Inequality in measles vaccination coverage in the “big six” countries of the WHO South-East Asia region

Abstract

The "big six" countries (Bangladesh, India, Indonesia, Myanmar, Nepal, and Thailand) in the World Health Organization South-East Asia Region (WHO SEAR) are currently facing severe challenges in measles elimination and consequent childhood mortality reduction, with inadequacies and inequalities in the coverage of the measles-containing-vaccine first-dose (MCV1) being major obstacles. However, these issues of inequality in MCV1 coverage have not yet been systematically examined. We used data from the latest Demographic and Health Surveys and Multiple Indicator Cluster Surveys. To provide a comprehensive picture of existing MCV1 coverage gaps, data were disaggregated by geographic location, as well as by socioeconomic and nutritional dimensions. National MCV1 coverage ranged from 77% in Myanmar to 92% in Thailand. Only nine of the 104 sub-national districts had achieved the 95% MCV1 coverage goal as set by the WHO. Geographic inequalities were more pronounced in countries with lower coverage levels. Areas in clusters with poor MCV1 coverage performances as well as disadvantaged socioeconomic profiles require increased attention. Inequalities were evident in all countries, except Thailand, and were more pronounced in the sectors of wealth, education, antenatal care (ANC) status, and vitamin A supplementation (VAS) when compared against the areas of gender and urban/rural residence. Wealth-related inequality in Bangladesh, education-related inequality in Indonesia, ANC-related inequalities in Myanmar and Nepal, and VAS-related inequalities in Indonesia and Myanmar were all noteworthy. Equity-oriented changes in policies focusing on health promotion and integrated interventions among disadvantaged populations need to be implemented in order to increase MCV1 coverage and reduce childhood mortality.

Vaccine Equity in Low and Middle Income Countries: A Systematic Review and Meta-analysis

“…The greatest differences in immunisation coverage as a result of gender were seen in India — here, females were more likely to be completely unvaccinated or have incomplete vaccination statuses. [57, 58, 62, 25]. Interestingly, this trend did not hold when considering complete immunisation system failure, defined by Gaudin as when “the infrastructure to provide immunization [was] not in place, affecting all groups” [59], and in some instances, varied when other demographic factors, including religion and caste, were taken into account [64].…”

“…In studies that examined multiple countries, children from families in the richest wealth quintiles had a greater likelihood of full immunisation coverage, with notable inequalities in DTP3, OPV, and MCV1 coverage and in MCV, DTP1, and DTP3 dropout rates [19, 8, 20, 21, 22, 3, 25, 26, 27, 7, 28, 12, 30, 31, 24, 115]. Children from poorer households were additionally more likely to have an increased zero-dose prevalence, and in some countries, lower participation rates in SIA [27, 3], though this varied [33].…”

Can early measles vaccination control both measles and respiratory syncytial virus infections?

“…Measles vaccine coverage of 95% has not been achieved in many LMICs, including Bangladesh, India, Indonesia, Myanmar, Nepal, Papua New Guinea, Thailand, and a number of countries in Africa. 16 , 18 This suboptimal measles vaccination can lead to low-level population immunity during pregnancy, leaving infants susceptible to measles virus infections in the first few months of life due to lower maternal measles antibodies. 19 Additionally, maternal measles antibodies in vaccinated mothers also wane faster compared with natural infection.…”

Ecological Analysis of Health Resource Related to Measles at Primary Health Center in Indonesia

“…The geographic disparity caused the immunization coverage of the "big six countries" especially India, Bangladesh, Indonesia, and Myanmar was not the track. The countries can not achieve the outlined goals to eliminated measles by 2020 4 .The disparity between the eastern and western regions of Indonesia has inhibited the acceleration of equitable development 18,19 .Although immunization was provided free charge, but not guarantee the immunization coverage achieved the target, especially for the community who live in hardly achievable areas 15 . Thus, the health workerin areas with physical constraints have to innovative programs to increase coverage.…”

“…Half of global measles mortality came from South-East Region (SEARO) 3 .Indonesia is one of the "big six countries" with measles endemic 4 .The susceptible group of measles in Indonesia wasa child aged more than 1-year-old, unvaccinated infants, adolescents, and young adultsfor the second dose. The high incidence of measles occurred in a child aged less than 5 years were reached 5% in 2013 5 .More than 11,000 cases of suspected measles are reported in Indonesia each year, as much as 12% to 39% were being confirmed measles.…”