·001) and in ethnic minority girls (P=0·013). The relatively small proportion of parents who actively refused vaccination by returning a negative consent form were more likely to come from more advantaged areas (P<0·001). Non-responding parents were from more deprived (P<0·001) and ethnic minority (P=0·001) backgrounds. Girls who did not receive HPV vaccination were less likely to have received all their childhood immunizations particularly measles, mumps and rubella (MMR). Different approaches may be needed to maximize HPV vaccine uptake in engaged and non-responding parents, including ethnic-specific approaches for non-responders.

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Nabila, Alya, and Kandi Kirana Larasati. "The Role of International Organizations in Handling Covid-19 Pandemic." SASI 28, no. 3 (October 13, 2022): 397. http://dx.doi.org/10.47268/sasi.v28i3.1027.

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Introduction: The spread of the Covid-19 virus after being designated as a pandemic by the WHO (World Health Organization) in early 2020 had a negative impact on the sustainability of life in the world. The hampering of activities due to lockdown policies to break the chain of transmission of the virus, paralyzed the movement of the world economy.Purposes of the Research: This study aims to find out the development of handling the Covid-19 virus as a pandemic and the role of WHO as an international health organization in equalizing vaccine availability.Methods of the Research: Normative juridical approach method with a statute approach, a historical approach and an analytical approach.Results of the Research: That as an effort to address inequality of access and distribution of Covid-19 vaccines between poor and rich countries, WHO formed a cooperation forum with the Global Alliance for Vaccines and Immunizations (GAVI), Vaccine Alliance, Coalition for Epidemic Preparedness Innovations (CEPI), and UNICEF namely Covid-19 Vaccines Global Access (COVAX) which has set up a pricing mechanism for rich countries to pay a requisite fees as a form of subsidize to poor countries.

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Lerm, Beatriz Raffi, Yanick Silva, Bianca O. Cata-Preta, and Camila Giugliani. "Inequalities in child immunization coverage: potential lessons from the Guinea-Bissau case." Cadernos de Saúde Pública 39, no. 1 (2023). http://dx.doi.org/10.1590/0102-311xen102922.

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Immunization is one of the main interventions responsible for the decline in under-5 mortality. This study aimed to assess full immunization coverage trends and related inequalities, according to wealth, area of residence, subnational regions, and maternal schooling level in Guinea-Bissau. Data from the 2006, 2014, and 2018 Guinea-Bissau Multiple Indicator Cluster Surveys (MICS) were analyzed. The slope index of inequality (SII) was estimated by logistic regression for wealth quintiles and maternal schooling level as a measure of absolute inequality. A linear regression model with variance-weighted least squares was used to estimate the annual change of immunization indicators at the national level and for the extremes of wealth, maternal schooling level, and urban-rural areas. Full immunization coverage increased by 1.8p.p./year (95%CI: 1.3; 2.3) over the studied period. Poorer children and children born to uneducated mothers were the most disadvantaged groups. Over the years, wealth inequality decreased and urban-rural inequalities were practically extinguished. In contrast, inequality of maternal schooling level remained unchanged, thus, the highest immunization coverage was among children born to the most educated women. This study shows persistent low immunization coverage and related inequalities in Guinea-Bissau, especially according to maternal schooling level. These findings reinforce the need to adopt equity as a main principle in the development of public health policies to appropriately reduce gaps in immunization and truly leave no one behind in Guinea-Bissau and beyond.

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Yibeltal, Kalkidan, Sitota Tsegaye, Hasset Zelealem, Walelegn Worku, Meaza Demissie, Alemayehu Worku, and Yemane Berhane. "Trends, projection and inequalities in full immunization coverage in Ethiopia: in the period 2000-2019." BMC Pediatrics 22, no. 1 (April 11, 2022). http://dx.doi.org/10.1186/s12887-022-03250-0.

