Increased immunization coverage addresses the equity gap in Nepal

Bulletin of the World Health Organization
Volume 95, Number 4, April 2017, 241-312
http://www.who.int/bulletin/volumes/95/4/en/

RESEARCH
Increased immunization coverage addresses the equity gap in Nepal
Ashish KC, Viktoria Nelin, Hendrikus Raaijmakers, Hyung Joon Kim, Chahana Singh & Mats Målqvist
http://dx.doi.org/10.2471/BLT.16.178327
Abstract
Objective
To compare immunization coverage and equity distribution of coverage between 2001 and 2014 in Nepal.
Methods
We 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.
Findings
From 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.
Conclusion
The improvement in immunization coverage between 2001 and 2014 in Nepal can mainly be attributed to the interventions targeting the disadvantaged populations.