1159Inequities in on-time childhood vaccination: Evidence from sub-Saharan Africa

Abstract

Abstract Introduction Vaccination coverage has improved over the past decade but inequalities persist; the poorest, least educated, and rural communities are left behind. Programming has focused on increasing coverage and reaching the hardest to reach children but vaccination timeliness is equally important as delays leave children vulnerable to infections. This study examines the levels and inequities of on-time vaccination in the sub-Saharan African (SSA) region. Methods: The most recent Demographic and Health Surveys or Multiple Indicator Clusters Surveys since 2000 from SSA were used to assess on-time vaccination and inequalities by household wealth, maternal education, and place of residence. Inequalities were quantified using slope index of inequality and concentration index. Results The analysis included 153,632 children aged 12-36 months from 40 SSA countries. Median on-time vaccination coverage was below 50% in all four sub-regions. Differences in on-time vaccination were observed by place of residence in Southern (20.8 pp, 95%CI (0.8; 40.8)), West (17.5 pp, 95%CI (5.1; 29.9)), and Eastern (20.9 pp, 95%CI (6.5; 35.2)) regions. Wealth-related inequities were observed in Southern (22.6 pp, 95%CI (4.0; 41.2)), West (30.6 pp, 95%CI (19.1; 42.1)), and Eastern (26.1 pp, 95%CI (8.2; 44.0)) regions. Significant education-related differences in on-time vaccination were observed in West (20.7 pp, 95%CI (10.9; 30.5)), and Eastern (21.2 pp, 95%CI (7.0; 35.4)) regions. Conclusions On-time vaccination coverage was low in all sub-regions and nearly all countries. Inequalities in on-time immunization by household wealth, place of residence, and education existed in most countries. Concrete strategies to improve levels of timeliness are needed