Abstract
ObjectiveTo compare immunization coverage and equity distribution of coverage between 2001 and 2014 in Nepal.MethodsWe used data from the Demographic and Health Surveys carried out in 2001, 2006 and 2011 together with data from the 2014 Multiple Indicator Cluster Survey. We calculated the proportion, in mean percentage, of children who had received bacille Calmette–Guérin (BCG) vaccine, three doses of polio vaccine, three doses of diphtheria–pertussis–tetanus (DPT) vaccine and measles vaccine. To measure inequities between wealth quintiles, we calculated the slope index of inequality (SII) and relative index of inequality (RII) for all surveys.FindingsFrom 2001 to 2014, the proportion of children who received all vaccines at the age of 12 months increased from 68.8% (95% confidence interval, CI: 67.5–70.1) to 82.4% (95% CI: 80.7–84.0). While coverage of BCG, DPT and measles immunization statistically increased during the study period, the proportion of children who received the third dose of polio vaccine decreased from 93.3% (95% CI: 92.7–93.9) to 88.1% (95% CI: 86.8–89.3). The poorest wealth quintile showed the greatest improvement in immunization coverage, from 58% to 77.9%, while the wealthiest quintile only improved from 84.8% to 86.0%. The SII for children who received all vaccines improved from 0.070 (95% CI: 0.061–0.078) to 0.026 (95% CI: 0.013–0.039) and RII improved from 1.13 to 1.03.ConclusionThe improvement in immunization coverage between 2001 and 2014 in Nepal can mainly be attributed to the interventions targeting the disadvantaged populations.
Highlights
Immunization is a proven, cost-effective intervention to reduce morbidity and mortality from vaccine-preventable diseases.[1]
To reach universal immunization coverage and to increase equity, countries need to focus on targeted interventions that reach the most disadvantaged populations, rather than only focusing on increasing coverage at the national level.[1,5]
This study shows that immunization coverage of Nepalese children aged 12 months or younger has improved significantly between 2001 and 2014; an increase that has been accompanied by improved equity
Summary
Immunization is a proven, cost-effective intervention to reduce morbidity and mortality from vaccine-preventable diseases.[1] Each year immunization averts 2.5 million deaths in children younger than 5 years.[2] Globally in 2011, 103 million (83% of total) children received all three doses of diphtheria–pertussis– tetanus (DPT3) vaccine, but an estimated 22 million children did not complete such vaccination.[1] Gaps in immunization coverage exist between and within countries, and in some places, the gap is increasing. The average DPT3 coverage in low-income countries was 15 percentage points lower than that of high-income countries in 2011.1,3,4. To reach universal immunization coverage and to increase equity, countries need to focus on targeted interventions that reach the most disadvantaged populations, rather than only focusing on increasing coverage at the national level.[1,5] For example, countries with the most rapid increase in overall coverage of measles vaccination show the greatest improvement in coverage of the population in the poorest wealth quintile.[6]
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