Inequalities in full immunization coverage: trends in low- and middle-income countries.

María Clara Restrepo-Méndez,Aluísio Jd Barros,Giovanny Va França,Kerry Lm Wong,Cesar G Victora,Hope L Johnson,George Pariyo,Fernando C Wehrmeister

doi:10.2471/blt.15.162172

María Clara Restrepo-Méndez, Aluísio Jd Barros + Show 6 more

Open Access

https://doi.org/10.2471/blt.15.162172

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Abstract

ObjectiveTo investigate disparities in full immunization coverage across and within 86 low- and middle-income countries.MethodsIn May 2015, using data from the most recent Demographic and Health Surveys and Multiple Indicator Cluster Surveys, we investigated inequalities in full immunization coverage – i.e. one dose of bacille Calmette-Guérin vaccine, one dose of measles vaccine, three doses of vaccine against diphtheria, pertussis and tetanus and three doses of polio vaccine – in 86 low- or middle-income countries. We then investigated temporal trends in the level and inequality of such coverage in eight of the countries.FindingsIn each of the World Health Organization’s regions, it appeared that about 56–69% of eligible children in the low- and middle-income countries had received full immunization. However, within each region, the mean recorded level of such coverage varied greatly. In the African Region, for example, it varied from 11.4% in Chad to 90.3% in Rwanda. We detected pro-rich inequality in such coverage in 45 of the 83 countries for which the relevant data were available and pro-urban inequality in 35 of the 86 study countries. Among the countries in which we investigated coverage trends, Madagascar and Mozambique appeared to have made the greatest progress in improving levels of full immunization coverage over the last two decades, particularly among the poorest quintiles of their populations.ConclusionMost low- and middle-income countries are affected by pro-rich and pro-urban inequalities in full immunization coverage that are not apparent when only national mean values of such coverage are reported.

Highlights

Despite the improvements made in global immunization coverage for children over the past decade,[1,2] an estimated 21.8 million infants worldwide are still not being reached by routine immunization services.[3]
In 2013, most of the World Health Organization’s (WHO) regions reached more than 80% of their target populations with three doses of diphtheria, pertussis and tetanus (DTP) vaccine but coverage with such vaccine remained well short of the 2015 goal of 90%, in the African (75%) and South-East Asia regions (77%).[2,3]
In India, for example, national immunization coverage has been increasing since the early 1990s but the proportion of children who, in 2006, had received all of the immunizations recommended for their age group as part of WHO’s Expanded Programme on Immunization was still under 50%

Summary

Objective

To investigate disparities in full immunization coverage across and within 86 low- and middle-income countries. Methods In May 2015, using data from the most recent Demographic and Health Surveys and Multiple Indicator Cluster Surveys, we investigated inequalities in full immunization coverage – i.e. one dose of bacille Calmette-Guérin vaccine, one dose of measles vaccine, three doses of vaccine against diphtheria, pertussis and tetanus and three doses of polio vaccine – in 86 low- or middle-income countries. Among the countries in which we investigated coverage trends, Madagascar and Mozambique appeared to have made the greatest progress in improving levels of full immunization coverage over the last two decades, among the poorest quintiles of their populations. Conclusion Most low- and middle-income countries are affected by pro-rich and pro-urban inequalities in full immunization coverage that are not apparent when only national mean values of such coverage are reported

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