Essential childhood immunization in 43 low- and middle-income countries: Analysis of spatial trends and socioeconomic inequalities in vaccine coverage

Abstract

Background Globally, access to life-saving vaccines has improved considerably in the past 5 decades. However, progress has started to slow down and even reverse in recent years. Understanding subnational heterogeneities in essential child immunization will be critical for closing the global vaccination gap. Methods and findings We use vaccination information for over 220,000 children across 1,366 administrative regions in 43 low- and middle-income countries (LMICs) from the most recent Demographic and Health Surveys. We estimate essential immunization coverage at the national and subnational levels and quantify socioeconomic inequalities in such coverage using adjusted concentration indices. Within- and between-country variations are summarized via the Theil index. We use local indicator of spatial association (LISA) statistics to identify clusters of administrative regions with high or low values. Finally, we estimate the number of missed vaccinations among children aged 15 to 35 months across all 43 countries and the types of vaccines most often missed. We show that national-level vaccination rates can conceal wide subnational heterogeneities. Large gaps in child immunization are found across West and Central Africa and in South Asia, particularly in regions of Angola, Chad, Nigeria, Guinea, and Afghanistan, where less than 10% of children are fully immunized. Furthermore, children living in these countries consistently lack all 4 basic vaccines included in the WHO’s recommended schedule for young children. Across most countries, children from poorer households are less likely to be fully immunized. The main limitations include subnational estimates based on large administrative divisions for some countries and different periods of survey data collection. Conclusions The identified heterogeneities in essential childhood immunization, especially given that some regions consistently are underserved for all basic vaccines, can be used to inform the design and implementation of localized intervention programs aimed at eliminating child suffering and deaths from existing and novel vaccine-preventable diseases.

Continuum of care for maternal and child health and child undernutrition in Angola

“…Therefore, the utilization of care continuity needs to be strengthened. A long distance to a health facility [ 50 ], the mother’s low education level [ 23 , 28 , 30 , 31 ], the partner’s low education level [ 48 ], less participation of women in decision-making [ 48 ], economic restrictions [ 24 , 26 – 29 ], and a lack of knowledge regarding ANC [ 51 ] prevent mothers from utilizing ANC. A delay in a first ANC visit also contributes to less frequency of ANC visits [ 52 ].…”

“…Therefore, this low percentage in our study suggested that health care providers did not sufficiently educate mothers on the importance of delivery with an SBA during ANC. There are also other reasons why women avoid delivery with an SBA or institutional delivery, such as economic restrictions [ 24 , 26 – 29 ] and a long distance to a health facility [ 23 ].…”

“…Utilization of health services is hampered by rural residence, a long distance from health facilities, low literacy and education background of mothers, and younger age of mothers in Angola [ 23 ]. Other factors are the experience of miscarriage [ 24 ], parity [ 25 ], women’s and/or household’s wealth [ 24 , 26 – 29 ], women’s or parents’ education [ 23 , 28 , 30 , 31 ], birth plan [ 24 , 28 ], ethnicity [ 28 , 30 ], and sex of the healthcare providers [ 27 ] as reported from African countries. However, mothers who use ANC services are more likely to re-visit to receive care [ 26 , 27 , 32 ].…”

Assessing Geographic Overlap between Zero-Dose Diphtheria–Tetanus–Pertussis Vaccination Prevalence and Other Health Indicators

“…At the population level, analyses of the spatial overlap between gaps in immunization coverage and other health services can complement these individual-level analyses. Spatial analyses conducted in recent years have emphasized the substantial degree of subnational inequality in vaccine coverage [13,[17][18][19][20][21][22][23], as well as other key health services and indicators [22,[24][25][26][27][28][29][30][31]. Fewer studies have assessed whether subnational distributions of zero-dose (or no-DTP) children are similar to those for other health indicators [32].…”

Assessing Childhood Immunization Coverage Using Novel Approach of Lot Quality Assurance Sampling (LQAS) Methodology in Shikarpur, Pakistan

“…With a population of 1,233,760 residents overall, the area struggles with health and educational inadequacies that may affect vaccination rates. These challenges are compounded by socioeconomic inequalities since children from economically disadvantaged homes have a much lower likelihood of receiving complete immunization [9].…”