Applying an equity lens in the Decade of Vaccines

Brearley, Lara; Eggers, Rudolf; Steinglass, Robert; Vandelaer, Jos

doi:10.1016/j.vaccine.2012.11.088

Cited by 31 publications

(35 citation statements)

References 21 publications

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“…Subsequently, reaching unreached children is recognised as central to this vision [18]. Actually, those left out from vaccinations are thought to be at highest risk of VPDs and are also unlikely to access other essential child health services [36], [37].…”

Section: Discussionmentioning

confidence: 99%

“…Indeed, to scale up coverage successfully contingent to well-known scaling up concern, the problem is not just to reach more children, but to reach those facing specific barriers. It is therefore essential to conduct population-based assessments of patterns, distribution and determinants of non-vaccination in order to identify barriers within subpopulations in every context [18]. Given the complexity of the different relationships between influential variables at individual and contextual levels, it is important to assess their relative contribution in a multilevel model that can properly account for individual and contextual factors and their potential interactions.…”

Section: Introductionmentioning

confidence: 99%

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The Influence of Compositional and Contextual Factors on Non-Receipt of Basic Vaccines among Children of 12-23-Month Old in India: A Multilevel Analysis

et al. 2014

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BackgroundChildren unreached by vaccination are at higher risk of poor health outcomes and India accounts for nearly a quarter of unvaccinated children worldwide. The objective of this study was to investigate compositional and contextual determinants of non-receipt of childhood vaccines in India using multilevel modelling.Methods and FindingsWe studied characteristics of unvaccinated children using the District Level Health and Facility Survey 3, a nationally representative probability sample containing 65 617 children aged 12–23 months from 34 Indian states and territories. We developed four-level Bayesian binomial regression models to examine the determinants of non-vaccination. The analysis considered two outcomes: completely unvaccinated (CUV) children who had not received any of the eight vaccine doses recommended by India’s Universal Immunization Programme, and children who had not received any dose from routine immunisation services (no RI). The no RI category includes CUV children and those who received only polio doses administered via mass campaigns. Overall, 4.83% (95% CI: 4.62–5.06) of children were CUV while 12.01% (11.68–12.35) had received no RI. Individual compositional factors strongly associated with CUV were: non-receipt of tetanus immunisation for mothers during pregnancy (OR = 3.65 [95% CrI: 3.30–4.02]), poorest household wealth index (OR = 2.44 [1.81–3.22] no maternal schooling (OR = 2.43 [1.41–4.05]) and no paternal schooling (OR = 1.83 [1.30–2.48]). In rural settings, the influence of maternal illiteracy disappeared whereas the role of household wealth index was reinforced. Factors associated with no RI were similar to those for CUV, but effect sizes for individual compositional factors were generally larger. Low maternal education was the strongest risk factor associated with no RI in all models. All multilevel models found significant variability at community, district, and state levels net of compositional factors.ConclusionNon-vaccination in India is strongly related to compositional characteristics and is geographically distinct. Tailored strategies are required to overcome current barriers to immunisation.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

The Influence of Compositional and Contextual Factors on Non-Receipt of Basic Vaccines among Children of 12-23-Month Old in India: A Multilevel Analysis

et al. 2014

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“…Immunization is a proven, cost-effective intervention to reduce morbidity and mortality from vaccine-preventable diseases 1 . Each year immunization averts 2.5 million deaths in children younger than 5 years 2 .…”

Section: Introductionmentioning

confidence: 99%

“…Each year immunization averts 2.5 million deaths in children younger than 5 years 2 . Globally in 2011, 103 million (83% of total) children received all three doses of diphtheria–pertussis–tetanus (DPT3) vaccine, but an estimated 22 million children did not complete such vaccination 1 . Gaps in immunization coverage exist between and within countries, and in some places, the gap is increasing.…”

Section: Introductionmentioning

confidence: 99%

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Increased immunization coverage addresses the equity gap in Nepal

Ashish¹,

Nelin

Raaijmakers³

et al. 2017

Bull. World Health Organ.

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ObjectiveTo compare immunization coverage and equity distribution of coverage between 2001 and 2014 in Nepal.MethodsWe used data from the Demographic and Health Surveys carried out in 2001, 2006 and 2011 together with data from the 2014 Multiple Indicator Cluster Survey. We calculated the proportion, in mean percentage, of children who had received bacille Calmette–Guérin (BCG) vaccine, three doses of polio vaccine, three doses of diphtheria–pertussis–tetanus (DPT) vaccine and measles vaccine. To measure inequities between wealth quintiles, we calculated the slope index of inequality (SII) and relative index of inequality (RII) for all surveys.FindingsFrom 2001 to 2014, the proportion of children who received all vaccines at the age of 12 months increased from 68.8% (95% confidence interval, CI: 67.5–70.1) to 82.4% (95% CI: 80.7–84.0). While coverage of BCG, DPT and measles immunization statistically increased during the study period, the proportion of children who received the third dose of polio vaccine decreased from 93.3% (95% CI: 92.7–93.9) to 88.1% (95% CI: 86.8–89.3). The poorest wealth quintile showed the greatest improvement in immunization coverage, from 58% to 77.9%, while the wealthiest quintile only improved from 84.8% to 86.0%. The SII for children who received all vaccines improved from 0.070 (95% CI: 0.061–0.078) to 0.026 (95% CI: 0.013–0.039) and RII improved from 1.13 to 1.03.ConclusionThe improvement in immunization coverage between 2001 and 2014 in Nepal can mainly be attributed to the interventions targeting the disadvantaged populations.

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