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Abstract Background Immunization is among the most cost-effective health interventions to improve child survival. However, many countries in sub-Saharan Africa failed to achieve their national and international coverage targets repeatedly. The present study investigated trends of coverage and inequalities in coverage in Ethiopia. Methods This study used data from five rounds of the Demographic and Health Surveys conducted in Ethiopia in 2000, 2005, 2011, 2016, and 2019. The surveys used a multistage cluster sampling procedure to obtain a nationally and sub-nationally representative data. The outcome variables included in the study were full immunization coverage and inequality. The World Health Organization’s Health Equity Assessment Toolkit was used to conduct the inequality analysis. Projections for 2025 were based on smoothed averages generated using the demographic and health survey data from 2000 to 2019. Results The full (basic) immunization coverage in Ethiopia has increased steadily from 14.3% in 2000 to 44.1% in 2019. Based on the average past performance, the immunization coverage is projected to reach 53.6% by 2025, which will be short of the 75% national full (basic) immunization coverage target for the year 2025. Mothers with higher levels of education are more likely to get their children all basic vaccinations than those with lower levels of education. Similarly, the inequality gaps due to wealth and residency are significant; where children in the lowest wealth strata and those living in rural areas remained disadvantaged. Conclusion Despite a steady increase in immunization coverage in the past two decades the country is yet to achieve its immunization target. Thus, more efforts are needed to achieve the current and future national immunization targets. A more focused intervention targeting the disadvantaged groups could be an effective strategy to achieve coverage and minimize the inequality gaps in immunization.

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Lauridsen, Jørgen, and Jalandhar Pradhan. "Socio-economic inequality of immunization coverage in India." Health Economics Review 1, no. 1 (August 5, 2011). http://dx.doi.org/10.1186/2191-1991-1-11.

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Kannankeril Joseph, Vinod Joseph. "Understanding inequalities in child immunization in India: a decomposition approach." Journal of Biosocial Science, March 16, 2021, 1–13. http://dx.doi.org/10.1017/s0021932021000110.

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Abstract The importance of childhood immunization for healthy child growth and development is well recognized and is considered to be the best and most cost-effective lifesaver. Low socioeconomic status has been shown to be associated with low child immunization and health care utilization, but the inequalities in immunization coverage due to social and economic factors are poorly understood. This study aimed to explore the association between child immunization coverage and various socioeconomic factors and to quantify their contributions to generating inequalities in immunization coverage in India. The study data are from the National Family Health Survey-4 conducted in 2015–16. The association between socioeconomic determinants and child full immunization coverage was estimated using the χ2 test and binary logistic regression. Concentration indices were estimated to measure the magnitude of inequality, and these were further decomposed to explain the contribution of different socioeconomic factors to the total disparity in full immunization coverage. The results showed that the uptake of immunization in 2015–16 was highly associated with mother’s educational status and household wealth. The concentration index decomposition revealed that inequality (immunization disadvantage) was highest among poorer economic groups and among children whose mothers were illiterate. The overall concentration index value indicates that the weaker socioeconomic groups in India are more disadvantaged in terms of immunization interventions. The results offer insight into the dynamics of the variation in immunization coverage in India and help identify vulnerable populations that should be targeted to decrease socioeconomic inequalities in the country.

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Wahl, Brian, Madhu Gupta, Daniel J. Erchick, Bryan N. Patenaude, Taylor A. Holroyd, Molly Sauer, Madeleine Blunt, Mathuram Santosham, and Rupali Jayant Limaye. "Change in full immunization inequalities in Indian children 12–23 months: an analysis of household survey data." BMC Public Health 21, no. 1 (May 1, 2021). http://dx.doi.org/10.1186/s12889-021-10849-y.

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Abstract Background India has made substantial progress in improving child health in recent years. However, the country continues to account for a large number of vaccine preventable child deaths. We estimated wealth-related full immunization inequalities in India. We also calculated the degree to which predisposing, reinforcing, and enabling factors contribute to these inequalities. Methods We used data from the two rounds of a large nationally representative survey done in all states in India in 2005–06 (n = 9582) and 2015–16 (n = 49,284). Full immunization status was defined as three doses of diphtheria-tetanus-pertussis vaccine, three doses of polio vaccine, one dose of Bacillus Calmette–Guérin vaccine, and one dose of measles vaccine in children 12–23 months. We compared full immunization coverage by wealth quintiles using descriptive statistics. We calculated concentration indices for full immunization coverage at the national and state levels. Using predisposing, reinforcing, and enabling factors associated with full immunization status identified from the literature, we applied a generalized linear model (GLM) framework with a binomial distribution and an identity link to decompose the concentration index. Results National full immunization coverage increased from 43.65% in 2005–06 to 62.46% in 2015–16. Overall, full immunization coverage in both 2005–06 and 2015–16 in all states was lowest in children from poorer households and improved with increasing socioeconomic status. The national concentration index decreased from 0.36 to 0.13 between the two study periods, indicating a reduction in poor-rich inequality. Similar reductions were observed for most states, except in states where inequalities were already minimal (i.e., Tamil Nadu) and in some northeastern states (i.e., Meghalaya and Manipur). In 2005–06, the contributors to wealth-related full immunization inequality were antenatal care, maternal education, and socioeconomic status. The same factors contributed to full immunization inequality in 2015–16 in addition to difficulty reaching a health facility. Conclusions Immunization coverage and wealth-related equality have improved nationally and in most states over the last decade in India. Targeted, context-specific interventions could help address overall wealth-related full immunization inequalities. Intensified government efforts could help in this regard, particularly in high-focus states where child mortality remains high.

