Milestones :: Perspectives
Explorations of inequality: Childhood immunization
World Health Organization 2018 : 92 pages
This report takes a detailed look at the current status of childhood immunization in 10 priority countries: Afghanistan, Chad, Democratic Republic of the Congo, Ethiopia, India, Indonesia, Kenya, Nigeria, Pakistan and Uganda.
In each country, childhood immunization coverage is broken down by multiple factors to show inequality according to child, mother, household and geographical characteristics. Then, the report employs multiple regression analysis to identify factors that are associated with immunization coverage. A multicountry assessment illustrates similarities and differences between countries.
The findings of the report show how a child’s likelihood of being vaccinated is affected by compounding advantage or vulnerability; they also provide insight into how policies, programmes and practices can be targeted to promote universal childhood immunization coverage. Interactive visuals and tables accompany the report, enabling further exploration of the data.
Across the 10 priority countries, the national DTP3 immunization coverages ranged from 34% in Chad to 90% in Kenya. Evaluating performance based on national averages alone, however, masks the situation in population subgroups. The countries faced distinct patterns of inequality, from Uganda, where inequality tended to be very small for most of the featured characteristics, to Nigeria, where inequality was pronounced for most characteristics.
Despite the uniqueness of each country situation, some commonalities emerged. Inequalities by child’s sex tended to be minimal or non-existent, and inequality by subnational region tended to be substantial. All countries reported variation by mother’s education and subnational region and all (except Uganda) demonstrated inequality on the basis of household economic status. All 10 priority countries showed a positive association between mother’s education level and childhood immunization coverage. Countries that reported low national coverage (e.g. Chad, Ethiopia and Nigeria) tended to demonstrate steep gradients and/or mass deprivation patterns across socioeconomic subgroups; the odds of immunization tended to be significantly higher in more advantaged subgroups in these countries. Countries with higher national coverage (e.g. India, Indonesia, Kenya and Uganda), more often demonstrated marginal exclusion or
universal patterns across socioeconomic subgroups, and tended to have lower urban–rural inequality.
When considered alongside knowledge of the country context, the results of this report can be used to inform equity-oriented policies, programmes and practices to promote universal childhood immunization coverage. This report serves as a basis for more detailed explorations at the national and subnational levels, and a baseline for future health inequality monitoring efforts. Monitoring and exploring inequalities in health is essential as countries strive to “leave no one behind” on the path towards sustainable development.