Abstract
Objective: The objectives of this study were to determine the degree and risk factors of the inequity in the childhood coverage of full primary immunization (FPI) in Zhejiang province. Method: We used data from two rounds of vaccination coverage surveys among children aged 24–35 months conducted in 2014 and 2017, respectively. The household income per month was used as an index of socioeconomic status for the inequality analysis. The concentration index (CI) was used to quantify the degree of inequality, and the decomposition approach was applied to quantify the contributions from demographic factors to inequality in the coverage of FPI. Results: The coverage rates of FPI were 80.6%, with a CI value of 0.12028 for the 2014 survey, while the coverage rates of FPI were 85.2%, with a CI value of 0.10129 for the 2017 survey. The results of decomposition analysis suggested that 68.2% and 67.1% of the socioeconomic inequality in the coverage of FPI could be explained by the mother’s education level for the 2014 and 2017 survey, respectively. Other risk factors including birth order, ethnic group, mother’s age, maternal employment status, residence, immigration status, GDP per-capita, and the percentage of the total health spending allocated to public health could also explain this inequality. Conclusion: The socioeconomic inequity in the coverage of FPI still remained, although this gap was reduced between 2014 and 2017. Policy recommendations for health interventions on reducing the inequality in the coverage of FPI should be focused on eliminating poverty and women’s illiteracy.
Highlights
The United Nations Sustainable Development Goals include a focus on the improvement of children’s health and survival as a global priority [1]
In the 2011 provincial coverage survey, we found that each antigen reached the goal of 90% at 12 months old
Of the children included in the 2014 coverage survey, 50.3% were male, 70.4% were first-born, 91.1% were of Han ethnicity, and 40.1% were migrant
Summary
The United Nations Sustainable Development Goals include a focus on the improvement of children’s health and survival as a global priority [1]. Such goals have led to an increase of investments aiming to promote the accessibility and affordability of childhood health intervention programs, regarding vaccination services and nutrition. Launched the Expanded Program on Immunization (EPI) in 1974 as a public health initiative targeting the improvement of childhood health [2]. The primary immunization schedule includes one dose of Bacillus. It is recommended that a child receive the primary required immunizations before 12 months of age.
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