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Srivastava, Shobhit, Pradeep Kumar, Shekhar Chauhan, and Adrita Banerjee. "Household expenditure for immunization among children in India: a two-part model approach." BMC Health Services Research 21, no. 1 (September 22, 2021). http://dx.doi.org/10.1186/s12913-021-07011-0.

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Abstract Background Despite the Indian government’s Universal Immunization Program (UIP), the progress of full immunization coverage is plodding. The cost of delivering routine immunization varies widely across facilities within country and across country. However, the cost an individual bears on child immunization has not been focussed. In this context, this study tries to estimate the expenditure on immunization which an individual bears and the factors affecting immunization coverage at the regional level. Methods Using the 75th round of National Sample Survey Organization data, the present paper attempts to check the individual expenditure on immunization and the factors affecting immunization coverage at the regional level. Descriptive statistics and multivariate regression analysis were used to fulfil the study objectives. The two-part model has been employed to inspect the determinants of expenditure on immunization. Results The overall prevalence of full immunization was 59.3 % in India. Full immunization was highest in Manipur (75.2 %) and lowest in Nagaland (12.8 %). The mean expenditure incurred on immunization varies from as low as Rs. 32.7 in Tripura to as high as Rs. 1008 in Delhi. Children belonging to the urban area [OR: 1.04; CI: 1.035, 1.037] and richer wealth quintile [OR: 1.14; CI: 1.134–1.137] had higher odds of getting immunization. Moreover, expenditure on immunization was high among children from the urban area [Rs. 273], rich wealth quintile [Rs. 297] and who got immunized in a private facility [Rs. 1656]. Conclusions There exists regional inequality in immunization coverage as well as in expenditure incurred on immunization. Based on the findings, we suggest looking for the supply through follow-up and demand through spreading awareness through mass media for immunization.

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Sanoussi, Yacobou, Bright Opoku Ahinkorah, Aduragbemi Banke-Thomas, and Sanni Yaya. "Assessing and decomposing inequality of opportunity in access to child health and nutrition in sub-Saharan Africa: evidence from three countries with low human development index." International Journal for Equity in Health 19, no. 1 (August 25, 2020). http://dx.doi.org/10.1186/s12939-020-01258-5.

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Abstract Background Inequality of opportunity in health and nutrition is a major public health issue in the developing regions. This study analyzed the patterns and extent of inequality of opportunity in health and nutrition among children under-five across three countries sub-Saharan Africa with low Human development index (HDI). Methods We used data from the Multiple Indicator Cluster Survey of the Democratic Republic of Congo (20,792 households, 21,756 women aged 15 to 49 and 21,456 children under five), Guinea Bissau (6601 households, 10,234 women aged 15–49 and 7573 children under five) and Mali (11,830 households, 18,409 women in 15–49 years and 16,468 children under five) to compute the human opportunity index (HOI) and the dissimilarity index (D-index). Secondly, the Shapley decomposition method was used to estimate the relative contribution of circumstances that are beyond the control of children under-five and affecting their development outcomes in later life stages. Results The study revealed that children belonging to the most favorable group had higher access rates for immunization (93.64%) and water and sanitation facilities (73.59%) in Guinea Bissau. In Congo DR, the access rate was high for immunization (93.9%) for children in the most favorable group. In Mali, access rates stood at 6.56% for children in the most favorable group. In Guinea Bissau, the inequality of opportunity was important in access to health services before and after delivery (43.85%). In Congo DR, the inequality of opportunity was only high for the immunization composite indicator (83.79%) while in Mali, inequality of opportunity was higher for access to health services before and after delivery (41.67%). Conclusion The results show that there are efforts in some places to promote access to health and nutrition services in order to make access equal without distinction linked to the socio-economic and demographic characteristics in which the children live. However, the inequalities of opportunity observed between the children of the most favorable group and those of the least favorable group, remain in general at significant levels and call on government of these countries to implement policies taking them into account.

