Inequalities in immunisation and breast feeding in an ethnically diverse urban area: cross-sectional study in Manchester, UK

Abstract

Objectives. To examine inequalities in immunisation and breastfeeding by ethnic group and their relation to relative deprivation.Design. Cross -sectional study. Results. Black or Black British infants had the highest rates of breastfeeding at 2 weeks postpartum (89%), and South Asian infants had highest Triple and MMR vaccination rates (Indian, 95%, 96%; Pakistani 95%, 95%; Bangladeshi 96.%, 95%) after controlling for area level of deprivation, parity, parenthood status and age. White infants were least likely to be breastfed at 2 weeks postpartum (36%), and to be vaccinated with Triple (92%) and MMR vaccines (88%). Within the White ethnic group lower percentages of immunisation and breastfeeding were significantly associated with living in a deprived area and with increasing parity. This was not found within Black or Black British and Pakistani ethnic groups. Setting DiscussionPractices that are protective of child health were consistently less likely to be adopted by White mothers living in deprived areas. Methods of health education and service delivery that are designed for the general population are unlikely to be successful in this context and evidence of effective interventions needs to be established.

Childhood vaccination coverage by ethnicity within London between 2006/2007 and 2010/2011

“…Previously, the Millennium Cohort Study identified differences in coverage by ethnicity 16. A study in Manchester found that white infants were least likely to be vaccinated with primary vaccines, and that for white infants (as found here) lower coverage was significantly associated with living in a deprived area 15. For black infants or black British infants and Pakistanis, there was no significant association between deprivation and immunisation 15…”

“…However, some ethnicities, for example, Romanian, are not captured individually. In other published analyses, additional factors have been studied such as family size, maternal smoking, maternal education and lone parenthood,15 16 but this study was restricted to CHIS fields. Deprivation in this study was assigned based on postcode, relating deprivation to a geographical area.…”

Factors associated with breastfeeding in England: an analysis by primary care trust

“…Non-white ethnicity has consistently been linked to increased breastfeeding in individual level studies,16 17 20 22 26 although there is some variation between individual ethnic groups and by acculturation status 35. The existing literature suggests that the strongest overall effect of ethnicity is on initiation and continuation, with minimal differences by ethnicity in the number of women who breastfeed exclusively 36 37.…”

“…There is evidence that this latter trend cannot be generalised to mothers from non-White backgrounds 17. Several studies have found that the effects of deprivation,17 socioeconomic status19 and income22 are negligible when looking at breastfeeding among certain minority ethnic groups. Outside London, both deprivation and area level ethnicity remained independent predictors of breastfeeding even after adjusting for the other.…”

Use of a geographic information system to map cases of measles in real-time during an outbreak in Dublin, Ireland, 2011

“…The location of measles outbreaks in areas of deprivation is also an issue for other European countries [25] and shows that vaccination education and delivery designed for the general population is unlikely to be successful in deprived inner city areas. Tailored evidence-based interventions, such as the Community Mothers Programme, in these locations are required [26]. The combination of low vaccination rates, deprivation, high population density and a lack of specific preventative measures for disadvantaged areas together led to the two clusters in CCA-7.…”