Abstract
Abstract Background Although, WHO notes that there has been 'tremendous progress' towards controlling spread of Tuberculosis (TB) by 2015, situation in endemic countries like Pakistan need global attention. Pakistan currently ranks fifth among TB-high burden countries and it accounts for 61% of the TB burden in the WHO Eastern Mediterranean Region. We aim to explore the trends in relative and absolute socioeconomic inequalities in BCG vaccination coverage. Methods Data from Pakistan Demographic and Health Surveys (PDHS) 2006-7 (n = 9177 data used 8442), and 20012-13 (n = 13558, used n = 6982) were used. Information was collected from all mothers in reproductive age group, regarding BCG vaccination of their children aged < 5 years. Wealth index and education were used to assess socioeconomic position. Socioeconomic inequalities for BCG vaccination coverage were assessed by calculating Relative Index of Inequality (RII) and Absolute Index of Inequality (SII). Results Although reported frequency of not getting the child BCG vaccinated has decreased over the decade (25% in 2006, 18% in 2013). Nevertheless, socioeconomic inequalities in BCG vaccination have significantly widened over the last decade. Education related inequalities [2006-7 Urban: SII=-1.34 (-0.91, -1.76); 2012-13 Urban: SII=-1.88 (-1.43, -2.32)]; [2006-7 Rural: SII=-1.31 (-0.96, -1.65); 2012-13 Rural: SII=-1.54 (-1.13, -1.94)] have increased. Similarly, wealth related inequalities [2006-7 Urban: SII=-1.27 (-0.91, -1.62); 2012-13 Urban: SII=-1.75 (-1.37, -2.12)]; [2006-7 Rural: SII=-1.19 (-0.98, -1.39); 2012-13 Rural: SII=-1.72 (-1.43, -2.00)] have increased. Conclusions Widening absolute inequalities in BCG vaccination coverage among children over the last decade in a TB-high burden country gives rise to global concern, at a time when world aims for tuberculosis free future. The results warrant the essential public health efforts to avoid further widening in TB related socioeconomic inequalities in Pakistan. Key messages The results warrant the need to continue monitoring of TB control at population level. Study findings may help to improved TB management programs to initiate evidence-based guidelines for maternal and child health.
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