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Egondi, Thaddaeus, Maharouf Oyolola, Martin Kavao Mutua, and Patricia Elung’ata. "Determinants of immunization inequality among urban poor children: evidence from Nairobi’s informal settlements." International Journal for Equity in Health 14, no. 1 (February 27, 2015). http://dx.doi.org/10.1186/s12939-015-0154-2.

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Moon, Daseul, Saerom Kim, Myoung-Hee Kim, Dawoon Jeong, and Hongjo Choi. "Contracting Out National Immunization Program Does Not Improve Vaccination Rate Nor Socioeconomic Inequality: A Case Study of Seasonal Influenza Vaccination in South Korea." Frontiers in Public Health 9 (November 4, 2021). http://dx.doi.org/10.3389/fpubh.2021.769176.

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The objective of the present study was to investigate if the policy for contracting out the Korean influenza National Immunization Program (NIP) for individuals aged ≥ 65 years affects a reduction in vaccination inequality based on gender and socioeconomic position (SEP). In South Korea, initially only public health centers provided influenza vaccination for free; however, starting from the fall of 2015, the program was expanded to include private medical institutions. The policy was expected to improve overall vaccination rate and reduce its inequality, through improving access to vaccination. The present study analyzed how the gap in the vaccination rate changed between before and after contracting out. A multivariate logistic regression model stratified by gender and SEP of individuals aged ≥ 65 years was used. The study also analyzed changes in the unvaccinated rates between before and after contracting out based on an interrupted time series model. The gap in the unvaccinated rate based on SEP present prior to contracting out of the NIP for individuals aged ≥ 65 years did not decrease afterwards. In particular, the step changes were 0.94% (95% confidence interval [CI]: 0.00, 1.89) and 1.34% (95% CI: 1.17, 1.52) in men and women, respectively. In the pre-policy period, among women, the unvaccinated rate of the medical aid beneficiaries group was 1.22-fold higher (95% CI: 1.12, 1.32) than that of the health insurance beneficiaries, and the difference was not reduced post-policy implementation (odds ratio: 1.27, 95% CI: 1.20, 1.36). The findings of the study were that contracting out of the NIP was not effective in improving vaccination rate nor resolving vaccination inequality. Future studies should focus on identifying the mechanism of vaccination inequality and exploring measures for resolving such inequality.

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Zaheer, S., S. Kanwal, and K. Shafique. "Trends in socioeconomic inequalities in childhood BCG immunization coverage in Pakistan." European Journal of Public Health 30, Supplement_5 (September 1, 2020). http://dx.doi.org/10.1093/eurpub/ckaa165.1127.

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Abstract Background Although, WHO notes that there has been 'tremendous progress' towards controlling spread of Tuberculosis (TB) by 2015, situation in endemic countries like Pakistan need global attention. Pakistan currently ranks fifth among TB-high burden countries and it accounts for 61% of the TB burden in the WHO Eastern Mediterranean Region. We aim to explore the trends in relative and absolute socioeconomic inequalities in BCG vaccination coverage. Methods Data from Pakistan Demographic and Health Surveys (PDHS) 2006-7 (n = 9177 data used 8442), and 20012-13 (n = 13558, used n = 6982) were used. Information was collected from all mothers in reproductive age group, regarding BCG vaccination of their children aged < 5 years. Wealth index and education were used to assess socioeconomic position. Socioeconomic inequalities for BCG vaccination coverage were assessed by calculating Relative Index of Inequality (RII) and Absolute Index of Inequality (SII). Results Although reported frequency of not getting the child BCG vaccinated has decreased over the decade (25% in 2006, 18% in 2013). Nevertheless, socioeconomic inequalities in BCG vaccination have significantly widened over the last decade. Education related inequalities [2006-7 Urban: SII=-1.34 (-0.91, -1.76); 2012-13 Urban: SII=-1.88 (-1.43, -2.32)]; [2006-7 Rural: SII=-1.31 (-0.96, -1.65); 2012-13 Rural: SII=-1.54 (-1.13, -1.94)] have increased. Similarly, wealth related inequalities [2006-7 Urban: SII=-1.27 (-0.91, -1.62); 2012-13 Urban: SII=-1.75 (-1.37, -2.12)]; [2006-7 Rural: SII=-1.19 (-0.98, -1.39); 2012-13 Rural: SII=-1.72 (-1.43, -2.00)] have increased. Conclusions Widening absolute inequalities in BCG vaccination coverage among children over the last decade in a TB-high burden country gives rise to global concern, at a time when world aims for tuberculosis free future. The results warrant the essential public health efforts to avoid further widening in TB related socioeconomic inequalities in Pakistan. Key messages The results warrant the need to continue monitoring of TB control at population level. Study findings may help to improved TB management programs to initiate evidence-based guidelines for maternal and child health.

