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. 2022 Feb 7;12(2):e046971.
doi: 10.1136/bmjopen-2020-046971.

Inequalities in full vaccination coverage based on maternal education and wealth quintiles among children aged 12-23 months: further analysis of national cross-sectional surveys of six South Asian countries

Kiran Acharya  1 , Dinesh Dharel  2 , Raj Kumar Subedi  3 , Asmita Bhattarai  4 , Yuba Raj Paudel  5
Affiliations

Inequalities in full vaccination coverage based on maternal education and wealth quintiles among children aged 12-23 months: further analysis of national cross-sectional surveys of six South Asian countries

Kiran Acharya et al. BMJ Open. .

Abstract

Objective: This study was conducted to compare full vaccination coverage and its inequalities (by maternal education and household wealth quintile).

Design: This further analysis was based on the data from national-level cross-sectional Demographic and Health Survey (DHS) from six countries in South Asia.

Setting: We used most recent DHS data from six South Asian countries: Nepal, India, Pakistan, Bangladesh, Afghanistan and the Maldives. The sample size of children aged 12-23 months ranged from 6697 in the Maldives to 628 900 in India.

Primary and secondary outcome measures: To measure absolute and relative inequalities of vaccination coverage, we used regression-based inequality measures, slope index of inequality (SII) and the relative index of inequality (RII), respectively, by maternal education and wealth quintile.

Results: Full vaccination coverage was the highest in Bangladesh (84%) and the lowest in Afghanistan (46%), with an average of 61.5% for six countries. Pakistan had the largest inequalities in coverage both by maternal education (SII: -50.0, RII: 0.4) and household wealth quintile (SII: -47.1, RII: 0.5). Absolute inequalities were larger by maternal education compared with wealth quintile in four of the six countries. The relative index of inequality by maternal education was lower in Pakistan (0.5) and Afghanistan (0.5) compared with Nepal (0.7), India (0.7) and Bangladesh (0.7) compared with rest of the countries. By wealth quintiles, RII was lower in Pakistan (0.5) and Afghanistan (0.6) and higher in Nepal (0.9) and Maldives (0.9).

Conclusions: The full vaccination coverage in 12-23 months old children was below 85% in all six countries. Inequalities by maternal education were more profound than household wealth-based inequalities in four of six countries studied, supporting the benefits of maternal education to improve child health outcome.

Keywords: community child health; epidemiology; health economics; public health.

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Conflict of interest statement

Competing interests: None declared.

Figures

Figure 1
Figure 1
Full vaccination coverage in selected South Asian countries.
Figure 2
Figure 2
Maternal education-related inequalities. SII, slope index of inequality (2A); RII, relative index of inequality (2B).
Figure 3
Figure 3
Wealth quintile-related inequalities. SII, slope index of inequality (3A); RII, relative index of inequality (3B).
Figure 4
Figure 4
Crude prevalence difference in full vaccination coverage in South Asia by maternal education (4A) and wealth quintile (4B).
See this image and copyright information in PMC

References

    1. United Nations . Transforming our world: The 2030 agenda for sustainable development. General Assembley 70 session, 2015.
    1. WHO . Global vaccine action plan 2011-2020, 2013.
    1. World Health Organization . WHO-Vaccine preventable diseases: monitoring system. 2017, 2018.
    1. Hasman A, Noble DJ. Childhood immunisation in South Asia - overcoming the hurdles to progress. Perspect Public Health 2016;136:273–7. 10.1177/1757913916658633 - DOI - PMC - PubMed
    1. The United Nations Children’s Fund . 20 million children missed out on lifesaving measles, diphtheria and tetanus vaccines in 2018, 2018. Available: https://www.unicef.org/press-releases/20-million-children-missed-out-lif... [Accessed 06 Mar 2020].

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