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Wuneh, Alem Desta, Araya Abrha Medhanyie, Afework Mulugeta Bezabih, Lars Åke Persson, Joanna Schellenberg, and Yemisrach Behailu Okwaraji. "Wealth-based equity in maternal, neonatal, and child health services utilization: a cross-sectional study from Ethiopia." International Journal for Equity in Health 18, no. 1 (December 2019). http://dx.doi.org/10.1186/s12939-019-1111-2.

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Abstract Background Despite the pro-poor health policies in Ethiopia, the utilization of maternal, neonatal, and child health services remains a challenge for the country. Health equity became central in the post-2015 Sustainable Development Goals globally and is a priority for Ethiopia. The aim of this study was to assess equity in utilization of a range of maternal and child health services by applying absolute and relative equity indices. Methods Data on maternal and child health utilization emanated from a baseline survey conducted for a large project ‘Optimizing the Health Extension Program from December 2016 to February 2017 in four regions of Ethiopia. The utilization of four or more antenatal care visits; skilled birth attendance; postnatal care within 2 days after childbirth; immunization with BCG, polio 3, pentavalent 3, measles and full immunization of children aged 12–23 months; and vitamin A supplementation for 6–23 months old children were stratified by wealth quintiles. The socioeconomic status of the household was assessed by household assets and measured by constructing a wealth index using principal component analysis. Equity was assessed by applying two absolute inequity indices (Wealth index [quintile 5- quintile 1] and slope index of inequality) and two relative inequity indices (Wealth index [quintile5: quintile1] and concentration index). Results The maternal health services utilization was low and inequitably distributed favoring the better-off women. About 44, 71, and 18% of women from the better-off households had four or more antenatal visits, utilized skilled birth attendance and postnatal care within two days compared to 20, 29, and 8% of women from the poorest households, respectively. Skilled birth attendance was the most inequitably distributed maternal health service. All basic immunizations: BCG, polio 3, pentavalent 3, measles, and full immunization in children aged 12–23 months and vitamin A supplementation were equitably distributed. Conclusion Utilization of maternal health services was low, inequitable, and skewed against women from the poorest households. In contrast, preventive child health services were equitably distributed. Efforts to increase utilization and reinforcement of pro-poor and pro-rural strategies for maternal, newborn and immunization services in Ethiopia should be strengthened.

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Raza, Owais, Fahad Saqib Lodhi, Esmaeil Khedmati Morasae, and Reza Majdzadeh. "Differential achievements in childhood immunization across geographical regions of Pakistan: analysis of wealth-related inequality." International Journal for Equity in Health 17, no. 1 (August 17, 2018). http://dx.doi.org/10.1186/s12939-018-0837-6.

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Shahi, Min Bahadur. "Women Literacy and Health Outcomes Inequality in Nepal." Journal of Tikapur Multiple Campus, July 14, 2022, 76–90. http://dx.doi.org/10.3126/jotmc.v5i1.46516.

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This article assesses the women literacy and health outcome inequality in Nepal. The study attempted to assess the nexus between women literacy and some key health outcomes based on provincial level data of Nepal. Basically the study follows the descriptive analysis with explanatory design under quantitative research based on the secondary data from ministry of health and population of Nepal (2017). Statistical analysis of provincial wise key health outcome data was done using chi-squire test of the goodness of fit to ensure evidence of inequality of the health outcome across the provinces of Nepal. Likewise, to find the causal relationship between women literacy rate (WLR) and institutional delivery rate (ID), contraceptive prevalence among married women (CPMW), child immunization rate (CIR), ANC (Antenatal Care) service receive by women (ANCRW), teenage pregnancy rate (TPR), total fertility rate (TFR) in seven provinces was observed using correlation and regression analysis tool. The result of chi-square test shows that there could be observed inequality in WLR and ID. Likewise, correlation analysis shows that there is positive correlation between WLR and ID, WLR and CPMW, and WLR and ANCRW but there is negative relation between WLR and CIR, WLR and TPR, WLR and TFR. The regression analysis shows that there is significant relationship among the variables WLR and ID, ANCRW, TPR, TFR. Therefore, it can be concluded that it is essential to increase women literacy to bring improvement in aforementioned key health outcomes. The implication of the study will help to make effective public health policy and strategy to reduce the equity gaps in health outcomes in Nepal.

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Siddiqui, Mohammad Zahid, Srinivas Goli, and Anu Rammohan. "Testing the regional Convergence Hypothesis for the progress in health status in India during 1980–2015." Journal of Biosocial Science, June 10, 2020, 1–17. http://dx.doi.org/10.1017/s0021932020000255.

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Abstract The key challenges of global health policy are not limited to improving average health status, with a need for greater focus on reducing regional inequalities in health outcomes. This study aimed to assess health inequalities across the major Indian states used data from the Sample Registration System (SRS, 1981–2015), National Family Health Survey (NFHS, 1992–2015) and other Indian government official statistics. Catching-up plots, absolute and conditional β-convergence models, sigma (σ) plots and Kernel Density plots were used to test the Convergence Hypothesis, Dispersion Measure of Mortality (DMM) and the Gini index to measure progress in absolute and relative health inequalities across the major Indian states. The findings from the absolute β-convergence measure showed convergence in life expectancy at birth among the states. The results from the β- and σ-convergences showed convergence replacing divergence post-2000 for child and maternal mortality indicators. Furthermore, the estimates suggested a continued divergence for child underweight, but slow improvements in child full immunization. The trends in inter-state inequality suggest a decline in absolute inequality, but a significant increase or stationary trend in relative health inequality during 1981–2015. The application of different convergence metrics worked as robustness checks in the assessment of the convergence process in the selected health indicators for India over the study period.

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Kakama, Alex Ayebazibwe, and Robert Basaza. "Trends in inequality in maternal and child health and health care in Uganda: Analysis of the Uganda demographic and health surveys." BMC Health Services Research 22, no. 1 (October 20, 2022). http://dx.doi.org/10.1186/s12913-022-08630-x.

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Abstract Background Uganda has made great strides in improving maternal and child health. However, little is known about how this improvement has been distributed across different socioeconomic categories, and how the health inequalities have changed over time. This study analyses data from Demographic and Health Surveys (DHS) conducted in 2006, 2011, and 2016 in Uganda, to assess trends in inequality for a variety of mother and child health and health care indicators. Methods The indicators studied are acknowledged as critical for monitoring and evaluating maternal and child health status. These include infant and child mortality, underweight status, stunting, and prevalence of diarrhea. Antenatal care, skilled birth attendance, delivery in health facilities, contraception prevalence, full immunization coverage, and medical treatment for child diarrhea and Acute Respiratory tract infections (ARI) are all health care indicators. Two metrics of inequity were used: the quintile ratio, which evaluates discrepancies between the wealthiest and poorest quintiles, and the concentration index, which utilizes data from all five quintiles. Results The study found extraordinary, universal improvement in population averages in most of the indices, ranging from the poorest to the wealthiest groups, between rural and urban areas. However, significant socioeconomic and rural-urban disparities persist. Under-five mortality, malnutrition in children (Stunting and Underweight), the prevalence of anaemia, mothers with low Body Mass Index (BMI), and the prevalence of ARI were found to have worsening inequities. Healthcare utilization measures such as skilled birth attendants, facility delivery, contraceptive prevalence rate, child immunization, and Insecticide Treated Mosquito Net (ITN) usage were found to be significantly lowering disparity levels towards a perfect equity stance. Three healthcare utilization indicators, namely medical treatment for diarrhea, medical treatment for ARI, and medical treatment for fever, demonstrated a perfect equitable situation. Conclusion Increased use of health services among the poor and rural populations leads to improved health status and, as a result, the elimination of disparities between the poor and the wealthy, rural and urban people. Recommendation Intervention initiatives should prioritize the impoverished and rural communities while also considering the wealthier and urban groups.

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Lawal, Bola Biiaminu, Lawal Ahmadu, Abdulhakeem Olorukooba, Tukur Dahiru, and Olatayo Olawepo. "Socio-economic inequality of childhood routine immunization coverage in Nigeria: analysis of 2003 - 2013 Nigeria demographic and health survey data." Pan African Medical Journal Conference Proceedings 2 (2018). http://dx.doi.org/10.11604/pamj.cp.2018.8.97.678.

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Journal articles on the topic 'Immunization Inequality'

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